| Objective To explore the clinical application of contrast-enhanced voiding urosonography(CeVUS)in children with vesicoureteral reflux(VUR)and the relationship between the diagnostic value of CeVUS combined with procalcitonin in children with vesicoureteral reflux and the severity of vesicoureteral reflux.Methods The sex,age,urinary ultrasound,procalcitonin(PCT),C-reactive protein(CRP)and urine bacterial culture of outpatients and inpatients with urinary tract infection diagnosed for the first time in the affiliated Hospital of Inner Mongolia Medical University from December 2019 to December 2020 were collected.CeVUS was performed by intravesical administration of ultrasound contrast agent Sono Vue,and the application of CeVUS in VUR was analyzed.The CeVUS results were used as VUR and non-VUR grouping criteria and VUR grading criteria,and the diagnostic parameters of PCT and CRP for VUR were compared.Results A total of 67 children with urinary tract infection were included.A total of136 renal pelvis-ureteral units(PUUs),were diagnosed in 29 cases(43.3%)by CeVUS examination,including 10 cases of male(34.5%,including 6 cases of bilateral reflux and 4 cases of unilateral reflux),19 cases of female(65.5%,including12 cases of bilateral reflux and 7 cases of unilateral reflux),47 PUUs(34.6%)and25(36.2%)VUR of 69 PUUs on the left.Of the 67 PUUs on the right,22(32.8%) have VUR.There were 11 cases in mild reflux subgroup(37.9%,3 males and 8 females)and 18 severe reflux subgroups(62.1%,7 males and 11 females).There were38 cases(56.7%)in the non-reflux group,including 14 males(36.8%)and 24 females(63.2%).No adverse events occurred.PCT(ng/m L)of reflux-free group(0.60±0.21)is lower than reflux group(1.00±0.35),the difference is statistically significant(P<0.05),Both the mild reflux subgroup(0.80±0.17)and the severe reflux subgroup(1.12±0.38)were higher than the no reflux group,and the difference was statistically significant(P<0.05).The mild reflux subgroup was lower than the severe reflux subgroup,and the difference was statistically significant(P<0.05).The CRP(mg/L) reflux group(16.72±8.28)was higher than the no reflux group(12.03±8.41),and the difference was statistically significant(t=2.276,P=0.026),the difference between the non-reflux group and the mild reflux subgroup(12.33±2.98)was not statistically significant(P>0.05),and the difference from the severe reflux subgroup(19.41±9.36)was statistically significant(P<0.05);The mild reflux subgroup was lower than the severe reflux subgroup,and the difference was statistically significant(P<0.05).The ROC curve shows that the diagnostic performance of PCT is better than that of CRP.The best cut-off value of PCT to distinguish the presence or absence of reflux is 0.71ng/m L,the sensitivity is 71.1%,the specificity is 79.3%,and the area under the ROC curve is 0.682(95%CI: 0.556,0.809).Under the condition of controlling for age and other factors,the risk of VUR in children with PCT≥0.71 ng/m L is 11.01 times that of children with PCT<0.71 ng/m L.Conclusion CeVUS is safe,reliable,highly accurate and non-radiation,so it can be used as the first choice for VUR screening and follow-up in children.PCT has a certain clinical value in judging the existence and severity of VUR in children with urinary tract infection,and can be used as an independent predictor of VUR. |
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