胎儿双侧肾回声增强的产前超声特征与妊娠结局分析

Relationship between prenatal ultrasonographic characteristics of fetal bilateral hyperechogenic kidneys and pregnancy outcomes

目的探讨胎儿双侧肾回声增强的产前超声特征及其与妊娠结局的关系.方法随访2015年1月至2018年12月于解放军总医院第一医学中心产前超声诊断胎儿双侧肾回声增强的26例病例的妊娠结局,分为引产/死亡组(19例)和存活组(7例),采用Fisher确切概率检验比较2组病例皮髓质分界、髓质回声、羊水量、肾体积、有无囊肿以及是否合并肾外异常情况等超声特征的差异,采用Spearman相关分析上述超声特征与妊娠结局的相关性.结果皮髓质分界存在的10例胎儿,7例存活,3例引产,皮髓质分界缺失/倒置者16例,无一存活;髓质回声正常者9例,6例存活,3例引产,髓质回声异常者17例,无一存活.存活组和引产/死亡组皮髓质分界及髓质回声比较,差异均具有统计学意义(P<0.001、=0.002);羊水量、肾体积、有无囊肿、是否合并肾外异常方面比较,差异均无统计学意义(P均>0.05).皮髓质分界、髓质回声与妊娠结局及预后有显著相关性(r=0.768、0.652,P均<0.01),而羊水量、肾体积、有无囊肿、是否合并肾外畸形与妊娠结局及预后无明显相关性(P均>0.05).结论胎儿双侧肾回声增强时,皮髓质分界缺失/回声倒置、髓质回声异常与不良妊娠结局显著相关,会增加胎儿死亡和远期肾功能损害的风险.

Objective To explore the relationship between the prenatal ultrasound characteristics of fetal bilateral hyperechogenic kidneys and pregnancy outcomes,in order to provide a reference for prenatal consultation of such disease.Methods From January 2015 to December 2018,26 cases of fetal bilateral hyperechogenic kidneys were diagnosed by prenatal ultrasound at the First Medical Center of PLA General Hospital,which were divided into either an induced labor/death group(19 cases)or a survival group(7 cases).Fisher exact probability test was used to compare the differences in ultrasonic characteristics between the two groups,including corticomedullary differentiation(CMD),medulla echogenicity,amniotic fluid volume,kidney volume,cyst,and extrarenal malformation.Results There were 10 cases with CMD,of which 7 survived and 3 underwent induced labor,16 cases with CMD absence/reversal,of which none survived,9 cases with normal medullary echo,of which 6 survived and 3 underwent induced labor,and 17 cases with abnormal medullary echo,of which none survived.There were statistically significant differences between the survival group and the induced labor/death group in CMD and medulla echogenicity(P<0.001 and=0.002,respectively),but there were no statistically significant differences in amniotic fluid volume,kidney volume,cyst,or extrarenal malformation(P>0.05 for all).CMD and medulla echogenicity were significantly correlated with pregnancy outcome(r=0.768 and 0.652,respectively;P<0.01 for both),while amniotic fluid volume,kidney volume,cyst,and extrarenal malformation were not significantly correlated with pregnancy outcome(P>0.05 for all).Conclusion When fetal bilateral kidneys are hyperechogenic,CMD absence/reversal and medullary echogenicity are significantly associated with adverse pregnancy outcomes,and significantly increase the risk of fetal mortality and long-term kidney impairment.