Razi Journal of Medical Sciences

fa ارزش تشخیصی حجم متوسط پلاکتی (MPV) در افتراق پیلونفریت از سیستیت حاد در کودکان مبتلا به عفونت ادراری Diagnostic Value of Mean Platelet Volume (MPV) in Differentiating Pyelonephritis from Acute Cystitis in Children with Urinary Tract Infection عفونی اطفال Pediatric Infectious پژوهشي Research <div style="text-align: justify;">زمینه و هدف: عفونت ادراری یکی از شایع‌ترین عفونت‌ها در کودکان می‌باشد که می‌تواند مجاری ادراری تحتانی یا فوقانی را درگیر کند. حدود 30- 10 درصد کودکان در اولین سال‌های زندگی، عفونت ادراری را تجربه میکنند. حجم متوسط پلاکتی (Mean platelet volume -MPV) یک شاخص مهم در تعیین التهاب است. هدف از انجام این مطالعه، بررسی ارزش تشخیصی MPV در افتراق پیلونفریت از سیستیت حاد در کودکان مبتلا به عفونت ادراری بوده است. روش  کار: در این مطالعه توصیفی-مقطعی، تحلیلی و تشخیصی، 141 کودک (یک ماه الی 18 سال) مبتلا به عفونت مجاری ادراری بستری در بیمارستان کودکان امیرکلا، بابل مورد بررسی قرار گرفتند و میزان MPV بین پیلونفریت (90 نف) و سیستیت (51 نفر) مقایسه شد. همچنین میزان ارزش تشخیصی MPV با استفاده از شاخصهای آماری اختصاصیت و سطح زیر منحنی محاسبه گردید و یافته‌های حاصله مورد آنالیز آماری قرار گرفت و (05/0  P<) معنی دار تلقی شد. یافته‌ها: میانگین MPV در گروه پیلونفریت 7/8 فمتولیتر و در گروه سیستیت 5/8 فمتولیتر بود که نشان می‌داد اختلاف آماری معناداری بین دو گروه پیلونفریت و سیستیت وجود نداشت (329/0 = P). میزان MPV، در 6/55 درصد  در گروه پیلونفریت و 1/43 درصد در گروه سیستیت بالا بود که اختلاف آماری معناداری را نشان نمی‌داد (157/0 = P).  بر اساس آنالیز ROC سطح زیر منحنی MPV برای پیلونفریت 563/0و برای سیستیت 416/0 بود، که برای پیلونفریت یالاتر بوده و با در نظر گرفتن نقطه برش 6/8 فمتولیتر دارای حساسیت و ویژگی 7/56 درصد و 9/52 درصد بود. نتیجه‌گیری: هدف از انجام این مطالعه بررسی نقش MPV به منظور افتراق پیلونفریت از سیستیت حاد انجام شد. بر این اساس، حجم متوسط پلاکتی ارزش تشخیصی نسبتاً پایینی در افتراق پیلونفریت از سیستیت حاد در میان کودکان مبتلا به عفونت ادراری دارد. </div> <div style="text-align: justify;">Background & Aims: Urinary tract infections (UTIs) are among the most common bacterial and frequently recurring infection during childhood, especially in the ages of three months that can involve upper UTI (pyelonephritis) and lower UTI (cystitis). There are three forms of urinary tract infections include pyelonephritis, cystitis and bacteriuria without symptoms.  Approximately 10-30% of children experience a urinary tract infection in the early years of life. The prevalence of UTI has estimated 36.8% in some third world countries. Enterobacteriacea, especially Escherichia coli has been detected as the most common cause of UTI. The crucial criteria to diagnose of UTI are including: fever, pyuria, the growth of organism more than 105  colonies in culture medium. Nowadays, antibiotic resistance is a global concerning among pediatric patient with UTI. The other important issues are including, urine reflection and scar in the lining of the kidney tissue, failure in growth and function of kidney, chronic of kidney and eventually kidney graft and dialysis. So fast diagnostic and treatment of these patients to prevent of development is so important. Although DMSA scanning is a gold standard to detect of renal parenchymal tissue involvement but due to high cost, no accessible in all of the clinical centers and exposure to dangerous chemical substances of radioactive, it is used less. Some clinical symptoms, such as fever, stomachache, backache, nausea, anorexia and inflammatory markers such as white blood cell (WBC), Erythrocyte sedimentation rate (ESR),C_ Reactive Protein (CRP ) can be handy methods to detect of the site of urinary infectious, but it is not reliable method. So there is not a practical, fast and reliable method to separate of pyelonephritis and cystitis. Pyelonephritis can lead to scar and the next stages high blood pressure and kidney failure. The prevalence of kidney scars due to pyelonephritis had reported 26.5% to 49%.  Mean platelet volume (MPV) is an important index in detection of inflammatory. The aim of this study was to investigate the value of MPV in differentiation of pyelonephritis from cystitis in children with UTI. Methods: In this analytical cross- sectional and diagnostic study which was approved by the Ethics Committee of Babol University of Medical Sciences, Babol, Iran, with the ethics code IR. MUBABOL1724132572, a total of 141 children (1 month to 18 years) with urinary tract infections hospitalized in pediatric Hospital of Amirkola, Babol were enrolled from 2015 to 2020. Inclusion criteria including positive urine culture and exclusion criteria including negative urine culture, lack of diagnosis of pyelonephritis and cystitis, lack of cooperative of patients and the history of blood disorder associated with abnormal platelets (Bernard-Soulier syndrome, gene mutation myh9, ITP). Considering the inclusion and exclusion criteria, diagnosis of pyelonephritis and the result of positive culture, patients