临床干预前儿童输尿管末端囊肿发生症状性尿路感染的危险因素分析

Risk factors for symptomatic urinary tract infection in children with ureterocele before treatment

摘要

目的 分析输尿管末端囊肿患儿在临床干预之前发生症状性尿路感染（UTI）的危险因素，为临床优化本病的诊疗提供参考。方法 我们回顾性分析了2015年1月-2023年12月收治的103例输尿管末端囊肿患儿的临床资料。根据是否出现症状性UTI将患儿资料分为A组和B组，并对相关因素进行二元Logistic回归分析。结果 共56名（54%）患儿出现了症状性尿路感染。多因素Logistic回归分析显示女性性别（OR=5.326，95%CI：1.851～15.321，P=0.002）、重复肾合并上下肾输尿管扩张（OR=3.883，95%CI：1.026～14.701，P=0.046）、输尿管远端直径比（UDR）（OR=6.133，95%CI：1.749～21.513，P=0.005）、尿培养阳性（OR=4.268，95%CI：1.155～15.768，P=0.030）为症状性UTI的相关危险因素。同时用受试者工作特征（ROC）曲线来评估UDR对症状性尿路感染的诊断效能，曲线下面积（AUC）为0.775，最佳截断值为0.688。结论 女性、重复肾合并双输尿管扩张、UDR＞0.688和尿培养阳性与接受治疗前输尿管末端囊肿患儿发生症状性UTI密切相关。当存在上述危险因素时，应采取更严格的随访和积极的干预，以尽量减少潜在的肾损伤。

Abstract

Objective To identify the risk factors associated with symptomatic urinary tract infection（UTI）in children with initially diagnosed ureterocele before any clinical intervention，so as to provide reference for the optimization of the diagnosis and treatment of this condition. Methods The clinical data of 103 children with ureterocele treated during Jan.2015 and Dec.2023 were retrospectively analyzed. The subjects were divided into group A and group B based on whether they had symptomatic UTI，and binary Logistic regression analysis was conducted on related factors. Results A total of 56（54%）children developed symptomatic UTI. Logistic analyses showed that female gender （OR=5.326，95%CI：1.851-15.321，P=0.002），duplex kidney with upper and lower renal ureteral dilation（OR=3.883，95%CI：1.026-14.701，P=0.046），ureteral diameter ratio（UDR）（OR=6.133，95%CI：1.749-21.513，P=0.005），and positive urine culture（OR=4.268，95%CI：1.155-15.768，P=0.030）were identified as risk factors associated with symptomatic UTI. Additionally，the receiver operating characteristic（ROC）curve was used to evaluate the diagnostic efficacy of UDR for symptomatic UTI，yielding an area under the ROC curve（AUC）of 0.775 and an optimal cutoff value of 0.688. Conclusion Occurrence of symptomatic UTI in children with ureterocele is significantly associated with female gender，presence of duplex kidney with upper and lower renal ureteral dilation，UDR＞0.688，and a positive urine culture. In the presence of these risk factors，more rigorous follow-ups and aggressive interventions should be adopted to minimize potential renal damage.

关键词

输尿管末端囊肿 / 泌尿系感染 / 重复肾 / 危险因素

Key words

ureterocele / urinary tract infection / duplex kidney / risk factors

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