影响后尿道瓣膜症最终肾结局的危险因素分析
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摘要
目的分析影响后尿道瓣膜症肾功能的相关危险因素。方法回顾性分析郑州大学第三附属医院小儿泌尿外科2005—2016年收治的48例后尿道瓣膜症患儿的临床资料,评估肾脏功能,对相关的危险因素采用单因素分析和多因素Logistic回归分析。结果共有48例患儿纳入研究,中位随访时间3 a。随访结束时有18例(37.5%)患儿出现肾功能不全,其中4例(8.3%)进展到终末期肾病。将病例分为肾功能正常组和肾功能不良结局(CKD/ESRD)组。单因素分析结果显示,两组产前诊断羊水过少、初始血肌酐值、最低血肌酐值、肾回声改变、膀胱功能障碍和膀胱输尿管反流比较,差异有统计学意义(均P<0.05)。多因素Logistic回归分析显示,最低血肌酐值是预测最终肾功能结局的独立危险因素(P<0.05)。结论产前诊断羊水过少、初始血肌酐值、肾回声改变、膀胱功能障碍和膀胱输尿管反流与后尿道瓣膜症的远期肾功能密切相关。最低血肌酐值是后尿道瓣膜症肾功能不良结局的独立危险因素。
Objective To analyze the risk factors of renal function in posterior urethral valvular disease.Methods The clinical data of 48 children with posterior urethral valvular disease admitted to the Third Affiliated Hospital of Zhengzhou University from 2005 to 2016 were analyzed retrospectively, and the renal function was evaluated. Univariate analysis and multi-factor Logistic regression analysis were used to analyze the risk factors.Results A total of 48 children were enrolled in the study, with a median follow-up time of 3 a. At the end of follow-up, 18 cases(37.5%) had renal insufficiency, and 4 cases(8.3%) developed to end-stage renal disease. The children were divided into normal renal function group and renal dysfunction outcome(CKD/ESRD) group. The results of univariate analysis showed that there were significant differences in amniotic fluid, initial blood creatinine, minimum creatinine, renal echo, bladder dysfunction and vesicoureteral regurgitation between the two groups(all P<0.05). Multi-factor Logistic regression analysis showed that the low-blood myocardiac value was an independent risk factor for predicting the end of the final renal function(P<0.05).Conclusion The prenatal diagnosis of oligohydramnios, the initial blood myocardiac value, the change of the renal echo, the function of the bladder and the return of the vesical ureter and the posterior urethral valve long-term renal function is closely related. The minimum blood myocardiac value is an independent risk factor for the adverse outcome of renal function in the posterior urethral valve.
Objective To analyze the risk factors of renal function in posterior urethral valvular disease.Methods The clinical data of 48 children with posterior urethral valvular disease admitted to the Third Affiliated Hospital of Zhengzhou University from 2005 to 2016 were analyzed retrospectively, and the renal function was evaluated. Univariate analysis and multi-factor Logistic regression analysis were used to analyze the risk factors.Results A total of 48 children were enrolled in the study, with a median follow-up time of 3 a. At the end of follow-up, 18 cases(37.5%) had renal insufficiency, and 4 cases(8.3%) developed to end-stage renal disease. The children were divided into normal renal function group and renal dysfunction outcome(CKD/ESRD) group. The results of univariate analysis showed that there were significant differences in amniotic fluid, initial blood creatinine, minimum creatinine, renal echo, bladder dysfunction and vesicoureteral regurgitation between the two groups(all P<0.05). Multi-factor Logistic regression analysis showed that the low-blood myocardiac value was an independent risk factor for predicting the end of the final renal function(P<0.05).Conclusion The prenatal diagnosis of oligohydramnios, the initial blood myocardiac value, the change of the renal echo, the function of the bladder and the return of the vesical ureter and the posterior urethral valve long-term renal function is closely related. The minimum blood myocardiac value is an independent risk factor for the adverse outcome of renal function in the posterior urethral valve.
引文
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[13] COLEMAN R,KING T,NICOARA C D,et al.Nadir creatinine in posterior urethral valves:How high is low enough?[J].J Pediatr Urol,2015,11(6):351-356.
[14] BILGUTAY A N,ROTH D R,GONZALES E J,et al.Posterior urethral valves:risk factors for progression to renal failure[J].J Pediatr Urol,2016,12(3):171-179.
