超声评分法及肾动脉阻力指数对胎儿肾积水预后的评价价值分析

目的:研究超声评分法及肾动脉阻力指数(RRI)对胎儿肾积水预后的评价价值。方法:将从2016年1月2019年1月经我院超声检查发现的孕晚期肾积水胎儿210例纳入研究,测定其肾实质厚度(RPT)、肾盂前后径(APD)以及肾盂肾盏形态,对上述各项超声检测指标进行评分,累计计算分值。此外,对所有胎儿的积水肾脏肾门部位的RRI值进行测定,并以受试者工作特征(ROC)曲线分析超声评分法与RRI值诊断胎儿肾积水预后类型的价值。结果:所有胎儿出生1年内分别行超声检查以及临床诊断,结果显示210例胎儿,共计420只肾脏,共发生285只肾积水,包括病理性肾积水84只(病理性组),非病理性肾积水201只(非病理性组)。病理性肾积水胎儿超声评分为13分的肾只数占比显著低于非病理性胎儿(P<0.05),而79分的肾只数占比显著高于非病理性胎儿(P<0.05)。病理性肾积水胎儿的平均RRI值为0.74±0.05,显著高于非病理性肾积水胎儿的0.63±0.02,差异有统计学意义(t=26.563,P=0.000)。超声评分法与RRI联合诊断病理性肾积水的曲线下面积(AUC)、敏感度、特异度、准确度均显著高于超声评分法或RRI单独诊断(P<0.05)。结论:超声评分法及RRI诊断对胎儿肾积水预后评价具有较重要的价值,值得临床推广应用。

The Value of Ultrasonography and Renal Artery Resistance Index in Evaluating the Prognosis of Fetal Hydronephrosis

Objective:To study the value of ultrasonography and renal artery resistance index(RRI)in evaluating the prognosis of fetal hydronephrosis.Methods:210 cases of fetuses with late gestational hydronephrosis discovered by ultrasonography in our hospital from January 2016 to January 2019 were included in the study.Their renal parenchymal thickness(RPT),anteroposterior diameter(APD),and calyces morphology were measured.The above ultrasonographic indicators were scored and scores were calculated.In addition,RRI values of renal hilum in all fetuses were measured.The diagnostic value of ultrasonography and RRI in the prognosis of fetal hydronephrosis was analyzed by receiver operating characteristic(ROC)curve.Results:Ultrasound examination and clinical diagnosis were performed on all fetuses 1 year after birth,the results showed that 210 fetuses,a total of 420 kidneys,had 285 hydronephrosis,including 84 cases of pathological hydronephrosis(pathological group),and 201 cases of non-pathological hydronephrosis(non-pathological group).The ratio of the number of kidneys in the pathological hydronephrosis fetus with 1-3 points was significantly lower than that in the non-pathological fetus(P<0.05),while the ratio of the number of kidneys in the 7-9 points was significantly higher than that in the non-pathological fetus(P<0.05).The mean RRI of fetuses with pathological hydronephrosis was 0.74±0.05,which was significantly higher than that of fetuses without pathological hydronephrosis 0.63±0.02,the difference was statistically significant(t=26.563,P=0.000).The area under curve(AUC),sensitivity,specificity,and accuracy of combined ultrasonography and RRI in the diagnosis of pathological hydronephrosis were significantly higher than that of ultrasonography or RRI alone(P<0.05).Conclusion:Ultrasonic scoring and RRI diagnosis have important value in evaluating the prognosis of fetal hydronephrosis,which is worthy of clinical application.