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.expand_btn{-webkit-flex:1;-ms-flex:1;flex:1;background:url('data:image/svg+xml;base64,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') no-repeat 6px;background-position:center;margin-top:10px;min-width:55px;display:none;} @media (min-width:768px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .expand_btn{display:none;}} .vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-text{-webkit-flex:9;-ms-flex:9;flex:9;text-align:left;padding:21px 37px 10px 0px;font-size:16px;font-weight:700;} @media (min-width:768px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-text{padding:19px 18px 10px 18px;}} @media (min-width:992px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-text{padding:19px 21px 10px 21px;}} .vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url{-webkit-flex:1;-ms-flex:1;flex:1;background:url('data:image/svg+xml;base64,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') no-repeat 6px;background-position:center;padding:16px 0 16px 0;min-width:62px;max-width:62px;} @media (min-width:768px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url{padding:16px 0 17px 0;min-width:52px;max-width:52px;}} @media (min-width:992px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url{padding:15px 0 17px 0;min-width:60px;max-width:60px;}} .vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url:hover{-webkit-text-decoration:none;text-decoration:none;} .vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption-text{font-size:14px;padding:0px 18px 17px 22px;} @media (min-width:768px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption-text{padding:0px 15px 15px 18px;}} @media (min-width:992px){.vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption-text{padding:0px 18px 19px 21px;}} .vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption-text figcaption{margin:0;padding:0;} .vOMzS .floats-partial-section .floats-partial-footer .floats-partial-caption-text svg{max-width:100%;} .vOMzS ol{font-size:16px;padding-left:32px;font-family:STIXGeneral-Regular;line-height:24px;margin:15px 0;} .vOMzS ol li{margin:10px 0;padding-left:10px;word-break:normal;} .vOMzS ol li a{word-break:break-all;} .vOMzS ol li .reflinks{display:block;} .vOMzS ol li .reflinks a{color:#4D8A17;-webkit-text-decoration:none;text-decoration:none;cursor:pointer;} .vOMzS ol li .reflinks a:hover{-webkit-text-decoration:underline;text-decoration:underline;} .vOMzS ol li .reflinks .sep{color:#000000;} .vOMzS .table-wrapper{width:auto;overflow-x:auto;} .vOMzS .table-wrapper::-webkit-scrollbar{-webkit-appearance:none;width:5px;height:5px;} .vOMzS .table-wrapper::-webkit-scrollbar-thumb{border-radius:5px;background-color:rgba(0,0,0,.5);-webkit-box-shadow:0 0 1px rgba(255,255,255,.5);} @media (min-width:768px){.vOMzS .table-wrapper{overflow-x:auto;width:auto;-webkit-break-word:word-break;break-word:word-break;margin:0 auto;}} @media (min-width:992px){.vOMzS .table-wrapper{width:auto;}} @media (min-width:1324px){.vOMzS .table-wrapper{width:auto;}} @media (min-width:320px){.vOMzS{margin-bottom:33px;padding:0;}} @media (min-width:992px){.vOMzS{padding:0;margin-bottom:100px;}} @media (min-width:1325px){.vOMzS{margin-bottom:100px;}} .vOMzS .owl-stage{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;} .vOMzS .floats-partial-middle--thumbs{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;} .vOMzS .floats-partial-middle--thumbs .partial-carousel-dot svg{fill:#4D8A17;} .vOMzS .floats-partial-middle--thumbs .partial-carousel-dot strong{color:#4D8A17;font-weight:500;} .vOMzS .floats-partial-middle--thumbs .partial-carousel-dot.active strong{color:#007B8B;} .vOMzS .floats-partial-middle--thumbs .partial-carousel-dot.active svg{fill:#007B8B;} .vOMzS .floats-partial-middle--thumbs .partial-carousel-dot .nowrap{white-space:nowrap;} .vOMzS .partial-carousel-dot{text-align:center;cursor:pointer;border:0;width:100px;padding-bottom:20px;background-color:#fff;display:table-cell;} .vOMzS .partial-carousel-dot:focus-visible{outline-offset:-3px;} .vOMzS .partial-carousel-dot strong{font-size:11px;padding-top:12px;} @media (min-width:767.5px){.vOMzS .partial-carousel-dot strong{font-size:16px;}} .vOMzS .partial-carousel-dot img{width:90px;height:90px;border:1px solid #979797;margin:10px 0;} .vOMzS .partial-carousel-wrapper .floats-partial-middle{border-top:1px solid #e3e3e3;display:block;margin-bottom:50px;padding-top:1px;} @media (min-width:767.5px){.vOMzS .partial-carousel-wrapper .floats-partial-middle{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;margin-bottom:0;}} .vOMzS .partial-carousel--single-image{overflow:hidden;text-align:center;} .vOMzS 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href="//www.newsama.com/journals/au/" aria-label="Advances in Urology">泌尿外科的进步</gydF4y2Baa>/<gydF4y2Baa class="sc-htpNat bUhGXt link sc-eitiEO jXeALb breadCrumb" href="//www.newsama.com/journals/au/contents/year/2008/" aria-label="2008">2008年</gydF4y2Baa>/<gydF4y2Baspan class="sc-bhlBdH UVThf">文章</gydF4y2Baspan> </div> <div class="threeColumn__ThreeColumnWrapper-sc-1bf4078-0 dDyxFF threeColumnWrapper"> <div class="threeColumn__LeftWrapper-sc-1bf4078-1 fkVFlF leftWrapper"> <button type="button" class="sc-eKZiaR dzZrgS section__button " id="sectionButton"><span class="sc-htoDjs diutvq icon__dots dots__detector icon-colored _3n-7Ho7DlfjMlZbrRr9Q4a icon-themeable" title="" font-size="22"></span>文章部分</gydF4y2Babutton> <div class="sc-bEjcJn jLUVhb static_contents__section_links links__hidden "> <div