基于泌尿系统扩张分级系统对影响胎儿肾积水转归的多因素分析

Multivariate analysis of outcome of fetal hydronephrosis based on the grading system of prenatal and postnatal urinary tract dilation

目的评估泌尿系统扩张(UTD)分级系统作为新的胎儿肾积水分级系统的可靠性和有效性,分析影响胎儿肾积水预后的风险因素。方法回顾性分析2016年1月至7月在四川省医学科学院·四川省人民医院门诊诊断的胎儿肾积水患者的超声检查资料。对所有纳入研究的肾使用UTD分级系统重新划分级别。随访入组患儿的临床转归,以出现手术指征而接受手术治疗或未接受手术治疗但年龄满2周岁为观察终点。评估UTD分级系统预测胎儿肾积水在胎儿出生2年内接受需外科干预风险的有效性。单因素和多因素分析可能影响胎儿肾积水预后的风险因素。结果共有94例患儿(136只肾)纳入观察。在观察期内,43只肾出现临床手术指征而接受手术干预,余93只肾在观察期结束之前未手术。对孕中期发现的胎儿肾积水超声结果按照UTD分级系统分级后UTD A1级51只,其中观察期内接受手术7只(13.73%);UTD A2-3级74只,其中观察期内接受手术治疗35只(47.30%)。孕晚期UTD A1级54只,其中观察期内接受手术3只(5.56%);UTD A2-3级82只,其中观察期内接受手术40只(48.78%)。多因素分析显示,32周前肾实质厚度变薄和孕晚期UTD A2-3级是胎儿肾积水出生后需手术治疗的危险因素。结论UTD分级系统对于评价胎儿期肾积水较可靠。孕晚期UTD A2-3级、孕32周前超声检查发现肾实质变薄是肾积水胎儿出生2年内需接受手术治疗的风险因素。基于UTD分级系统的胎儿肾积水数据分析及规范随访可有效管控胎儿肾积水风险。

Objective To assess the reliability and validity of the Urinary Tract Dilation (UTD) classification system as a new grading system for fetal hydronephrosis, and analyze the risk factors for prognosis of fetal hydronephrosis. Methods The data of patients who presented with fetal hydronephrosis from January to July 2016 at Sichuan Aca-demy of Medical Sciences & Sichuan Provincial People′s Hospital were retrospectively reviewed.The outcome of the patients who were treated with surgery or without surgical treatment was recorded if they were older than 2 years old.All renal nephrons were regraded if UTD classification system had been used for antenatal hydronephrosis assessment reliability previously.Univariate and multivariate analysis was performed to analyze the risk factors for prognosis of fetal hydronephrosis. Results A total of 94 patients (136 renal nephrons) were eligible for enrollment.During the observation period, 43 kidneys received surgery which had clinical indications for surgery, and the remaining 93 kidneys without surgery were stable until the end of the observation period.Ultrasound finding of fetal hydronephrosis in the second trimester were graded according to UTD grading system.Among the 51 kidneys with UTD A1, 7 kidneys (13.73%) received surgery during the observation period, and 35 kidneys (47.30%) received surgery during the observation period among 74 kidneys with UTD A2-3.In the third trimester of pregnancy, among 54 kidneys with UTD A1, 3 kidneys (5.56%) were operated during the observation period, and among 82 kidneys with UTD A2-3, 40 kidneys (48.78%) were operated during the observation period.Multivariate analysis revealed that parenchymal thickness before 32 weeks and UTD classification system during the third trimester of pregnancy were risk factors for fetal hydronephrosis which required surgical treatment after birth. Conclusions The UTD classification system is reliable for the evaluation of fetal hydronephrosis and is valid in predicting surgical intervention.Parenchymal thickness before 32 weeks and grading UTD A2-3 after 32 weeks is a risk factor for postnatal surgery.Analysis of fetal hydronephrosis data based on UTD grading system and standardized follow-up are helpful to control the risk of fetal hydronephrosis effectively.