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产前超声定量指标预测胎儿肾盂增宽预后的价值 |
刘瑶,吴青青 |
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(首都医科大学附属北京妇产医院/北京妇幼保健院) |
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摘要: |
目的 探讨产前超声定量指标预测胎儿肾盂增宽预后的诊断价值。方法 收集2017年7月至2019年3月我院因产前超声发现肾盂扩张的胎儿,将其分为孕中期组、孕晚期组以及亚组,比较孕中期组、孕晚期组中病理性肾盂增宽与生理性肾盂增宽肾脏的肾盂前后径(APD)、肾实质变薄比例的差异。以患儿生后2年的超声诊断结果为参考,以肾盂持续性扩张且肾盏变钝诊断为病理性肾盂增宽,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。收集自孕中期持续至孕晚期均表现肾盂扩张肾脏,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%)。两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%。对孕中期持续至孕晚期均表现肾盂扩张的肾脏联合应用APD指标,其诊断特异性可达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 |
关键词: 超声检查 胎儿 肾盂增宽 定量指标 |
DOI: |
投稿时间:2022-03-13修订日期:2022-06-16 |
基金项目: |
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Quantitative index study on predicting renal pelvis widening based on fetal prognosis assessment |
Liu Yao,Wu Qingqing |
(Beijing Obstetrics and Gynecology Hospital,Capital Medical UniversityBeijing Maternal and Child Health Care Hospital) |
Abstract: |
Objective To investigate the diagnostic value of prenatal ultrasonic quantitative indexes in predicting the prognosis of fetal renal pelvis widening.Methods The fetuses found to have renal pelvis dilated detected by prenatal ultrasound in our hospital from July 2017 to March 2019 were collected, and they were divided into the second trimester group, third trimester group and subgroups. The difference of anteroposterior diameter of renal pelvis(APD)and the renal parenchymal thinning ratio between pathological and physiologic renal pelvis widening in the second trimester and third trimester group was compared.Based on the ultrasound diagnosis results of 2 years after birth,with persistent renal pelvis dilation and renal calices bluntness as the criteria for the pathological pelvis widening.Receiver operating characteristic(ROC)curves were 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 of renal pelvis dilatation from the second trimester to the third trimester were collected,and the efficacy of the second trimester combined with the third trimester APD in diagnosing pathological renal pelvis widening was calculate.
Results A total of 1512 kidneys were included, of which 829 were in the second trimester group, including 23(2.8%)of pathological renal pelvis widening; there were 390 kidneys in the third trimester group, including pathological pelvis widening in 25(6.4%).There were statistically significant difference in the APD and renal parenchymal thinning ratio between pathological and physiological pelvis widening in the two groups(both P<0.001). ROC curve analysis showed that the area under the curve of pathological renal pelvis widening by APD in the second and third trimesters were 0.974 and 0.982, respectively, which was better than the area under the curve(0.897 and 0.875)of renal parenchyma thinning in the same period, and the differences were statistically significant(P=0.0361、0.0036).The 0.8 cm and 1.1 cm were used as the cut-off values, respectively, and the corresponding sensitivity was 95.7% and 100%, the specificity was 92.8% and 88.8%.The APD indexes are applied in combination with kidneys that exhibit pyelectasis from the second trimester to the third trimester, and the diagnostic specificity can reach to 98.5%.
Conclusion Ultrasound 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 the renal parenchymal thickness measured in the same period. |
Key words: Ultrasonography Fetal Renal pelvis widening Quantitative index |
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