id="leftSectionMenu" class="sc-cbkKFq prcY sc-bGbJRg dVCLgr left_section_menu"> <p>在这一页上</gydF4y2Bap> <span class="sc-likbZx bBmZJZ grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-ePZHVD ewHMLz" href="#abstract" aria-label="">文摘</gydF4y2Baa></span> <span class="sc-likbZx bBmZJZ grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-ePZHVD ewHMLz" href="#introduction" aria-label="">介绍</gydF4y2Baa></span> <span class="sc-likbZx bBmZJZ grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-ePZHVD ewHMLz" href="#conclusion" aria-label="">结论</gydF4y2Baa></span> <span class="sc-likbZx bBmZJZ grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-ePZHVD ewHMLz" href="#references" aria-label="">引用</gydF4y2Baa></span> <span class="sc-likbZx bBmZJZ grey" property="background-color" color="#D8D8D8"><a class="sc-htpNat bUhGXt link sc-ePZHVD ewHMLz" href="#copyright" aria-label="">版权</gydF4y2Baa></span> </div> </div> </div> <div class="threeColumn__ContentWrapper-sc-1bf4078-3 bbzREB contentWrapper"> <div class="threeColumn__Content-sc-1bf4078-4 jknsZc content"> <div class="articleContent__ArticleContentsWrapper-sc-2yl9jy-0 eSvjPB article_contents"> <div class="articleContent__ArticleContentsSectionsWrapper-sc-2yl9jy-1 jntdRu article_contents__sections_wrapper"> <div class="articleContent__ArticleWrapper-sc-2yl9jy-2 hAzjHP"> <div class="sc-chbbiW mBGSe article_header_class"> <div class="sc-kxynE fgGykB"> <span class="sc-cooIXK gQxyld">特殊的问题</gydF4y2Baspan> <h2 class="sc-fcdeBU bVtmCk">儿童膀胱输尿管的回流不断变化的概念</gydF4y2Bah2> <a class="sc-htpNat bUhGXt link sc-gmeYpB hSHJbi" href="//www.newsama.com/journals/au/si/215723/" aria-label="">把这个特殊的问题</gydF4y2Baa> <hr class="sc-clNaTc ktFfKO"> </div> <p class="sc-kZmsYB bkiEfx article_type">评论文章|<gydF4y2Ba!-- -->开放获取</gydF4y2Bap> <div class="sc-RcBXQ ztvYg article_citation"> 体积<gydF4y2Ba!-- --> 2008年<gydF4y2Ba!-- --> <span class="sc-fZwumE cUsFHx">|</gydF4y2Baspan>文章的ID<gydF4y2Ba!-- --> 367320年<gydF4y2Ba!-- --> <span class="sc-fZwumE cUsFHx">|</gydF4y2Baspan> <a class="sc-htpNat bUhGXt link sc-fQejPQ duuwge" href="https://doi.org/10.1155/2008/367320" aria-label="Doi-link">https://doi.org/10.1155/2008/367320</gydF4y2Baa> </div> <div class="sc-LKuAh lcOiDF article_full_citation"> <div class="sc-hzNEM gsmOCv isHide"> <p>苏米特戴夫,安东尼·e·库利<gydF4y2Ba!-- -->,<gydF4y2Ba!-- --> ”<gydF4y2Baspan class="adjust-article-svg-size">2007年诊断方法回流</gydF4y2Baspan>”,<gydF4y2Ba!-- --><i>泌尿外科的进步</gydF4y2Bai>,<gydF4y2Ba!-- --> 卷。<gydF4y2Ba!-- -->2008年<gydF4y2Ba!-- -->,<gydF4y2Ba!-- --> 文章的ID<gydF4y2Ba!-- -->367320年<gydF4y2Ba!-- -->,<gydF4y2Ba!-- --> 8<gydF4y2Ba!-- -->   页面<gydF4y2Ba!-- -->,<gydF4y2Ba!-- --> 2008年<gydF4y2Ba!-- -->。<gydF4y2Ba!-- --> https://doi.org/10.1155/2008/367320</gydF4y2Bap> </div> <button class="sc-hSdWYo etauus sc-iBEsjs kPshFw" color="">显示引用</gydF4y2Babutton> </div> <h1 class="sc-iRbamj jZOxOO sc-iSDuPN HhXOr article_title adjust-article-svg-size heading-title">2007年诊断方法回流</gydF4y2Bah1> </div> <div class="sc-jrIrqw eHMFfo article_authors"> <hr class="sc-cEvuZC XkrFe hr__author"> <span class="">苏米特戴夫<gydF4y2Basup>1</gydF4y2Basup>和</gydF4y2Baspan> <span class=""><b>安东尼·e·库利</gydF4y2Bab><a class="sc-htpNat bUhGXt link" href="mailto:" aria-label="Mail Option"><span class="sc-htoDjs kNoiZu sc-hjRWVT irNWJI icon-colored _2zt-1j0LmaF8UjTQAM413G icon-themeable" title="" font-size="16"></span></a><sup>2</gydF4y2Basup></span> <div class="sc-fHxwqH dMuGGA isHide"> <p><sup>1</gydF4y2Basup><span>泌尿外科分工、儿童医院、伦敦健康科学中心,伦敦,加拿大安大略省</gydF4y2Baspan></p> <p><sup>2</gydF4y2Basup><span>泌尿外科部门,加州大学欧文分校医疗、加州大学欧文分校,橙色,CA 92868,美国</gydF4y2Baspan></p> </div> <button class="sc-hSdWYo etauus sc-iQtOjA kfDwZY" color="">显示更多</gydF4y2Babutton> </div> <div class="articleContent__EditorWrapper-sc-2yl9jy-3 evMkvU"> <div class="articleContent__TextWrapper-sc-2yl9jy-8 fYrLtk"> <b>学术编辑器:</gydF4y2Bab>瓦利德a高人气的</gydF4y2Badiv> <div class="articleContent__PublicationTimeLineWrapper-sc-2yl9jy-4 fjviok"> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">收到了</gydF4y2Baspan> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2008年5月05</gydF4y2Baspan> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC notPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">接受</gydF4y2Baspan> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2008年6月30日</gydF4y2Baspan> </div> <div class="articleContent__PublcationCol-sc-2yl9jy-5 hgKieC isPublished"> <span class="articleContent__PublicationField-sc-2yl9jy-6 cIribm">发表</gydF4y2Baspan> <span class="articleContent__PublicationValue-sc-2yl9jy-7 khHUcu">2008年8月28日</gydF4y2Baspan> </div> </div> </div> <article class="sc-jtRlXQ vOMzS article_body "> <div> <div class="xml-content"> <h4 class="header" id="abstract">文摘</gydF4y2Bah4> <p>有正在进行的争论关于vesicoureteric返流(VUR)之间的关系,复发性尿路感染(UTI)和肾损害。尽管如此,日常工作为VUR仍建议在大多数孩子发热性泌尿道感染。本文回顾了适应症和成像模式可供VUR诊断。膀胱造影术先生和排尿urosonography等其他新技术进行了讨论。越来越多的证据表明DMSA扫描的作用在管理孩子VUR突出显示。</gydF4y2Bap> <span class="end-abs"></span> <h4 id="introduction">1。介绍</gydF4y2Bah4> <p>一般的目标成像过程确认诊断疑似有高度的敏感性和特异性,以帮助治疗和允许预言。另一方面,它是专为治疗医师分析风险和收益的诊断过程和理解疾病的自然历史问题建立的疾病的诊断和治疗是否会改变长期的结果或影响管理决策。</gydF4y2Bap> <p>的诊断vesicoureteric返流(VUR)是一个相对简单的和完善的过程。然而,潜在的理由确定VUR防止复发性肾盂肾炎(PN)和长期肾损害被强烈质疑在最近的文献[<gydF4y2Baa href="#B1">1</gydF4y2Baa>- - - - - -<gydF4y2Baa href="#B4">4</gydF4y2Baa>]。加上这个,已经有越来越多的辐射暴露的风险意识和意识到绝对VUR调查是一种侵入性手术和一个不愉快的经历。因此,当务之急是小儿泌尿科医生和肾脏重新评估的指标和目标成像VUR,重新定义所使用的模式,为后续建立指导方针。</gydF4y2Bap> <p>本文回顾了可用模式评估VUR,调查孩子疑似VUR表明协议,介绍了最近的证据证明这些建议。</gydF4y2Bap> <h4 id="imaging-modalities-for-diagnosis-of-vur">2。为诊断VUR成像模式</gydF4y2Bah4> <h5 id="subsec2.1">2.1。