[15] LOPEZ P P,ESPINOSA L,MARTINEZ U M,et al.Posterior urethral valves:prognostic factors[J].BJU Int,2003,91(7):687-690.
[16] 张潍平,王朝旭,莫志强,等.后尿道瓣膜症治疗现状[J].中华实用儿科临床杂志,2017,32(11):801-804.
[17] 梁海燕,张潍平,孙宁,等.小儿后尿道瓣膜切除后合并排尿异常的尿动力学研究[J].中华小儿外科杂志,2014,35(9):683-686.
[18] HEIKKILA J,HOLMBERG C,KYLLONEN L,et al.Long-term risk of end stage renal disease in patients with posterior urethral valves[J].J Urol,2011,186(6):2392-2396.
[19] COZZI D A,MORGANTE D,FREDIANI S,et al.Posterior urethral valves:relationship between vesicoureteral reflux and renal function[J].Urology,2011,77(5):1209-1212.
[2] HODGES S J,PATEL B,MCLORIE G,et al.Posterior urethral valves[J].ScientificWorldJournal,2009,9:1119-1126.
[3] DESHPANDE A V.Current strategies to predict and manage sequelae of posterior urethral valves in children[J].Pediatr Nephrol,2018,33(10):1651-1661.
[4] NASIR A A,AMEH E A,ABDUR-RAHMAN L O,et al.Posterior urethral valve[J].World J Pediatr,2011,7(3):205-216.
[5] LAL R,BHATNAGAR V,MITRA D K.Long-term prognosis of renal function in boys treated for posterior urethral valves[J].Eur J Pediatr Surg,1999,9(5):307-311.
[6] MATSELL D G,YU S,MORRISON S J.Antenatal determinants of long-term kidney outcome in boys with posterior urethral valves[J].Fetal Diagn Ther,2016,39(3):214-221.
[7] EL-SHERBINY M T,HAFEZ A T,SHOKEIR A A.Posterior urethral valves:does young age at diagnosis correlate with poor renal function?[J].Urology,2002,60(2):335-338.
[8] ZIYLAN O,OKTAR T,ANDER H,et al.The impact of late presentation of posterior urethral valves on bladder and renal function[J].J Urol,2006,175(5):1894-1897.
[9] ANSARI M S,GULIA A,SRIVASTAVA A,et al.Risk factors for progression to end-stage renal disease in children with posterior urethral valves[J].J Pediatr Urol,2010,6(3):261-264.
[10] SARHAN O,EL-DAHSHAN K,SARHAN M.Prognostic value of serum creatinine levels in children with posterior urethral valves treated by primary valve ablation[J].J Pediatr Urol,2010,6(1):11-14.
[11] LEMMENS A S,MEKAHLI D,DEVLIEGER R,et al.Population-specific serum creatinine centiles in neonates with posterior urethral valves already predict long-term renal outcome[J].J Matern Fetal Neonatal Med,2015,28(9):1026-1031.
[12] SARHAN O M,EL-GHONEIMI A A,HELMY T E,et al.Posterior urethral valves:multivariate analysis of factors affecting the final renal outcome[J].J Urol,2011,185(6):2491-2495.
[13] COLEMAN R,KING T,NICOARA C D,et al.Nadir creatinine in posterior urethral valves:How high is low enough?[J].J Pediatr Urol,2015,11(6):351-356.
[14] BILGUTAY A N,ROTH D R,GONZALES E J,et al.Posterior urethral valves:risk factors for progression to renal failure[J].J Pediatr Urol,2016,12(3):171-179.
[15] LOPEZ P P,ESPINOSA L,MARTINEZ U M,et al.Posterior urethral valves:prognostic factors[J].BJU Int,2003,91(7):687-690.
[16] 张潍平,王朝旭,莫志强,等.后尿道瓣膜症治疗现状[J].中华实用儿科临床杂志,2017,32(11):801-804.
[17] 梁海燕,张潍平,孙宁,等.小儿后尿道瓣膜切除后合并排尿异常的尿动力学研究[J].中华小儿外科杂志,2014,35(9):683-686.
[18] HEIKKILA J,HOLMBERG C,KYLLONEN L,et al.Long-term risk of end stage renal disease in patients with posterior urethral valves[J].J Urol,2011,186(6):2392-2396.
[19] COZZI D A,MORGANTE D,FREDIANI S,et al.Posterior urethral valves:relationship between vesicoureteral reflux and renal function[J].Urology,2011,77(5):1209-1212.