多参数超声评分法在胎儿肾积水产前诊断及预后评估中的应用研究

Application of multi-parameter ultrasound scoring in prenatal diagnosis and prognosis assessment of fetal hydronephrosis

目的探讨多参数超声评分法(MPUS)在胎儿肾积水产前诊断及预后评估中的应用价值。方法选取2017年4月至2019年3月在我院行产前B超检查胎儿肾盂积水的孕产妇116例,采取四维彩色超声诊断检查,记录肾盂前后径(APD)、肾实质厚度(RPT)、肾动脉血流阻力指数(RI),根据肾积水轻重程度赋值0~3分,统计APD、RPT、RI三参数MPUS。比较病理性肾积水与生理性肾积水APD、RPT、RI、MPUS值,分析APD、RPT、RI、MPUS对胎儿肾积水诊断效能。结果116例肾积水胎儿中共133只肾积水,其中生理性肾积水104只,病理性肾积水29只。病理性肾积水组APD、RI、MPUS高于生理性肾积水组,RPT低于生理性肾积水组(P<0.05)。MPUS诊断胎儿肾积水特异度(97.12%)、准确度(96.24%)高于APD、RPT、RI,阳性预测值(90.00%)高于APD、RPT(P<0.05)。结论MPUS能够提高胎儿肾积水产前诊断及预后评估的准确性。

Objective To investigate the application value of multi-parameter ultrasound scoring(MPUS)in prenatal diagnosis and prognosis assessment of fetal hydronephrosis.Methods One hundred and sixteen pregnant women with fetal hydronephrosis from April 2018 to March 2019 were selected as study subjects.They were diagnostically examined by using four-dimensional color ultrasound.The anteroposterior diameter of renal pelvis(APD),renal parenchymal thickness(RPT)and renal artery blood flow resistance index(RI)were recorded.0 to 3 points were assigned for the degree of hydronephrosis.The three parameters MPUS(APD,RPT and RI)was statistically analyzed.Then,APD,RPT,RI and MPUS were compared between pathological and physiological hydronephrosis.The diagnostic efficacy of these parameters for fetal hydronephrosis were analyzed.Results Of the 116 fetal hydronephrosis,there were 133 kidneys showing hydronephrosis,including 104 physiological hydronephrosis and 29 pathological hydronephrosis.APD,RT and MPUS were higher while RPT was lower in the pathologic hydronephrosis group than those in the physiologic hydronephrosis group(P<0.05).The specificity and accuracy of MPUS in diagnosis of fetal hydronephrosis were 97.12%and 96.24%,respectively,which were higher than those of APD,RPT or RI.The positive predictive value of MPUS was 90.00%which was higher than that APD or RPT(P<0.05).Conclusion MPUS can improve the accuracy of prenatal diagnosis and prognosis assessment of fetal hydronephrosis.