排尿膀胱尿道照片(VCUG)或放射性核素膀胱照片(RNC)</gydF4y2Bah5> <p>VUR检测的理想测试将一个不涉及辐射,无膀胱插管、镇静,低成本、高灵敏度,和一个提供完整的解剖细节。传统方法诊断VUR透视排尿膀胱尿道照片(VCUG)。目前,放射性核素膀胱造影术(RNC)仍然是主要的选择评估VUR VCUG。反对执行VCUG与传统VCUG的高辐射被认为是共和党全国委员会的100倍。然而,明智地使用数字和脉冲与细致的透视图像锥进,从VCUG明显减少了辐射(<gydF4y2Baa href="#B5">5</gydF4y2Baa>]。尽管这些措施,平均卵巢辐射剂量被证明是大约10倍VCUG相比,共和党全国委员会(<gydF4y2Baa href="#B6">6</gydF4y2Baa>]。共和党全国委员会的支持者辩称,这有效地减少了VCUG识别的敏感性VUR作为膀胱充盈的快照和排泄而不是连续成像。在一篇社论中发表评论,Benson说“辐射剂量在3分钟的透视时间接近两个盆腔螺旋CT扫描对比,1.5常规腹部CT扫描没有对比,3 DMSA扫描,60腹部平片,600年放射性核素VCUG,或10年的背景辐射”(<gydF4y2Baa href="#B7">7</gydF4y2Baa>]。</gydF4y2Bap> <p>几项研究已经VCUG的敏感性和共和党全国委员会的结论是,相比共和党全国委员会至少是一样敏感或超过VCUG检测VUR [<gydF4y2Baa href="#B8">8</gydF4y2Baa>- - - - - -<gydF4y2Baa href="#B10">10</gydF4y2Baa>]。雪等人观察2形式之间没有显著差异但指出共和党全国委员会提供了更高的灵敏度在年轻的年龄组<gydF4y2Baa href="#B8">8</gydF4y2Baa>]。此外,尽管没有达到统计学意义,儿童积极dimercapto-succinic酸(DMSA)扫描,共和党全国委员会确定VUR更高比例的孩子而不是VCUG。这是一个有关发现在当前时代积极DMSA扫描被认为是一个重要的发现在儿童呈现与PN(稍后讨论)。一个微不足道的1级VUR可能错过一个共和党全国委员会,但连续成像在填充和排泄VUR允许更大的检测,这是一个间歇现象。两个测试,这是应该执行完善的循环研究增加VUR的检测(<gydF4y2Baa href="#B11">11</gydF4y2Baa>]。定VCUG有超过一个共和党全国委员会优势在于解剖前获得的信息尤其是在评价男性的尿道。此外,国际逆流分级系统是基于VUR VCUG,因为大多数研究使用这个评分系统,治疗医生感到更舒适知道这个信息。然而,又由于治疗理念的变化,可以说,一个更广泛的分类VUR进入扩张(≥3级)和nondilating品种是可能的共和党全国委员会,使这一个无关紧要的问题决定研究获得。因此,目前VCUG仍然是标准与疑似VUR当最初评价一个孩子。所有后续研究共和党全国委员会是首选方法。麦地那等人进行了成本分析VUR成像使用VCUG和共和党全国委员会,而是强调另一个潜在的原因跟踪成像的共和党全国委员会(<gydF4y2Baa href="#B12">12</gydF4y2Baa>]。研究表明,执行VCUG的直接成本是1.74倍一个共和党全国委员会(<gydF4y2Basvg height="11.0625" id="M1" style="vertical-align:-0.30096pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 11.0625" width="56.150002" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.0625)"> <g transform="translate(72,-63.15)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> <</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> 。</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="38.559254" y="0"> 1</gydF4y2Batspan> </text> </g> </g> </svg>)。</gydF4y2Bap> <h5 id="subsec2.2">2.2。间接的共和党全国委员会</gydF4y2Bah5> <p>间接检测VUR共和党全国委员会提供的可能性没有膀胱导管插入术和可能在更多的生理环境与自然膀胱充盈。另一个优势是能够评估上呼吸道微分函数和排水注射放射性同位素。尽管一些报道表现出相当程度的敏感性之间的直接和间接的共和党全国委员会,由于无法研究的共识是充盈期和间接共和党全国委员会有一个相当大的假阴性率间接共和党全国委员会(<gydF4y2Baa href="#B13">13</gydF4y2Baa>- - - - - -<gydF4y2Baa href="#B15">15</gydF4y2Baa>]。可能有间接的共和党全国委员会的角色作为后续研究儿童马桶训练(<gydF4y2Baa href="#B14">14</gydF4y2Baa>]。</gydF4y2Bap> <h5 id="subsec2.3">2.3。排泄Urosonography (VUS开头)</gydF4y2Bah5> <p>的超声评价VUR后膀胱内的执行我们滴注法对比剂逐渐普及的vu过去十年。执行的全面审查的vu与VCUG相比,Darge显示,2893年1338例回流单元,VUS开头显示78%的诊断准确率-96% (<gydF4y2Baa href="#B16">16</gydF4y2Baa>]。整个协议2研究91%和9%的肾单位执行VUR只发现在的vu使它更敏感的研究。执行另一个潜在的优势的vu比共和党全国委员会是年级VUR类似国际逆流分级体系和执行之间的一致性表明75%的vu VCUG评分。不和谐的发现主要是由于大量的1级VUR VCUG被执行2级或2级高的vu。没有辐射,同时评估上大片的能力和更高的敏感度,让一个有吸引力的工具评估VUR。潜在的缺点包括膀胱和尿道形态学评估不足,对比剂的高成本,延长考试时间,其运营商的依赖。Transperineal执行我们的尿道的一部分的vu可靠地使用在几个研究但进一步评估该技术是必要的执行之前的vu可以替代VCUG作为第一个考试VUR尤其是男孩(<gydF4y2Baa href="#B17">17</gydF4y2Baa>]。执行目前的vu作用VUR跟踪检查,筛查的兄弟姐妹,可能作为VUR女孩的第一次考试。</gydF4y2Bap> <h5 id="subsec2.4">2.4。先生排尿膀胱造影术(MRVCUG)</gydF4y2Bah5> <p>膀胱造影术先生管理涉及到膀胱内的成像使用钆先生在填充和排泄。相对收益的过程,它可以评估VUR没有电离辐射和另外给重要的信息关于renal-acquired皮质缺陷和区分获得皮质缺陷和先天性发育异常。必须牢记,发育不良和疤痕是不同的实体组织病理学检查确诊。在本文中,我们把他们称为先天性和获得皮质的缺陷。潜在的缺点包括VCUG相比的敏感性较低,成本上升,需要镇静或麻醉进行研究。Takazakura等人显示出MRVCUG敏感性90%,特异性96%,和所有的孩子三年级以上VUR被确定使用这个模式(<gydF4y2Baa href="#B18">18</gydF4y2Baa>]。李等人进一步相关MRVCUG发现DMSA SPECT扫描证明这些额外信息的优势通过一个简单的测试(<gydF4y2Baa href="#B19">19</gydF4y2Baa>]。</gydF4y2Bap> <h5 id="subsec2.5">2.5。图片膀胱照片</gydF4y2Bah5> <p>鲁宾斯坦等人在2003年引入了一个新颖但有争议的技术来识别VUR儿童出现发热性尿路和消极VCUG [<gydF4y2Baa href="#B20">20.</gydF4y2Baa>]。作者完成了图片(定位在输尿管口的滴注法对比)膀胱照片通过定位膀胱镜输尿管的孔附近膀胱空虚和灌输对比gravity-aided方式从1米高度使用的灌溉端口范围。认为这种技术可以诱导VUR反驳通过使用一个对照组的儿童没有泌尿道感染和VUR图片膀胱照片也没有证明回流。相比之下,所有的孩子发热性尿路和没有VUR VCUG显示VUR PIC膀胱照片。多机构研究研究证实,照片VUR可以在82%的儿童伴有发热性泌尿道感染和正常VCUG [<gydF4y2Baa href="#B21">21</gydF4y2Baa>]。固有的问题,这两个研究的缺乏标准化VCUG技术使用,没有上尿路成像结果,和严格的泌尿道感染的定义。后者反对已经解决Tareen等人在最近的一项研究中,他们评估5儿童复发性发热性泌尿道感染和上呼吸道变化DMSA / CT扫描(<gydF4y2Baa href="#B7">7</gydF4y2Baa>]。图片上所有5例显示VUR膀胱造影术和内窥镜或开放VUR校正。这些研究的结果表明,大部分孩子发热性泌尿道感染和没有VUR VCUG会VUR PIC膀胱照片。之前添加这个调查作为儿童发热性泌尿道感染的常规形态和消极VCUGs,表示进一步的前瞻性随机研究来定义人将受益于这种干预。</gydF4y2Bap> <h4 id="indications-for-imaging-for-suspected-vur">3所示。适应症为疑似VUR成像</gydF4y2Bah4> <p>的主要适应症为评估儿童VUR将在本节中讨论。已经有相当大的进化我们的知识VUR管理在过去的几年中。抗生素预防预防复发感染的作用受到了挑战增加对抗生素耐药性的发展(<gydF4y2Baa href="#B1">1</gydF4y2Baa>- - - - - -<gydF4y2Baa href="#B3">3</gydF4y2Baa>]。这再加上识别等强大的感染复发的预测因素下尿路功能障碍(附近地区)已经导致了更为保守的方法在识别和治疗VUR [<gydF4y2Baa href="#B22">22</gydF4y2Baa>]。这部分表明孩子疑似VUR评估的建议。</gydF4y2Bap> <h5 id="subsec3.1">3.1。儿童尿路感染</gydF4y2Bah5> <p>美国儿科学会:质量改进委员会建议VCUG对所有儿童年龄在2个月到2岁后第一发热性泌尿道感染(<gydF4y2Baa href="#B23">23</gydF4y2Baa>]。这种做法的基本原理是基于传统的观点总是有不确定性先前感染是否错过,泌尿道感染的高复发率、高百分比的泌尿道感染患儿有VUR renal-acquired皮质缺陷的风险是最高的年轻的孩子。然而在实践中,这一建议往往不遵循严格的主要是因为糟糕的文档的重要菌尿和脓尿,泌尿道感染的诊断提出了质疑。对于大一点的孩子,年龄,性别,种族,类型(发热性或非发热),泌尿道感染的频率,必须考虑社会因素VCUG在继续之前。受女性儿童膀胱炎主要是评估通过一个完整的排尿日记和不正常的排尿症状评分(dv)而不是VCUG [<gydF4y2Baa href="#B24">24</gydF4y2Baa>]。在复发性膀胱炎患儿尿疗和美国。然而,在记录集PN的存在或复发性发热性泌尿道感染,VCUG或共和党全国委员会是必要的和我们或DMSA扫描来评估上大片。所有证据确凿的发热性泌尿道感染的男性应该接受一个VCUG。因为证据确凿的黑人孩子VUR发病率低,VCUG并不表示对老黑人孩子出现尿路感染。最初VCUG可以无热的孩子之后,执行临床稳定的尿液是无菌的<gydF4y2Baa href="#B25">25</gydF4y2Baa>]。抗生素预防每天翻了一倍的剂量在测试前,继续一天后测试的治疗水平。</gydF4y2Bap> <h5 id="subsec3.2">3.2。兄弟姐妹VUR</gydF4y2Bah5> <p>主要VUR是最常见的遗传性疾病的泌尿生殖系统和作为孟德尔遗传的主要部分表达式(<gydF4y2Baa href="#B26">26</gydF4y2Baa>]。几个兄弟姐妹VUR研究已经确定了因素,它可以帮助预测同胞VUR的风险。Hollowell 1768兄弟姐妹的分析显示,平均VUR发病率为32%,在兄弟姐妹44%小于2岁比9%的兄弟姐妹大于6年(<gydF4y2Baa href="#B27">27</gydF4y2Baa>]。如果兄弟姐妹的性别或渊源者是单独考虑没有统计协会。另一方面,女性女性的兄弟姐妹指数患者有更高的可能性比男性(VUR<gydF4y2Baa href="#B28">28</gydF4y2Baa>]。同卵双胞胎有一个明显的风险高于异卵双胞胎。Hollowell显示大约三分之二的兄弟姐妹有低品位(I, II) VUR和自发的解析率较高的孩子相比,诊断为泌尿道感染(VUR后<gydF4y2Baa href="#B27">27</gydF4y2Baa>]。