enrolled to this study. And then, whole blood specimens from patients were collected to detect of MPV, CRP, and ESR. According to traditional guidelines, chocolate/ blood agar (non selective medium) used for routine urine cultures. MPV was investigated and compared between patients with pyelonephritis and cystitis. Diagnostic value of MPV by statistical indicators specificity, sensitivity and AUC were calculated and finally statistical analysis of data was carried out using the SPSS (v 16.0) software package.The statistical tests, such as chi- square test, independent t- test, Mann withney, Spearman rank correlation, ROC and Kolmogorov-Smirnov were used in this study. P-Value less than 0.05 were assumed as statistical significance. MPV was evaluated in patients with pyelonephritis and cystitis by independent t- test. Correlation analytical was used to detect of relationship between MPV, ESR, CRP and leucocytes among two groups of pyelonephritis and cystitis. ROC (Receiver Operating Characteristics Curve) was used to evaluate and comparison of sensitivity, specificity and the area under the curve for the MPV in patients with pyelonephritis and cystitis. Results: Among 141 patients with UTI, 63.8% with pyelonephritis and 36.2% with cystitis enrolled in this study. MPV in patients with reflux was detected 8.67± 0.95 fl and in patients without reflux was detected 8.66± 0.99 fl. This finding was no statistically significant difference between MPV and reflux (P= 0.96). In this study, according to two groups of patients with pyelonephritis and cystitis the frequency of bacteria was investigated. The most common pathogen among both groups of patients was detected Escherichia coli. There was no statistically significant between type of pathogen among two groups ( P= 0.167).  The result of laboratory variables investigation in both groups of pyelonephritis and cystitis were detected 8.7 fl and 8.5 fl, respectively. There was no statistically significant difference between two groups (P= 0.329). Although there was no statistically significant difference in platelet count (P= 0.374), leucocyte (P= 0.115) and lymphocyte (P= 0.073), but we found statistically significant differences in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) between two groups, (P= 0.001). MPV comparison results between two groups (pyelonephritis and cystitis) showed there was no statistically significant difference between two groups.  There was no statistically significant between MPV and ESR, CRP and leucocyte, (P> 0.05). Conclusion: According to the result of our study, the role of MPV in differentiating pyelonephritis from acute cystitis was detected. The evidence of this study showed MPV has low diagnostic value in differentiating pyelonephritis from acute cystitis in children with UTI.  So, detection of Mean platelet volume is not an appropriate method and it needs to more studies to find Para clinical factor in diagnostic is worth wealthy.  </div> کودکان, حجم متوسط پلاکتی, عفونت ادراری, سیستیت, پیلونفریت Children, Mean Platelet Volume, Urinary tract infection, Cystitis, Pyelonephritis 24 32 http://rjms.iums.ac.ir/browse.php?a_code=A-10-3232-3&slc_lang=fa&sid=1 Hadi Sorkhi هادی سرخی 3900319475328460070150 3900319475328460070150 No MD, Professor of Pediatric Nephrology, Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran استاد نفرولوژی کودکان، مرکز تحقیقات بیماری‌های غیرواگیر کودک، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Atefeh Nikkhah عاطفه نیکخواه 3900319475328460070151 3900319475328460070151 No MD, Student Research Committee, Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran کمیته تحقیقات دانشجویی، مرکز تحقیقات بیماری‌های غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Parisa Ebrahimazdehmojaveri پریسا ابراهیم زاده مجاوری 3900319475328460070152 3900319475328460070152 No MSc in Microbiolody, Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran کارشناسی ارشد میکروبیولوژی، مرکز تحقیقات بیماری‌های غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Mahmood Hajiahmadi محمود حاجی احمدی 3900319475328460070153 3900319475328460070153 No PhD, Assistant Professor of Biostatistics , Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran استادیار آمار زیستی، مرکز تحقیقات بیماری‌های غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Mohsen Mohammadi محسن محمدی dr.mohamadi61@yahoo.com 3900319475328460070154 3900319475328460070154 Yes MD, Assistant Professor of Pediatric Infectious Disease, Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran استادیار بیماری‌های عفونی کودکان، مرکز تحقیقات بیماری‌های غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Hasan Mahmoodi Nesheli حسن محمودی نشلی 3900319475328460070155 3900319475328460070155 No MD, Associate Professor of Pediatric Hematology and Oncology , Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran دانشیار خون و سرطان کودکان، مرکز تحقیقات بیماری‌های غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران