产前超声诊断胎儿肾盂增宽与染色体异常及不良妊娠结局的相关性

The correlation between prenatal ultrasound diagnosis of fetal renal pelvis widening,chromosomal abnormalities,and adverse pregnancy outcomes

目的探讨产前超声诊断胎儿肾盂增宽与染色体异常及不良妊娠结局的相关性。方法选取产前经超声诊断为肾盂增宽的胎儿111例,根据是否合并其他超声检查异常分为孤立性肾盂增宽组和非孤立性肾盂增宽组,孤立性肾盂增宽组中再依据肾盂增宽程度分为轻、中、重度三组,比较不同分组间胎儿染色体异常及不良妊娠结局的差异。结果111例胎儿中,超声检查异常仅表现为肾盂前后径(APD)大于正常值(孕中期≥4 mm、孕晚期≥7 mm)的为孤立性肾盂增宽组,超声检查表现为APD大于正常值且合并除此以外的一个或多个超声检查异常为非孤立性肾盂增宽组。两组的染色体异常率分别为4.76%和18.51%,P=0.02;不良妊娠率分别为9.52%和44.44%,P<0.01。孤立性肾盂增宽组中轻、中、重度组的胎儿染色体异常率分别为0%、11.11%、3.22%,P=0.15;不良妊娠率分别为0%、11.11%、16.12%,P=0.11。结论当肾盂增宽合并其他超声检查异常时,胎儿染色体异常率和不良妊娠率随之增加;在孤立性肾盂增宽组中,增宽程度与染色体异常率及不良妊娠率无相关性。

Objective To explore the correlation between prenatal ultrasound diagnosis of fetal renal pelvis widening,chromosomal abnormalities,and adverse pregnancy outcomes.Methods 111 fetuses diagnosed with renal pelvis widening using prenatal ultrasound were selected and divided into isolated renal pelvis widening group and non isolated renal pelvis widening group based on the presence of other ultrasound abnormalities.The isolated group was further divided into three groups based on the degree of renal pelvis widening:mild,moderate,and severe.The differences in fetal chromosomal abnormalities and adverse pregnancy outcomes were compared among different groups.Results Among the 111 fetuses,the isolated group showed ultrasound abnormalities only when the anterior posterior diameter(APD)of the renal pelvis was greater than the normal value(≥4mm in mid pregnancy and≥7mm in late pregnancy).The non isolated group showed ultrasound abnormalities when the APD was greater than the normal value and combined with one or more other ultrasound abnormalities.The chromosome abnormality rates of isolated and non isolated groups were 4.76%and 18.51%,respectively,with P=0.02;the adverse pregnancy rates were 9.52%and 44.44%,respectively,with P<0.01.In the isolated group,grouping was based on the degree of renal pelvis widening.The rates of fetal chromosomal abnormalities in the mild,moderate,and severe groups were 0%11.11%and 3.22%,respectively,with P=0.15;the rates of adverse pregnancies were 0%、11.11%and 16.12%,respectively,with P=0.11.Conclusion When the renal pelvis widens and other ultrasound abnormalities are present,the rate of fetal chromosomal abnormalities and adverse pregnancy increases accordingly.In isolated renal pelvis widening,the degree of widening is not correlated with the rate of chromosomal abnormalities and adverse pregnancy rates.