女孩等人提出的长期结果无症状筛查VUR,最初我们(<gydF4y2Baa href="#B29">29日</gydF4y2Baa>]。117年的兄弟姐妹在这项研究中,11例(9.4%)有异常我们发现,其中5显示VUR VCUG。85年的兄弟姐妹,平均超过8年的跟踪,没有VUR并发症。其他作者认为更加积极主动的方法在诊断VUR在兄弟姐妹<gydF4y2Baa href="#B30">30.</gydF4y2Baa>,<gydF4y2Baa href="#B31">31日</gydF4y2Baa>]。Houle等人证明了兄弟姐妹皮质缺损的发生率26%,表明,兄弟姐妹筛选2岁后肾损害的风险更高(<gydF4y2Baa href="#B30">30.</gydF4y2Baa>]。另一种观点是,也许这些发现代表先天缺陷而不是获得预防缺陷。</gydF4y2Bap> <p>兄弟姐妹因此定制方法可以执行一个共和党全国委员会或的vu受年龄岁以下的兄弟姐妹和我们最初的筛选模式年长的兄弟姐妹。在任何美国的证据面前皮质损害VCUG建议5岁以下的儿童,因为他们形成肾损害风险最大的子集。有症状的兄弟姐妹在任何年龄VCUG评估。</gydF4y2Bap> <h5 id="subsec3.3">3.3。产前肾盂积水和VUR</gydF4y2Bah5> <p>VUR怀疑产前的输尿管的扩张和/或肾盂积水(HN)或以下的诊断异位肾,但发育异常的肾,和单侧肾发育不全,有一个反横向VUR发病率增加。范Eerde等人进行了荟萃分析评估的价值产前HN预测产后VUR [<gydF4y2Baa href="#B32">32</gydF4y2Baa>]。HN被定义为肾盆腔直径超过4毫米或无肾盏扩张。在1178例中,初级VUR的平均患病率为14.9%。当分层前后的肾盆腔直径(adp), VUR在14%的婴儿被诊断<gydF4y2Basvg height="12.3" id="M2" style="vertical-align:-1.29163pt;width:93.337502px;" version="1.1" viewbox="0 0 93.337502 12.3" width="93.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,12.3)"> <g transform="translate(72,-62.16)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 一个</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="9.0271664" y="0"> P</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="15.991337" y="0"> D</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="28.481834" y="0"> ≤</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="40.522224" y="0"> 1</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="46.773724" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="55.113224" y="0"> 米</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="64.840561" y="0"> 米</gydF4y2Batspan> </text> </g> </g> </svg>和12%的婴儿<gydF4y2Basvg height="12.3" id="M3" style="vertical-align:-1.29163pt;width:93.337502px;" version="1.1" viewbox="0 0 93.337502 12.3" width="93.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,12.3)"> <g transform="translate(72,-62.16)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 一个</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="9.0271664" y="0"> P</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="15.991337" y="0"> D</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="28.481834" y="0"> ≥</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="40.522224" y="0"> 1</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="46.773724" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="55.113224" y="0"> 米</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="64.840561" y="0"> 米</gydF4y2Batspan> </text> </g> </g> </svg>。众所周知,消极的产前筛查或一个正常的婴儿与产前产后我们HN并不排除VUR。在一个荟萃分析报告的李et al ., VUR的患病率在4.4%和14%之间(<gydF4y2Baa href="#B33">33</gydF4y2Baa>]。没有产前HN的程度之间的相关性和VUR存在或年级。同样,在另一项研究对108名儿童进行产前HN, VUR中检测出15%,之间没有相关性的程度pelviectasis产后我们和VUR的存在或严重性<gydF4y2Baa href="#B34">34</gydF4y2Baa>]。孩子和产前HN VUR更良性与高分辨率速度相比,儿童被诊断为泌尿道感染后VUR [<gydF4y2Baa href="#B35">35</gydF4y2Baa>,<gydF4y2Baa href="#B36">36</gydF4y2Baa>]。阿帕德海耶等人跟着25名儿童与产前检测HN VUR [<gydF4y2Baa href="#B36">36</gydF4y2Baa>]。回流是大于或等于70%的儿童三级。VUR解决52%,下调了24%。突破患者尿路感染发生在4年级IV和V回流和不正常排尿了5。后续肾扫描显示降低微分函数(平均18%)2单位没有新伤疤。选择性的方法是明智的与产前HN调查新生儿。如果肾脏大小和实质是不起眼的,它可能是合理的储备与学院3 - 4年级儿童VCUG HN或双边HN和输尿管的扩张的存在。</gydF4y2Bap> <h5 id="subsec3.4">3.4。其他情况下</gydF4y2Bah5> <p>常规VCUG推荐工作的孩子但发育异常的肾(MCDK)基于报道VUR患病率在15% - -25%的儿童MCDK [<gydF4y2Baa href="#B37">37</gydF4y2Baa>- - - - - -<gydF4y2Baa href="#B40">40</gydF4y2Baa>]。米勒等人发现VUR 25%患者在75年对侧肾MCDK [<gydF4y2Baa href="#B37">37</gydF4y2Baa>]。在本系列中,大约50%的儿童与VUR分数≥3,自发地解决50%的5岁,只有1 75名儿童为VUR需要手术治疗。Guarino等人记录,16%的患儿MCDK VUR, VUR年级显著高于在男孩与女孩<gydF4y2Baa href="#B39">39</gydF4y2Baa>]。这个发现被Selzman研究中还指出,老人,其中15%的儿童显示侧VUR,患病率在男孩和白人(高<gydF4y2Baa href="#B40">40</gydF4y2Baa>]。伊斯玛仪派等人建议2连续正常我们研究新生儿期标识符最重要侧异常避免使用常规VCUG [<gydF4y2Baa href="#B38">38</gydF4y2Baa>]。在他们的研究中,61的76新生儿与MCDK 2正常新生儿。其中,4(7%)低品位VUR之前解决自发地在所有2岁。还需要进一步的研究来验证这一发现之前停止常规VCUGs MCDK儿童。</gydF4y2Bap> <p>VUR的发病率在儿童单侧肾发育不全(URA所言)略高于MCDK和24% - -28%之间的不同<gydF4y2Baa href="#B39">39</gydF4y2Baa>,<gydF4y2Baa href="#B41">41</gydF4y2Baa>- - - - - -<gydF4y2Baa href="#B43">43</gydF4y2Baa>]。VUR可以优质并显示较低的自发的解决速度比MCDK [<gydF4y2Baa href="#B41">41</gydF4y2Baa>]。竞技场等人评估60儿童肾异位(简单交叉24日36)(<gydF4y2Baa href="#B44">44</gydF4y2Baa>]。作者建议完成泌尿评价儿童呈现与肾异位。VUR相关的发病率是37%交叉异位和17%与简单的异位。不像MCDK Guarino等人指出,女孩更高年级的VUR和低分辨率率(<gydF4y2Baa href="#B39">39</gydF4y2Baa>]。针对神经源性膀胱功能障碍的发生率高,VUR(20% - -47%)肛门直肠畸形患儿也应该接受VCUG [<gydF4y2Baa href="#B45">45</gydF4y2Baa>]。</gydF4y2Bap> <h4 id="what-should-the-first-investigation-following-pyelonephritis-be:-dmsa-or-vcug?">4所示。首先应该调查后肾盂肾炎:DMSA还是VCUG ?</gydF4y2Bah4> <p>主要VUR发生在不到总人口的1%,但多达50%的孩子现在有泌尿道感染会VUR [<gydF4y2Baa href="#B46">46</gydF4y2Baa>]。因此,检测VUR是异常发现。作为疾病实体识别VUR的主要原因是其与肾盂肾炎(PN),如果复发,会导致收购皮质缺陷和随后的高血压和/或肾功能衰竭阶段结束。这认为三位一体UTI-VUR-nephropathy亲密联系推动医生积极诊断和治疗VUR过去3年。</gydF4y2Bap> <p>有一个相当大的争论关于初步调查与一些研究发热性泌尿道感染后突出的新兴角色DMSA扫描VCUG请示。这个论点的理由源于最近的证据已下调VUR的重要性作为一个长期肾损害的唯一因素。事实上,我们积极管理VUR过去几十年没有长期肾功能影响的结果。克雷格等人回顾了澳大利亚和新西兰透析和移植注册中心在1971年和1998年之间,指出,在过去的几十年里,尽管VUR更积极的识别和治疗,返流性肾病ESRD的继续保持原因大约有14%的孩子注册(<gydF4y2Baa href="#B47">47</gydF4y2Baa>]。本节讨论当前的思维过程和重新定位我们的注意力,我们的主要目标是识别导致进行性肾损害的危险因素。</gydF4y2Bap> <h5 id="subsec4.1">4.1。肾盂肾炎和收购没有VUR皮质缺陷可能发生</gydF4y2Bah5> <p>最近的研究表明,获得肾瘢痕相关最好与复发性泌尿道感染,而不是VUR和初级VUR既不充分也不必不可少的肾损害。这条规则的例外是二次回流与膀胱出口梗阻或高压神经性膀胱功能障碍有关。戈登等人进行了荟萃分析来确定的价值VUR诊断预测肾损害儿童住院治疗泌尿道感染(<gydF4y2Baa href="#B4">4</gydF4y2Baa>]。分析评估12个研究包括537名儿童与1032名肾脏和显示主要VUR是一个贫穷的儿童肾损害的预测DMSA扫描与泌尿道感染住院。积极VCUG积极DMSA扫描的几率增加了只有20%而消极VCUG负DMSA扫描的几率增加了8%。作者得出的结论是,VCUG不能用作初级筛选试验来检测肾实质损害患儿尿路感染。