三维超声体积自动测量技术定量评估肾积水患儿残余肾功能的价值

Quantitative evaluation of residual renal function in children with hydronephrosis by automatic measurement of three-dimensional ultrasound volume

目的研究讨论三维超声体积自动测量(VOCAL)技术定量评估评估患儿残余肾功能(RRF)的应用价值。方法选取2016年7月至2018年9月在本院接受治疗的68例肾积水患儿(单侧)为主要研究对象,采用VOCAL检测患儿的肾功能指标,包括患侧肾积水(HV)、肾容积(RV)、肾实质容积(RPV),并得出肾积水容积比率(HVR);然后通过肾动态显像检测肾小球滤过率(GFR),Pearson相关性分析HVR与GFR的相关性,ROC曲线分析HVR对GFR的诊断价值。结果三维超声共检出1级肾积水7例,2级肾积水23例,3级肾积水28例,4级肾积水10例;患儿的HVR随着肾积水程度加深,呈逐级升高的趋势,组间差异有统计学意义(P<0.01);3、4级患儿RV显著高于1、2级,而RPV、GFR则显著低于1、2级,差异有统计学意义(均P<0.01);Pearson相关性分析结果显示:RPV与GFR呈正相关(P<0.01),HVR与GFR呈明显负相关(P<0.01);HVR诊断GFR的曲线下面积(AUC)为0.855,诊断特异度为79.10%,敏感度为87.50%。结论VOCAL技术可动态评估肾积水患儿的RRF功能,具有一定的临床应用前景。

Objective To evaluate the clinical value of three dimensional ultrasound volume automatic measurement (VOCAL) in evaluating residual renal function (RRF) in children with hydronephrosis. Methods Sixty-eight children with hydronephrosis (unilateral) who were treated at our hospital from July, 2016 to September, 2018 were selected as study objects. VOCAL was used to measure the children’s renal function, including hydronephrosis (HV), renal volume (RV), renal parenchymal volume (RPV), and volume ratio of hydronephrosis (HVR). The glomerular filtration rate (GFR) was detected by dynamic renal imaging. Pearson correlation analysis was used to analyzed the relationship between HVR and GFR. ROC curve was used to analyze the value of HVR in the diagnosis of GFR. Results Three-dimensional ultrasound detected 7 cases of grade 1 hydronephrosis, 23 grade 2, 28 grade 3, and 10 grade 4. The children’s HVR increased with hydronephrosis, with statistical difference between each two of the groups (P < 0.01). The RV was significantly higher and the RPV and GFR were significantly lower in the children with grade 3 and 4 hydronephrosis than in those with grade 1 and 2, with statistical differences (all P < 0.01). The results of Pearson correlation analysis showed that there was a positive correlation between RPV and GFR (P < 0.01), and a negative correlation between RPV and GFR (P < 0.01).The area under the curve of HVR for the diagnosis of GFR was 0.855, the diagnostic specificity was 79.10%, and the sensitivity was 87.50%. Conclusion VOCAL technique can dynamically evaluate the function of RRF in children with hydronephrosis.