产前超声定量指标预测胎儿肾盂增宽预后的价值

Value of prenatal ultrasonic quantitative indexes in predicting the prognosis of fetal renal pelvis widening

目的探讨产前超声定量指标预测胎儿肾盂增宽预后的临床应用价值。方法收集我院产前超声检查发现肾盂扩张的胎儿,将仅孕中期在我院产检出肾盂扩张的肾脏归为孕中期组,仅孕晚期在我院产检出肾盂扩张的肾脏归为孕晚期组,孕中期、孕晚期均在我院产检出肾盂扩张的肾脏归为亚组。超声随访至生后2年,以肾盂持续性扩张且肾盏变钝诊断为病理性肾盂增宽,比较孕中期组与孕晚期组病理性肾盂增宽和生理性肾盂增宽肾脏的肾盂前后径(APD)、肾实质变薄比例。绘制受试者工作特征(ROC)曲线分析并比较孕中期与孕晚期APD、肾实质变薄对病理性肾盂增宽的诊断效能。收集亚组肾盂扩张的肾脏,计算孕中期联合孕晚期APD诊断病理性肾盂增宽的效能。结果共纳入1512只肾脏,其中孕中期组肾脏829只,包括病理性肾盂增宽23只(2.8%);孕晚期组肾脏390只,包括病理性肾盂增宽25只(6.4%);亚组肾脏293只,包括病理性肾盂增宽25只(8.5%)。孕中期组与孕晚期组中病理性肾盂增宽与生理性肾盂增宽肾脏的APD、肾实质变薄比例比较,差异均有统计学意义(均P<0.001)。ROC曲线分析显示,孕中期与孕晚期APD诊断病理性肾盂增宽的曲线下面积分别为0.974、0.982,均优于同期肾实质变薄的曲线下面积(0.897、0.875),差异均有统计学意义(P=0.0361、0.0036),分别以0.8 cm、1.1 cm为截断值,其对应敏感性为95.7%、100%,特异性为92.8%、88.8%。对亚组肾盂扩张的肾脏联合应用孕中、晚期APD截断值进行诊断,其特异性为98.5%。结论孕中期及孕晚期应用超声测量APD可有效预测胎儿肾盂增宽预后,其诊断效能优于同期测量的肾实质厚度。

Objective To investigate the clinical application value of prenatal ultrasonic quantitative indexes in predicting the prognosis of fetal renal pelvis widening.Methods The fetuses with renal pelvis dilated detected by prenatal ultrasound in our hospital were collected,and they were divided into the second trimester group(kidney with dilated pelvis in our hospital in the second trimester),third trimester group(kidney with dilated pelvis in our hospital in the third trimester)and subgroup(kidney with dilated pelvis in our hospital in the second and third trimester).Based on the ultrasonic diagnosis results of 2 years after birth,with persistent renal pelvis dilation and renal calices bluntness as the criteria for the pathological pelvis widening,the differences of anteroposterior diameter(APD)of renal pelvis and the renal parenchymal thinning ratio between pathological and physiologic renal pelvis widening in the second trimester and third trimester group were compared.Receiver operating characteristic(ROC)curve was drawn to analyze and compare the diagnostic efficacy of APD and renal parenchymal thinning in the second and third trimesters for pathological renal pelvis widening.The kidneys with dilated pelvis in the second and third trimester were collected,and the efficacy of APD of second trimester combined with the third trimester in diagnosing pathological renal pelvis widening was calculate.Results A total of 1512 kidneys were included.829 kidneys were in the second trimester group,including 23(2.8%)of pathological renal pelvis widening.390 kidneys were in the third trimester group,including 25(6.4%)of pathological renal pelvis widening.293 kidneys were in the subgroups,including 25(8.5%)of pathological renal pelvis widening.There were statistically significant differences in the APD and renal parenchymal thinning ratio of pathological and physiological pelvis widening between the two groups(both P<0.001).ROC curve analysis showed that the area under the curve of pathological renal pelvis widening by APD of second and third trimesters were 0.974 and 0.982,respectively,which was better than that of renal parenchymal thinning in the same period(0.897 and 0.875),and the differences were statistically significant(P=0.0361,0.0036).Taking 0.8 cm and 1.1 cm as the cut-off values,and the corresponding sensitivity were 95.7%and 100%,the specificity were 92.8%and 88.8%,respectively.The APD indexes was applied in combination with kidneys that exhibited pyelectasis in the subgroup,and the diagnostic specificity was 98.5%.Conclusion Ultrasonic measurement of APD in the second and third trimesters of pregnancy can effectively predict the prognosis of fetal renal pelvis widening,and its diagnostic efficacy is better than that of renal parenchymal thickness measured in the same period.