Taskinen和Ronnholm指出,发烧超过<gydF4y2Basvg height="11.1625" id="M4" style="vertical-align:-0.27588pt;width:30.625px;" version="1.1" viewbox="0 0 30.625 11.1625" width="30.625" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,11.1625)"> <g transform="translate(72,-63.07)"> <text transform="matrix(1,0,0,-1,-71.95,63.39)"> <tspan style="font-size: 12.50px; " x="0" y="0"> 3</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="6.2515001" y="0"> 9</gydF4y2Batspan> </text> <text transform="matrix(1,0,0,-1,-59.45,68.56)"> <tspan style="font-size: 8.75px; " x="0" y="0"> ∘</gydF4y2Batspan> </text> <text transform="matrix(1,0,0,-1,-55.89,63.39)"> <tspan style="font-size: 12.50px; " x="0" y="0"> C</gydF4y2Batspan> </text> </g> </g> </svg>,<gydF4y2Basvg height="14.1" id="M5" style="vertical-align:-2.7337pt;width:121.1375px;" version="1.1" viewbox="0 0 121.1375 14.1" width="121.1375" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,14.1)"> <g transform="translate(72,-60.72)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> C</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="8.3395014" y="0"> R</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="16.679003" y="0"> P</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="27.106504" y="0"> ></gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="39.146893" y="0"> 1</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="45.398392" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="51.649895" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="59.989395" y="0"> 米</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="69.716728" y="0"> g</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="75.968231" y="0"> /</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="79.444061" y="0"> 米</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="89.171394" y="0"> l</gydF4y2Batspan> </text> </g> </g> </svg>在泌尿道感染,蛋白尿是肾损害的预测(<gydF4y2Baa href="#B48">48</gydF4y2Baa>]。VUR的存在并没有增加DMSA扫描肾缺陷的风险。在跟踪,DMSA扫描泌尿道感染后2年,9的12个病人显示皮质缺陷的证据没有VUR有关。</gydF4y2Bap> <h5 id="subsec4.2">4.2。皮质缺陷儿童VUR预测复发性感染</gydF4y2Bah5> <p>Mingin等人回顾了记录孩子接受DMSA扫描后发热性泌尿道感染或产前HN [<gydF4y2Baa href="#B49">49</gydF4y2Baa>]。88%的孩子与异常DMSA扫描3 - 5年级VUR。51的孩子异常DMSA与3 - 5年级VUR 60%随后突破泌尿道感染。相比之下,只有6%的儿童有类似VUR品位和正常DMSA扫描开发突破感染。此外,只有5%的儿童异常DMSA扫描显示改善VUR年级在后续相比那些没有DMSA异常解析率46%,事实上只有部分归因于较低的初始等级VUR的子集。</gydF4y2Bap> <h5 id="subsec4.3">4.3。积极DMSA扫描识别重大VUR在大多数情况下</gydF4y2Bah5> <p>303年不到2岁的儿童评估VCUG和DMSA扫描后泌尿道感染的一个插曲,汉森等人发现,51%有一个异常DMSA扫描和46%以积极DMSA扫描没有证据表明VUR VCUG [<gydF4y2Baa href="#B50">50</gydF4y2Baa>]。有显著关联≥三级VUR和DMSA积极的肾损伤。正常DMSA扫描和扩张VUR只有7个孩子被发现在这项研究中,其中只有1显示一个伤痕累累肾脏跟踪。没有后续7儿童复发性泌尿道感染。作者建议DMSA可以取代VCUG作为主要评价儿童泌尿道感染。VCUGs可以选择性地执行在儿童异常DMSA VCUGs的扫描和这将减少大约一半基于这项研究的结果。同一组进行了进一步的前瞻性研究来测试这一假说(<gydF4y2Baa href="#B51">51</gydF4y2Baa>]。290年泌尿道感染的儿童在婴儿期,52 VUR扩张在27。异常DMSA扫描记录与扩张VUR 26 27个孩子。曾等人也试图回答这个问题是否正常DMSA可以先排除后需要VCUG泌尿道感染(<gydF4y2Baa href="#B52">52</gydF4y2Baa>]。在142名儿童中,只有5个孩子与正常DMSA扫描VUR(所有小于或等于2级)和没有孩子扩张回流正常DMSA扫描。表<gydF4y2Baa href="//www.newsama.com/journals/au/2008/367320/tab1/" target="_blank">1</gydF4y2Baa>总结了这些结果。</gydF4y2Bap> <div class="floats-partial-section partial-other-wrapper" data-section="tab1"> <div class="floats-partial-content fig-content-tab1"> <table class="table-group" id="tab1"> <tbody> <tr> <td> <table class="table"> <tbody> <tr> <td class="thead-hr" colspan="5"> <hr></td> </tr> <tr class="thead"> <td align="left">研究(N)</gydF4y2Batd> <td align="center">POS DMSA POS VCUG</gydF4y2Batd> <td align="center">POS DMSA NEG VCUG</gydF4y2Batd> <td align="center">NEG DMSA POS VCUG</gydF4y2Batd> <td align="center">NEG DMSA NEG VCUG</gydF4y2Batd> </tr> <tr> <td class="thead-hr" colspan="5"> <hr></td> </tr> <tr> <td align="left">汉森et al。(303)</gydF4y2Batd> <td align="center">53 (17%)</gydF4y2Batd> <td align="center">103例(34%)</gydF4y2Batd> <td align="center"> <svg height="15.0875" id="M6" 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-72t53 -177q0 -133 -65 -229.5t-171 -139.5q-79 -32 -140 -32l-5 30q109 18 185 91t101 186l-68 -36q-29 -16 -60 -16q-79 0 -129 51.5t-50 130.5q0 80 57 146.5t149 66.5zM228 602q-52 0 -78 -45.5t-26 -98.5q0 -69 36.5 -115.5t97.5 -46.5 q53 0 90 28q4 31 4 66q0 51 -9.5 95.5t-39 80.5t-75.5 36z" id="x39"></path> </g> <g transform="matrix(.017,-0,0,-.017,33.244,12.138)"> <path d="M594 629l-404 -661l-31 23l402 661zM194 635q70 0 107 -56t37 -125t-37.5 -125.5t-107.5 -56.5t-107 56.5t-37 124.5q0 70 37.5 126t107.5 56zM193 605q-28 0 -45 -29t-21.5 -59.5t-4.5 -62.5t4.5 -63t22 -60t45.5 -29q22 0 37.5 16t22 42t9 48t2.5 45q0 152 -72 152z M567 351q69 0 106 -56t37 -125t-37 -125.5t-107 -56.5t-107.5 56.5t-37.5 124.5q0 43 14.5 83t49 69.5t82.5 29.5zM566 322q-28 0 -45 -28.5t-22 -59.5t-5 -64q0 -23 3 -46t10.5 -48.5t23 -41.5t36.5 -16q28 0 45 29.5t21 59.5t4 62q0 24 -2.5 46.5t-9.5 48.5t-22 42t-37 16 z" id="x25"></path> </g> <g transform="matrix(.017,-0,0,-.017,46.095,12.138)"> <path d="M275 270q0 -296 -211 -440l-19 23q75 62 116.5 174t41.5 243t-42 243t-116 173l19 24q211 -144 211 -440z" id="x29"></path> </g> <g transform="matrix(.017,-0,0,-.017,51.977,12.138)"> <path d="M114 412q23 0 39 -16t16 -41t-16 -41.5t-40 -16.5t-39.5 16.5t-15.5 41.5t15.5 41t40.5 16zM95 130q31 0 61 -30t30 -78q0 -53 -38 -88t-92 -52l-11 30q76 32 76 85q0 26 -17.5 43.5t-44.5 23.5q-13 3 -13 24q0 19 14.5 30.5t34.5 11.5z" id="x3B"></path> </g> <g transform="matrix(.017,-0,0,-.017,58.691,12.138)"> <path d="M531 285l-474 -214v56l416 183l-416 184v56l474 -215v-50zM531 -40h-474v50h474v-50z" id="x2265"></path> </g> <g transform="matrix(.017,-0,0,-.017,73.395,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> <g transform="matrix(.017,-0,0,-.017,79.192,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> <g transform="matrix(.017,-0,0,-.017,84.988,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> </svg>VUR 7</gydF4y2Batd> <td align="center">120例(39%)</gydF4y2Batd> </tr> <tr> <td align="left">曾et al。