CAJ | 학술논문

目的应用99Tcm-二巯基丁二酸(DMSA)肾皮质显像预测急性肾盂肾炎(APN)患儿肾瘢痕危险性及分析相关危险因素.方法研究对象为118例临床首次诊断为APN的患儿,男44例,女74例,年龄1个月至14岁.所有患儿急性期行99Tcm-DMSA肾皮质显像,根据肾受累范围将肾损害程度分为5级,0级为肾功能正常,肾损害自轻度到重度依次分为Ⅰ至Ⅳ级,治疗至少6个月再次显像判断是否形成肾瘢痕.72例患儿进行直接法核素膀胱显像(DRC)评价膀胱输尿管反流(VUR),反流程度分为轻、中、重度.应用SPSS 11.5软件,分别对相应数据进行Spearman等级相关分析.结果 118例患儿以单肾为单位共236个肾,急性期(发病2周内)肾显像结果,正常肾组79个,Ⅰ级肾损害组64个,Ⅱ级肾损害组51个,Ⅲ级肾损害组19个,Ⅳ级肾损害组23个.6个月后再次显像显示肾功能正常组无一个肾形成肾瘢痕;肾损害形成肾瘢痕的发生率分别为Ⅰ级7.81%(5/64),Ⅱ级49.02%(25/51),Ⅲ级68.42%(13/19),Ⅳ级100.00%(23/23).肾瘢痕发生率与首次肾显像肾损害程度呈明显正相关(r=0.877,P<0.01).另外,72例进行DRC患儿中,以单肾为单位共144个肾,VUR发生率54.17%(78/144),其中轻、中、重度反流肾分别为4,43和31个.66个无VUR肾瘢痕发生率仅为4.55%(3/66),肾瘢痕发生率在轻度VUR为1/4,在中度VUR为46.51%(20/43),在重度VUR为87.10%(27/31).VUR与肾瘢痕形成呈明显正相关(r=0.624,P<0.01).结论 APN患儿急性期99Tcm-DMSA肾皮质显像肾损害程度分级对预测肾瘢痕危险性有重要价值,肾损害程度越重,VUR程度越重,肾瘢痕形成危险性越大.对于急性期有肾损害,尤其是Ⅱ级以上肾损害、伴有输尿管反流的APN患儿应重视,积极治疗,以预防或减少永久性肾损害发生.
목적 응용99Tcm-이구기정이산(DMSA)신피질현상예측급성신우신염(APN)환인신반흔위험성급분석상관위험인소.방법 연구대상위118례림상수차진단위APN적환인,남44례,녀74례,년령1개월지14세.소유환인급성기행99Tcm-DMSA신피질현상,근거신수루범위장신손해정도분위5급,0급위신공능정상,신손해자경도도중도의차분위Ⅰ지Ⅳ급,치료지소6개월재차현상판단시부형성신반흔.72례환인진행직접법핵소방광현상(DRC)평개방광수뇨관반류(VUR),반류정도분위경、중、중도.응용SPSS 11.5연건,분별대상응수거진행Spearman등급상관분석.결과 118례환인이단신위단위공236개신,급성기(발병2주내)신현상결과,정상신조79개,Ⅰ급신손해조64개,Ⅱ급신손해조51개,Ⅲ급신손해조19개,Ⅳ급신손해조23개.6개월후재차현상현시신공능정상조무일개신형성신반흔;신손해형성신반흔적발생솔분별위Ⅰ급7.81%(5/64),Ⅱ급49.02%(25/51),Ⅲ급68.42%(13/19),Ⅳ급100.00%(23/23).신반흔발생솔여수차신현상신손해정도정명현정상관(r=0.877,P<0.01).령외,72례진행DRC환인중,이단신위단위공144개신,VUR발생솔54.17%(78/144),기중경、중、중도반류신분별위4,43화31개.66개무VUR신반흔발생솔부위4.55%(3/66),신반흔발생솔재경도VUR위1/4,재중도VUR위46.51%(20/43),재중도VUR위87.10%(27/31).VUR여신반흔형성정명현정상관(r=0.624,P<0.01).결론 APN환인급성기99Tcm-DMSA신피질현상신손해정도분급대예측신반흔위험성유중요개치,신손해정도월중,VUR정도월중,신반흔형성위험성월대.대우급성기유신손해,우기시Ⅱ급이상신손해、반유수뇨관반류적APN환인응중시,적겁치료,이예방혹감소영구성신손해발생.
Objective Acute pyelonephritis (APN) is a common infectious disease in childhood. APN may result in irreversible renal scarring.99Tcm-dimereaptsuccinic (DMSA) renal cortical scintigraphy was reported to be highly sensitive and specific for detection APN and renal scarring. The aim of this study was to determine the incidence of renal scarring in a group of children with APN and to evaluate the relative factors at risk of scarring using 99Tcm-DMSA renal cortical scintigraphy. Methods One hundred and eighteen patients (44 males, 74 females, age range: 1 month to 14 years) with APN underwent DMSA renal cortical scan before treatment and six month after treatment to identify renal damage and renal scarring. The degree of renal damage was divided to grade Ⅰ to Ⅳ. A directed radionuclide cystography (DRC) was performed in 72 cases to evaluate vesicoureteric reflux (VUR). Statistical analysis between all those relative factors was performed using Spearman grading relational analysis. The software was SPSS 11.5. Results The follow-up renal cortical scan revealed that 79 normal kidneys on first scan remained normal; of 64 kidneys with grade Ⅰ damage, 7.81% (5/64) developed renal scar; of 51 kidneys with grade Ⅱ, 49.02% (25/51) developed renal scar; of 19 with grade Ⅲ, 68.42% (13/19) developed renal scar; of 23 with grade Ⅳ, 100.00% (23/23) developed renal scar. There was a significant relationship between the incidence of renal scar on follow-up and the grade of renal damage on first scan (r=0.877, P<0.01). VUR was found in 54.17% (78/144) per renal unit. Only 4.55% (3/66) of those with non-refluxing ureters developed renal sears on follow-up. One of four patients with mild-refluxing ureters developed renal scars. 46.51% (20/43) of those with mederate-refluxing ureters developed renal scars. 87.10% (27/31) of those with severe-refluxing ureters developed renal scars. There was a significant relationship between the incidence of renal scarring in follow-up and the grade of VUR (r=0.624, P<0.01). Conclusions There are important clinical prognostic values on the risk prediction of renal scarring by using DMSA renal cortical scan in children with APN. Higher grade of renal damage on first DMSA cortical scan and higher grade of VUR predicted greater chance of future development of renal scarring. The results of this study prompted the importance of early treatment and regular follow-up of APN to avoid irreversible renal damage in children.