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Annals of Nuclear Medicine and Molecular Imaging

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篇名 Evaluation of Culture Negative Acute Pyelonephritis with 99mTc-DMSA Renal Scan in Children
卷期 16:3
並列篇名 利用鎝-99m-DMSA腎臟掃描評估尿液細菌培養陰性的兒童急性腎盂腎炎
作者 曹勤和林明賢林應然吳幸霖鄭澄意黃文盛
頁次 117-122
關鍵字 urinary tract infectionchildren99mTc-DMSA renal scannegative urine cultureacute pyelonephritis泌尿道感染兒童鎝-99m-DMSA腎臟掃描尿液細菌培養急性腎盂腎炎
出刊日期 200309

中文摘要

背景:泌尿道感染是兒童常見疾病,臨床表現可能有症狀也可能沒有症狀,可導致急性腎盂腎炎、腎臟結疤造成高血壓及腎功能不足的永久傷害。鎝-99m-DMSA腎臟掃描(RS)是對急性腎盂腎炎及腎臟結疤的最佳診斷工具,其敏感性、特異性、準確性分別為90%、95%及92%。它對急性腎盂腎炎的治療提供了重要的指標,同時也大大的影響疾病的預後。本研究目的在於評估臨床及實驗室檢查懷疑是泌尿道感染,但尿液細菌培養的結果是陰性或不確定,其RS的陽性率。我們還將所有病人分成三個年齡層組,以評估急性腎盂腎炎在各年齡層分佈的相關性。
方法:於1993至2002年期間,共計386位病童(男175人、女211人,年齡分佈在5天至15歲,平均年齡31個月),都具備了以下兩個條件而被診斷為疑似泌尿道感染:(1)體溫超過38.5T: (2)尿液分析主現陽性。每位病童都做RS及尿液細 菌培養,其中190位做膀胱輸尿管逆流造影。將病童區分為三個年齡層組,第一個年齡層為小於2歲,第二個年齡層為2到7歲,第三個年齡層為大於7歲。卡氏檢定統計用來評估RS陽性在不同年齡層上的差別。
結果:386位病童中,有245位(63%)尿液細菌培養結果呈陽性, 141位(37%)呈陰性或不確定。在尿液細菌培養陰性 或不確定病人中,有44位(31%)RS呈現陽性, 16位(28%)有膀胱輸尿管逆流的現像(在29位RS 陽性中,有15位;而在28位RS陰性中只有1位,P0.05) : (2)如果RS呈現陰性,膀胱輸尿管逆流造影幾乎不需要做。在尿液細菌培養陽性病童中,有109位(44%) RS 呈現陽性,43位(32%)有膀胱輸尿管逆流的現像(在72位RS陽性中有35位,而在61位RS陰性中只有8位,P0.05): (2) RS可用來篩 檢大部分的膀胱輸尿管逆流病人。
結論:在一個嚴重感染而不知感染源的小孩,無論年齡大小,鎝-99m-DMSA腎臟掃描可提供有效的診斷,特別是尿液分析有問題者,更須作鎝-99m-DMSA腎臟掃描。

英文摘要

Backgrounds: Urinary tract infection (UTI) is quite common in children and may be symptomatic or asymptomatic. It can lead to acute pyelonephritis (APN) and renal scarring with a risk of hypertension and renal insufficiency. 99mTc-DMSA renal scan (RS) is the gold standard for the definitive diagnosis of APN and subsequent renal cortical scarring with sensitivity, specificity and accuracy of 90%, 95% and 92%, respectively. RS was the guide to the therapy of suspected APN and affected prognosis substantially. The aim of this study was performed to evaluate the proportion of children with clinical and biological presentation indicative of APN that revealed abnormal RS findings and combined with negative or equivocal urine cultures. We made an attempt on three different age groups to correlate with the clinical and biological manifestations of UTI with the results of the RS
Methods: Between 1993 and 2002, 386 children (175 male and 211 female, age range from 5 days to 15 years, mean age of 31 months) fulfilled the following inclusion criteria for the diagnosis of suspected UTI: (1) fever (>38SC); (2) pyuria. All subjects had a RS and urine culture, 190 patients received voiding cystourethrography (VCUG) or radionuclide cystography (RNC) examinations (133 had VCUG, 66 had RIIC and 9 had both). To assess the correlation between the results of RS and different age groups, patients were divided into three age groups: group I less than 2 years; group II 2-7 years; group III older than 7 years. Chisquare statistical method was applied to evaluate the differences of positive RS among different age groups. Results: Of 386 patients enrolled in the study, 245 (63%) had positive urine culture and 141 (37%) had negative or equivocal results. In children with negative or equivocal urine cultu舟, 44 (31 %) had positive RS and 16 (28%) had vesicoureteral reflex (VUR) (15 shown in 29 with positive RS and only one in 28 with negative RS, P<0.01). That is, on the basis of negative or equivocal urine cultures in children with suspected UTI: (1) 31% of patients with APN and 28% with VUR could have been missed without performing RS and these results had no significant differences among each age group (P>0.05);(2) if RS was negative, VCUG or RIIC rarely had to be performed. In children with positive urine cultu舟, 109 (44%) of them had positive RS and 43 (32%) had VUR (35 shown in 72 with positive RS and only 8 in 61 with negative RS, P<0.01). That 侶,in children with UTI: (1) the rate of APN had no significant differences among each age group (P>0.05);(2) RS should be performed first for screening the higher possibility of VUR.
Conclusion: 99mTc-DMSA renal scan should be performed in any age groups of children with severe infection without clear etiology, especially in those with abnormal urinalysis.

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