| Objective:Ureteropelvic junction obstruction(UPJO)hydronephrosis is a kind of congenital disease that may seriously damage the renal function of children.The best treatment scheme is still controversial,and there is no unified standard follow-up scheme.This study was conducted to investigate whether serum cystatin C(Cys C)and urinary neutrophil gelatinase associated lipocalin(NGAL)can assist in the differentiation of surgical and non-surgical cases in children with UPJO hydronephrosis,and the application value of both in clinical follow-up.Methods:Part I: Total of 95 children with obstructive hydronephrosis at the ureteropelvic junction who were treated in Qingdao women’s and children’s Hospital from September 2018 to March 2020 were selected as the study group.According to whether they met the surgical indications of children’s hydronephrosis caused by UPJO in the 2017 European guidelines for urology for children,the study group was divided into operation group(s group)and non operation group(N Group),During the study,fasting venous blood and clean midstream urine samples were collected from all subjects to detect serum Cys C and urinary NGAL levels.The serum Cys C and urinary NGAL levels were analyzed before operation in group s and at the first visit in group n.binary logistic regression was used to analyze the correlation between the two levels and operation,and the probability value was calculated.The receiver operating characteristic(ROC)curve was drawn to determine the diagnostic value of serum Cys C and urinary NGAL,and to evaluate their sensitivity and specificity.PartⅡ: In the first part of this paper,N group and s group were selected as the research group,and 41 healthy children who underwent routine physical examination in the Department of child protection of our hospital at the same time were selected as the control group(Group C).There was no significant difference in sex composition ratio and age among the three groups(P > 0.05).Blood and urine samples were collected before operation and 1,3,6,9 and 12 months after operation in group s.blood and urine samples were collected at the first visit and 3,6 and 12 months after operation in group n.blood and urine samples were collected at the time of visit in group C.one renal ultrasound examination was performed at the same time.Serum Cys C,urinary NGAL and renal ultrasound indexes(renal cortex thickness,anterior and posterior diameter of renal pelvis)were analyzed,and the change trend of these indexes in the follow-up of children with surgical treatment and conservative treatment was observed.Results:Part I:(1)The incidence of obstructive hydronephrosis at the ureteropelvic junction was higher in both the operation group and the non operation group(P < 0.05),and the left kidney was more involved than the right kidney(P < 0.05).(2)For the whole cohort analysis,the area under the curve(AUC)of serum Cys C was 0.694(95% confidence interval(CI)0.589-0.799);The AUC of urinary NGAL was 0.723(95% confidence interval 0.614-0.831).Binary logistic regression was used to calculate the combined predictors,and the ROC curve was drawn,showing that the area under the curve(AUC)was 0.777(95% confidence interval(CI)0.681 ～ 0.874).The logistic regression equation of joint predictor was: Joint predictor = serum Cys C + urinary NGAL ×(0.465/1.628),the best cut-off value of combined predictors was 2.675,the sensitivity was 0.727(95% confidence interval(CI)0.581-0.837),and the specificity was 0.745(95% confidence interval(CI)0.611-0.845).PartⅡ:(1)In the operation group,the serum Cys C before operation was 1.581±0.3032 mg / L,at 1 month,3 months and 6 months after operation were 1.585±0.2871mg/L 、1.295±0.1770mg/L、1.250±0.1954mg/L.During the follow-up,serum Cys C decreased at 3months after operation,which was significantly lower than that at 1 month after operation(P< 0.0001),and basically reached the level of control group at 3 months after operation.The preoperative urinary NGAL was 5.350±2.036 ng / ml,and at 1 month,3 months,6 months,9months and 12 months after operation were 3.775±1.693ng/ml 、 3.285±1.428ng/ml 、2.356±1.096ng/ml、2.488±1.236ng/ml、2.099±1.067ng/ml.One month after operation,it was significantly lower than that before operation(P < 0.0001),and 6 months after operation was significantly lower than that 3 months after operation(P = 0.0007),which was roughly the same as that in the control group.The above two indicators in the non-surgical group were significantly different from the healthy control group,but showed a stable trend in the follow-up.(2)In the operation group,the anteroposterior diameter of renal pelvis was36.59±93 mm,1,3,6,9 and 12 months after operation were 29.52±9.477 mm 、24.16±9.226mm、19.55±8.698mm、17.25±8.397mm、14.84±7.56 mm.The anteroposterior diameter of renal pelvis decreased after operation(P < 0.05).The thickness of renal cortex was 1.966 ± 4856 mm,1 month,3 months,6 months,9 months and 12 months after operation were 2.402±0.8566 mm 、 2.80±0.9850 mm 、 3.291±1.136 mm 、 3.584±1.324 mm 、4.098±1.456 mm.The thickness of renal cortex increased after operation(P < 0.05).The above two indexes did not reach the normal level at 12 months after operation.After 12 months of follow-up,the anteroposterior diameter of renal pelvis in the non-surgical group was still significantly higher than that in the normal control group(P < 0.0001),while the thickness of renal cortex in the non-surgical group was significantly lower than that in the normal control group(P < 0.0001).Conclusion:1.Serum Cys C and urine NGAL levels can effectively reflect the early renal function changes of children with ureteropelvic junction obstruction hydronephrosis.2.Combined detection of serum Cys C and urine NGAL can help to identify the children who need surgery,so as to provide early surgical intervention,retain more renal function as far as possible,avoid excessive intervention in children who do not need surgery,and reduce the burden and anxiety of children and their families.3.In the follow-up work,serum Cys C and urine NGAL levels can effectively monitor the renal function of children during treatment and observation,so that clinicians can give corresponding intervention measures in time.4.The application of hematuria biomarkers and urinary ultrasound for joint follow-up can help to improve the efficiency and quality of follow-up,and provide a basis for more scientific and effective follow-up. |
PDF Full Text Request