肾盂前后径和超声评分法对单侧肾积水患儿出生后需要手术干预的预测价值

The value of anteroposterior of renal pelvis and ultrasound score in predicting children with unilateral hydronephrosis requiring surgical intervention after birth

目的探讨出生前后肾盂前后径(APD)和超声评分值对单侧肾积水患儿出生后需要肾盂输尿管离断成形术干预的预测价值,并对两种指标的预测效果进行对比。方法回顾性分析2017年9月至2019年10月在昆明医科大学第二附属医院泌尿外科、儿科和产科就诊的147例单侧肾积水患儿的临床资料。根据单侧肾积水患儿出生后是否手术干预分为观察组(67例)和手术组(80例),比较两组患儿临床数据的差异。使用ROC曲线分析患儿在母体孕中期、孕晚期和出生后48 h的肾盂APD值和超声评分值对需要手术干预的预测效果,并对两种指标的预测价值进行比较。结果两组患儿在性别、肾积水病变侧别差异无统计学意义(P>0.05)。手术组患儿在母体孕中期、孕晚期和出生后48 h的肾盂APD值和超声评分值均大于观察组(P<0.001)。ROC曲线分析显示患儿在三个不同时期的肾盂APD值和超声评分值均对需要手术干预表现出较好的预测效果(P<0.001)。在母体孕中期、孕晚期和出生后48 h,患儿肾盂APD值分别以7.5 mm、13.5 mm、14.5 mm作为最佳预测值时,对需要手术干预预测的ROC曲线下面积分别为0.882、0.965、0.961;在母体孕中期、孕晚期和出生后48h,患儿肾超声评分值分别以1.5、5.5、6.5作为最佳预测值时,对需要手术干预预测的ROC曲线下面积为0.931、0.982、0.995。其中超声评分值的预测效果优于肾盂APD值,差异具有统计学意义(P<0.05)。结论单侧肾积水患儿在母体孕中期、孕晚期和出生后48 h的肾盂APD值和超声评分值对需要手术干预均有较好的预测价值,超声评分值作为综合指标,对需要手术干预的预测价值优于肾盂APD值。

Objective To investigate the predictive value of anteroposterior diameter of renal pelvis and ultrasound score before and after birth for ureteropelvic resection in children with unilateral hydronephrosis after birth,and to compare the predictive effect of the two indicators.Methods The clinical data of 147 children with unilateral hydronephrosis in the Department of Urology,Pediatrics and Obstetrics of the Second Affiliated Hospital of Kunming Medical University from September 2017 to October 2019 were retrospectively analyzed.The children with unilateral hydronephrosis were divided into observation group(n=67)and operation group(n=80)according to whether surgical intervention was performed after birth,and the differences in clinical data between the two groups were compared.ROC curves were used to analyze the predictive effect of APD of renal pelvis and ultrasound scores on the need for surgical intervention in the second trimester,third trimester,and 48 hours after birth of the children,and the predictive value of the two indicators was compared.Results There was no significant difference in sex and side of hydronephrosis between the two groups(P>0.05).The APD of renal pelvis and ultrasound scores in the second trimester,third trimester and 48 hours after birth in the operation group were greater than those in the observation group(P<0.001).ROC curve analysis showed that both APD of renal pelvis and ultrasound scores at three different periods had good predictive effects for the need for surgical intervention(P<0.001).In the second trimester,third trimester and 48 hours after birth,the area under the ROC curve for the prediction of the need for surgical intervention was 0.882,0.965 and 0.961 when the APD of renal pelvis of the children was 7.5 mm,13.5 mm and 14.5 mm as the best predictive value,respectively;in the second trimester,third trimester and 48 hours after birth,the area under the ROC curve for the prediction of the need for surgical intervention was 0.931,0.982 and 0.995 when the ultrasound score of the children was 1.5,5.5 and 6.5 as the best predictive value,respectively.Among them,the prediction effect of ultrasound score was better than that of APD of renal pelvis,and the difference was statistically significant(P<0.05).Conclusion The APD of renal pelvis and ultrasound score in children with unilateral hydronephrosis in the second trimester,third trimester and 48 hours after birth have a good predictive value for the need of surgical intervention.The ultrasound score value,as a comprehensive index,is superior to the APD of renal pelvis for the need of surgical intervention.