(142)</gydF4y2Batd> <td align="center">37 (26%)</gydF4y2Batd> <td align="center">64例(45%)</gydF4y2Batd> <td align="center"> <svg height="15.0875" id="M7" style="vertical-align:-2.3205pt" version="1.1" viewbox="0 0 94.724998 15.0875" width="94.724998" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,12.138)"> <path d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8 l-26 -65h-233z" id="x35"></path> </g> <g transform="matrix(.017,-0,0,-.017,11.044,12.138)"> <path d="M300 -147l-18 -23q-106 71 -159 185.5t-53 254.5v1q0 139 53 252.5t159 186.5l18 -24q-74 -62 -115.5 -173.5t-41.5 -242.5q0 -130 41.5 -242.5t115.5 -174.5z" id="x28"></path> </g> <g transform="matrix(.017,-0,0,-.017,16.925,12.138)"> <path d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5 q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" id="x33"></path> </g> <g transform="matrix(.017,-0,0,-.017,25.085,12.138)"> <path d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" id="x2E"></path> </g> <g transform="matrix(.017,-0,0,-.017,28.96,12.138)"> <path d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8 l-26 -65h-233z" id="x35"></path> </g> <g transform="matrix(.017,-0,0,-.017,37.12,12.138)"> <path d="M594 629l-404 -661l-31 23l402 661zM194 635q70 0 107 -56t37 -125t-37.5 -125.5t-107.5 -56.5t-107 56.5t-37 124.5q0 70 37.5 126t107.5 56zM193 605q-28 0 -45 -29t-21.5 -59.5t-4.5 -62.5t4.5 -63t22 -60t45.5 -29q22 0 37.5 16t22 42t9 48t2.5 45q0 152 -72 152z M567 351q69 0 106 -56t37 -125t-37 -125.5t-107 -56.5t-107.5 56.5t-37.5 124.5q0 43 14.5 83t49 69.5t82.5 29.5zM566 322q-28 0 -45 -28.5t-22 -59.5t-5 -64q0 -23 3 -46t10.5 -48.5t23 -41.5t36.5 -16q28 0 45 29.5t21 59.5t4 62q0 24 -2.5 46.5t-9.5 48.5t-22 42t-37 16 z" id="x25"></path> </g> <g transform="matrix(.017,-0,0,-.017,49.971,12.138)"> <path d="M275 270q0 -296 -211 -440l-19 23q75 62 116.5 174t41.5 243t-42 243t-116 173l19 24q211 -144 211 -440z" id="x29"></path> </g> <g transform="matrix(.017,-0,0,-.017,55.852,12.138)"> <path d="M114 412q23 0 39 -16t16 -41t-16 -41.5t-40 -16.5t-39.5 16.5t-15.5 41.5t15.5 41t40.5 16zM95 130q31 0 61 -30t30 -78q0 -53 -38 -88t-92 -52l-11 30q76 32 76 85q0 26 -17.5 43.5t-44.5 23.5q-13 3 -13 24q0 19 14.5 30.5t34.5 11.5z" id="x3B"></path> </g> <g transform="matrix(.017,-0,0,-.017,62.567,12.138)"> <path d="M531 285l-474 -214v56l416 183l-416 184v56l474 -215v-50zM531 -40h-474v50h474v-50z" id="x2265"></path> </g> <g transform="matrix(.017,-0,0,-.017,77.271,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> <g transform="matrix(.017,-0,0,-.017,83.067,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> <g transform="matrix(.017,-0,0,-.017,88.864,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> </svg>VUR在0</gydF4y2Batd> <td align="center">36 (25%)</gydF4y2Batd> </tr> <tr> <td align="left">Preda et al。(290)</gydF4y2Batd> <td align="center">44 (15%)</gydF4y2Batd> <td align="center">105例(36%)</gydF4y2Batd> <td align="center"> <svg height="15.0875" id="M8" style="vertical-align:-2.3205pt" version="1.1" viewbox="0 0 94.724998 15.0875" width="94.724998" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <g transform="matrix(.017,-0,0,-.017,.062,12.138)"> <path d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5 t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" id="x38"></path> </g> <g transform="matrix(.017,-0,0,-.017,11.044,12.138)"> <path d="M300 -147l-18 -23q-106 71 -159 185.5t-53 254.5v1q0 139 53 252.5t159 186.5l18 -24q-74 -62 -115.5 -173.5t-41.5 -242.5q0 -130 41.5 -242.5t115.5 -174.5z" id="x28"></path> </g> <g transform="matrix(.017,-0,0,-.017,16.925,12.138)"> <path d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" id="x32"></path> </g> <g transform="matrix(.017,-0,0,-.017,25.085,12.138)"> <path d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z" id="x2E"></path> </g> <g transform="matrix(.017,-0,0,-.017,28.96,12.138)"> <path d="M447 623l8 -12l-283 -613l-74 -10l-7 11q174 283 297 551h-216q-48 0 -62.5 -12t-33.5 -63h-29q10 60 18 148h382z" id="x37"></path> </g> <g transform="matrix(.017,-0,0,-.017,37.12,12.138)"> <path d="M594 629l-404 -661l-31 23l402 661zM194 635q70 0 107 -56t37 -125t-37.5 -125.5t-107.5 -56.5t-107 56.5t-37 124.5q0 70 37.5 126t107.5 56zM193 605q-28 0 -45 -29t-21.5 -59.5t-4.5 -62.5t4.5 -63t22 -60t45.5 -29q22 0 37.5 16t22 42t9 48t2.5 45q0 152 -72 152z M567 351q69 0 106 -56t37 -125t-37 -125.5t-107 -56.5t-107.5 56.5t-37.5 124.5q0 43 14.5 83t49 69.5t82.5 29.5zM566 322q-28 0 -45 -28.5t-22 -59.5t-5 -64q0 -23 3 -46t10.5 -48.5t23 -41.5t36.5 -16q28 0 45 29.5t21 59.5t4 62q0 24 -2.5 46.5t-9.5 48.5t-22 42t-37 16 z" id="x25"></path> </g> <g transform="matrix(.017,-0,0,-.017,49.971,12.138)"> <path d="M275 270q0 -296 -211 -440l-19 23q75 62 116.5 174t41.5 243t-42 243t-116 173l19 24q211 -144 211 -440z" id="x29"></path> </g> <g transform="matrix(.017,-0,0,-.017,55.852,12.138)"> <path d="M114 412q23 0 39 -16t16 -41t-16 -41.5t-40 -16.5t-39.5 16.5t-15.5 41.5t15.5 41t40.5 16zM95 130q31 0 61 -30t30 -78q0 -53 -38 -88t-92 -52l-11 30q76 32 76 85q0 26 -17.5 43.5t-44.5 23.5q-13 3 -13 24q0 19 14.5 30.5t34.5 11.5z" id="x3B"></path> </g> <g transform="matrix(.017,-0,0,-.017,62.567,12.138)"> <path d="M531 285l-474 -214v56l416 183l-416 184v56l474 -215v-50zM531 -40h-474v50h474v-50z" id="x2265"></path> </g> <g transform="matrix(.017,-0,0,-.017,77.271,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> <g transform="matrix(.017,-0,0,-.017,83.067,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> <g transform="matrix(.017,-0,0,-.017,88.864,12.138)"> <path d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" id="x49"></path> </g> </svg>VUR 1</gydF4y2Batd> <td align="center">133例(46%)</gydF4y2Batd> </tr> <tr class="table-tr"> <td colspan="5"> <hr class="tbody-hr"></td> </tr> </tbody> </table></td> </tr> </tbody> </table> </div> <div class="floats-partial-footer"> <div class="floats-partial-caption"> <span class="caption-text">表1</gydF4y2Baspan> <a aria-label="full view" class="caption-partial-url" href="//www.newsama.com/journals/au/2008/367320/tab1/" title="" target="_blank"></a> </div> <div class="floats-partial-caption-text"> 研究结果分析DMSA与VCUG结果相一致。</gydF4y2Badiv> </div> </div> <h5 id="subsec4.4">4.4。抗生素预防并不能防止复发与低级VUR泌尿道感染的儿童</gydF4y2Bah5> <p>VUR的角色,尤其是低年级,复发性泌尿道感染的诱发因素也是有争议的。Nuutinen和Uhari指出较高的复发性尿路孩子年级III-V VUR与年级的孩子相比i ii VUR [<gydF4y2Baa href="#B53">53</gydF4y2Baa>]。现在认为,复发性泌尿道感染的易感性是更多的相关缺陷移行细胞防御机制和膀胱功能障碍而不是VUR有关。Roussey-Kessler等人进行了一项前瞻性研究1 - 3年级的孩子VUR随机接受复方磺胺甲恶唑或没有治疗泌尿道感染在跟踪作为一个终点<gydF4y2Baa href="#B3">3</gydF4y2Baa>]。没有显著差异在两组除了泌尿道感染的发生与三年级男孩VUR (<gydF4y2Basvg height="10.9125" id="M9" style="vertical-align:-0.17555pt;width:48.337502px;" version="1.1" viewbox="0 0 48.337502 10.9125" width="48.337502" xmlns="http://www.w3.org/2000/svg"> <g transform="matrix(1.25,0,0,-1.25,0,10.9125)"> <g transform="translate(72,-63.27)"> <text transform="matrix(1,0,0,-1,-71.95,63.5)"> <tspan style="font-size: 12.50px; " x="0" y="0"> </gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="10.890113" y="0"> =</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="22.930502" y="0"> 。</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="26.056252" y="0"> 0</gydF4y2Batspan> <tspan style="font-size: 12.50px; " x="32.307751" y="0"> 4</gydF4y2Batspan> </text> </g> </g> </svg>)。加林等人进行了一个随机前瞻性试验的218名儿童有或没有VUR面对PN,比较没有预防(预防<gydF4y2Baa href="#B2">2</gydF4y2Baa>]。这项研究只包括年级》VUR患者。被发现在组没有明显的统计学差异对复发性泌尿道感染,复发,随后的肾盂肾炎,肾实质和发展伤疤。整体的PN在这项研究中为5.5%,复发率VUR没有增加PN的可能性。作者得出结论,1年的观察,年级》VUR没有增加泌尿道感染的发病率,PN或皮质的缺陷。康威等人提出了对611名儿童进行了比较分析与确定第一个泌尿道感染抗生素预防和泌尿道感染和复发之间的关系来确定风险因素电阻(<gydF4y2Baa href="#B54">54</gydF4y2Baa>]。与复发性泌尿道感染的风险增加相关的因素在这个研究是白人种族、年龄在3 - 5年,年级IV-V VUR。性别和年级》VUR并不与复发的风险。此外,抗生素预防并不是与降低复发风险相关泌尿道感染在多变量分析中,但抗生素耐药性的危险因素与儿童复发性尿路感染。</gydF4y2Bap> <p>口译研究试图阐明这方面的问题是缺乏标准化的定义发热性泌尿道感染和可变性的方法获取尿液样本。正在进行的随机干预儿童vesicoureteric回流(RIVUR)的研究是一个多中心、双盲、随机、安慰剂对照试验旨在回答这个正在进行的争论关于抗生素预防的作用在预防复发性发热/有症状的泌尿道感染患儿VUR诊断泌尿道感染。</gydF4y2Bap> <p>总而言之:<gydF4y2Baspan class="list"><span class="list-item"><span class="list-label">(1)</gydF4y2Baspan><span class="list-content">看到一个儿童泌尿道感染,50%的儿童可能上尿路损害的证据,没有证据表明VUR VCUG;</gydF4y2Baspan></span><span class="list-item"><span class="list-label">(2)</gydF4y2Baspan><span class="list-content">自发的儿童VUR更高的分辨率和低级VUR正常DMSA扫描;</gydF4y2Baspan></span><span class="list-item"><span class="list-label">(3)</gydF4y2Baspan><span class="list-content">积极DMSA扫描在诊断预测较高的复发性泌尿道感染或突破VUR儿童感染;</gydF4y2Baspan></span><span class="list-item"><span class="list-label">(4)</gydF4y2Baspan><span class="list-content">ESRD VUR识别并没有改变了速度与返流性肾病有关。</gydF4y2Baspan></span></span>这些研究背后的理念是鼓励更有选择性的方法与第一个泌尿道感染调查孩子礼物,相反AAP实践指南。DMSA将初步调查和所有儿童异常DMSA VCUG将继续。这将把大部分孩子和扩张/重大VUR谁将受益于抗生素预防,从而减少VCUGs的数量和抗生素预防儿童的数量。这样一个有选择性的方法是合理的和男孩的反对意见是,一个潜在的后尿道瓣膜呈现在新生儿期可能错过了使用这种方法。然而,这可能是不可能如果美国一项研究是同时执行作为日常工作的一部分。</gydF4y2Bap> <h5 id="subsec4.5">4.5。尿路造影术先生(系统)</gydF4y2Bah5> <p>系统越来越被提倡是一个成像,可用于提供信息获得VCUG和DMSA扫描。系统的主要优点是能够区分肾发育不良(先天性皮质)和获得疤痕(获得皮质缺陷)[<gydF4y2Baa href="#B55">55</gydF4y2Baa>]。除了形态分析,系统可以提供关于肾灌注信息,浓度,对比媒体通过计算肾的排泄和calyceal交通时间。Patlak微分函数和计算Patlak数量每毫升的肾组织被认为是一个单一肾元代理肾小球滤过率(GFR),因此可以作为未来的一个重要工具和肾发育不良的孩子。</gydF4y2Bap> <h4 id="followup-imaging-for-vur">5。跟踪成像为VUR</gydF4y2Bah4> <p>和(低至合理可行的)概念强调的重要性减少辐射暴露在儿童被跟踪后保守VUR诊断(<gydF4y2Baa href="#B5">5</gydF4y2Baa>]。汤普森等人设计了一个理论模型来研究这个和儿童进行了一项回顾性研究主要VUR诊断泌尿道感染后评估不同的跟踪策略及其对抗生素暴露和成本的影响(<gydF4y2Baa href="#B56">56</gydF4y2Baa>]。作者建议,儿童有轻度VUR每2年进行VCUG而患有中度到重度VUR应该经历一次VCUG每3年。的一项调查显示美国儿科协会的成员出版于2001年,有99%的受访者表示,他们将执行VCUG或共和党全国委员会每12 - 18个月在跟踪<gydF4y2Baa href="#B57">57</gydF4y2Baa>]。当前的后续协议应该致力于减少VCUG /共和党全国委员会执行在儿童抗生素预防基础VUR的自然衰变曲线分辨率。接受的是,所有的后续跟踪研究VCUG应该是共和党全国委员会。</gydF4y2Bap> <h5 id="subsec5.1">5.1。因素识别预测VUR分辨率成像</gydF4y2Bah5> <p>持久性高档VUR VUR更有可能,在两国的儿童疾病(尤其是年级IV和V)和回流诊断时年龄的孩子。VCUG的价值和共和党全国委员会预测VUR分辨率进行了研究。已经证明,当VUR发生在不到60%的预期膀胱的容量和回流卷膀胱容量的2%以上,分辨率很差(<gydF4y2Baa href="#B58">58</gydF4y2Baa>,<gydF4y2Baa href="#B59">59</gydF4y2Baa>]。努森等人在最初的多变量分析指出,膀胱容量膀胱照片预测膀胱容量大于50%,小于2岁诊断,产前肾盂积水严重的历史因素预测VUR决议2年内(<gydF4y2Baa href="#B35">35</gydF4y2Baa>]。</gydF4y2Bap> <h4 id="conclusion">6。结论</gydF4y2Bah4> <p>VUR是一种异质的障碍,其诊断和管理继续保持小儿泌尿外科中最具争议的问题之一。有一个实现,而不是一种疾病实体,VUR总体上尿路功能障碍的一个标志,这可能引起尿路感染。治疗的主要目标医生应该继续保护肾功能,防止肾获得缺陷的相对较小的比例与VUR有关。有范式转变的诚挚的诊断VUR追求基于越来越多的证据表明,收购了肾缺陷往往VUR无关,我们当前的模式诊断VUR与不可接受的辐射和膀胱导管插入术相关联。新模式做进一步承诺但工作之前保证他们可以取代现有的成熟的技术。</gydF4y2Bap> </div> <div class="xml-content"> <h4 class="references" id="references">引用</gydF4y2Bah4> <ol> <li id="B1">g·j·威廉姆斯,l ., a·李和j·c·克雷格”长期抗生素对预防复发性尿路感染孩子,“Cochrane系统评价的数据库,没有。第三条ID CD001534, 2006。<gydF4y2Baspan class="reflinks">视图:<gydF4y2Baa href="https://doi.org/10.1002/14651858.CD001534.pub2">出版商的网站</gydF4y2Baa><span 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Duckett et al .,“直接膀胱输尿管的闪烁扫描法:量化早期结果预测儿童主要的回流,”的核医学杂志上,35卷,没有。10日,1602 - 1608年,1994页。<gydF4y2Baspan class="reflinks">视图:<gydF4y2Baa href="https://scholar.google.com/scholar_lookup?title=Direct%20vesicoureteral%20scintigraphy:%20quantifying%20early%20outcome%20predictors%20in%20children%20with%20primary%20reflux&author=P. D. Mozley&author=S. Heyman&author=J. W. Duckett et al.&publication_year=1994" target="_blank">谷歌学术搜索</gydF4y2Baa></span></li> <li id="B59">z . m .麦克米兰j·c·奥斯汀·m·j·努森c . e . Hawtrey和c·s·库珀,“膀胱体积在最初出现回流膀胱照片预测自发的决议,“泌尿外科杂志》,176卷,没有。4,补充1,第1841 - 1838页,2006年。<gydF4y2Baspan class="reflinks">视图:<gydF4y2Baa href="https://doi.org/10.1016/S0022-5347(06)00619-7">出版商的网站</gydF4y2Baa><span class="sep">|</gydF4y2Baspan><a href="https://scholar.google.com/scholar_lookup?title=Bladder%20volume%20at%20onset%20of%20reflux%20on%20initial%20cystogram%20predicts%20spontaneous%20resolution&author=Z. M. McMillan&author=J. C. Austin&author=M. J. Knudson&author=C. E. Hawtrey&author=&author=C. S. Cooper&publication_year=2006" target="_blank">谷歌学术搜索</gydF4y2Baa></span></li> </ol> </div> <div class="xml-content"> <h4 class="copyright" id="copyright">版权</gydF4y2Bah4> <p>版权©2008苏米特戴夫和安东尼·e·库利。这是一个开放的分布式下文章<gydF4y2Baa rel="license" href="http://creativecommons.org/licenses/by/3.0/">知识共享归属许可</gydF4y2Baa>,它允许无限制的使用、分配和复制在任何媒介,提供最初的工作是正确引用。</gydF4y2Bap> </div> </div> </article> </div> </div> </div> <div class="biblio__Wrapper-sc-1nou1lz-0 eyHfWh journal_article__BiblioIntegratorWidget-sc-12fk6zy-5 dbAANp article_widget biblioWrapper hide"> <hr> <h4 class="biblio__H4-sc-1nou1lz-2 becpDt hrTitleRef">更多相关文章</gydF4y2Bah4> <div id="biblio_widget" class="biblio__BiblioWrapper-sc-1nou1lz-1 jIyXzI"></div> </div> </div> </div> <div class="threeColumn__RightWrapper-sc-1bf4078-2 jzTMLK rightWrapper" id="rightSectionMenu"> <div> <div class="journal_article__ArticleStickyTopToolbar-sc-12fk6zy-0 gbrQxi article_sticky_top_toolbar"> <div class="sc-cBdUnI hRnXob article_top_toolbar"> <a class="sc-htpNat bUhGXt link sc-jtRfpW dIjoCg sc-exkUMo hymroZ pdf_desktop button__group" href="https://downloads.hindawi.com/journals/au/2008/367320.pdf" aria-label="" target="_blank" id="toolbar__dcNavSmall"><span><img alt="" class="sc-EHOje jOLhQl sc-kTUwUJ eujois" title="" role="presentation" src="https://static-01.hindawi.com/next_assets/hKR0fxuUbT8vhlyZA-b1u/_next/static/node_modules/hindawi-ui/src/icon/svg/pdf.svg" height="24"><span class="text">PDF</gydF4y2Baspan></span><span class="sc-htoDjs bqeMOy sc-dqBHgY cQgXqt fileArrow icon-colored _3P4iUn1NDM5G77nWCamJ4l icon-themeable" title="" font-size="20"></span></a> <a class="sc-htpNat bUhGXt link sc-jtRfpW dIjoCg sc-kcDeIU cbcyj ref_desktop" href="//www.newsama.com/journals/au/2008/367320.ris" aria-label="" target="" id="toolbar__dcNavLarge"><span><img alt="" class="sc-EHOje jOLhQl sc-kTUwUJ eujois" title="" role="presentation" 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height="24"><span class="text">下载引用</gydF4y2Baspan></span><span class="sc-htoDjs bqeMOy sc-dqBHgY cQgXqt fileArrow icon-colored _3P4iUn1NDM5G77nWCamJ4l icon-themeable" title="" font-size="20"></span></a> <a class="sc-htpNat bUhGXt link sc-jtRfpW dIjoCg sc-BngTV hmDWcT ref_desktop" href="//www.newsama.com/journals/au/2008/367320.ris" aria-label="" target="" id="toolbar__dcNavSmall"><span><img alt="" class="sc-EHOje jOLhQl sc-kTUwUJ eujois" title="" role="presentation" src="data:image/svg+xml;base64,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" height="24"><span class="text">引用</gydF4y2Baspan></span><span class="sc-htoDjs bqeMOy sc-dqBHgY cQgXqt fileArrow icon-colored _3P4iUn1NDM5G77nWCamJ4l icon-themeable" title="" font-size="20"></span></a> </div> </div> <div class="journal_article__ArticleStickyBottomToolbar-sc-12fk6zy-1 isgRZA article_sticky_bottom_toolbar"> <div class="sc-cTjmhe ihmyEq article_bottom_toolbar"> <div class="sc-cugefK itFKcQ accordion" property="background-color" color="#D8D8D8" id="toolbar__dofNav"> <span><img alt="" class="sc-EHOje jOLhQl sc-bfYoXt cGuwDn" title="" role="presentation" 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height="24"><span class="sc-dRFtgE jrsDZP">下载其他格式</gydF4y2Baspan><span class="sc-gkFcWv gWTCXQ">更多的</gydF4y2Baspan></span> <span class="sc-htoDjs bMdQcY sc-gbOuXE jGPvPL icon-colored _1CwL9R82TPl2HxDleeYGDR icon-themeable" title="" font-size="11"></span> </div> <div class="sc-fnwBNb etzuBr"> <a class="sc-htpNat bUhGXt link sc-iNhVCk gWgCNb open_panel" href="//www.newsama.com/downloads/journals/au/2008/367320.xml" aria-label="XML" property="background-color" color="#D8D8D8"> <div class="sc-eAKXzc WHkfb"> XML</gydF4y2Badiv><img alt="" class="sc-EHOje jOLhQl sc-bfYoXt cGuwDn" title="" role="presentation" 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height="24"><span class="sc-dRFtgE jrsDZP">订单打印副本</gydF4y2Baspan><span class="sc-gkFcWv gWTCXQ">订单</gydF4y2Baspan></span><span class="sc-htoDjs kNoiZu sc-gbOuXE jGPvPL right__icon icon-colored _32KP5uexH-Bgs7Kj8Gk1Tz icon-themeable" title="" font-size="16"></span></a> <div class="sc-hBbWxd kdRRST"> <div class="sc-dyGzUR cHatnS"> <div> 的观点<gydF4y2Baspan>1456年</gydF4y2Baspan> </div> <div> 下载<gydF4y2Baspan>574年</gydF4y2Baspan> </div> </div> <div> <div class="sc-drKuOJ kxdGAZ"> <span class="__dimensions_badge_embed__" data-doi="10.1155/2008/367320" data-style="small_circle"></span>引用</gydF4y2Badiv> </div> </div> <nav class="sc-bRBYWo fXBKFa sc-hUfwpO jHPgUP" id="toolbar__iconNav"> <h3 class="sc-Rmtcm hNPrIr">分享文章</gydF4y2Bah3> <ul class="sc-hzDkRC bnbfTS"> <li class="iconBorder"><a class="sc-htpNat bUhGXt link" href="https://twitter.com/share?url=https://doi.org/10.1155/2008/367320&via=Hindawi" aria-label="Sharing on Twitter" rel="noopener noreferrer" target="_blank"><img alt="" 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