CAJ | 학술논문

目的对比研究超声评分法与肾盂前后径(PAPD)等单项因素评估胎儿肾积水预后的价值.方法对晚孕期肾积水(PAPD≥10 mm)胎儿进行超声检查,将PAPD、肾实质厚度和肾盂肾盏形态分别进行超声评分并累计每个肾的总评分.根据随访结果将胎儿肾积水分为生理性和病理性肾积水,绘制各单因素与超声评分法鉴别两种肾积水的操作者特征(ROC)曲线,经Z检验对4条ROC曲线下面积进行配对比较.结果 158例共198个肾积水,其中139个(70.20％)为生理性,59个(29.80％)为病理性.对于诊断胎儿病理性肾积水,超声评分法(0.982)与PAPD( 0.897)、肾实质厚度(0.957)、肾盂肾盏形态(0.944)的曲线下面积比较差异有统计学意义(P＜0.05).结论超声评分法比PAPD、肾实质厚度、肾盂肾盏形态等单因素能更有效地鉴别诊断胎儿生理性与病理性肾积水,是一种评估胎儿肾积水预后的的新方法.
목적 대비연구초성평분법여신우전후경(PAPD)등단항인소평고태인신적수예후적개치.방법 대만잉기신적수(PAPD≥10 mm)태인진행초성검사,장PAPD、신실질후도화신우신잔형태분별진행초성평분병루계매개신적총평분.근거수방결과장태인신적수분위생이성화병이성신적수,회제각단인소여초성평분법감별량충신적수적조작자특정(ROC)곡선,경Z검험대4조ROC곡선하면적진행배대비교.결과 158례공198개신적수,기중139개(70.20％)위생이성,59개(29.80％)위병이성.대우진단태인병이성신적수,초성평분법(0.982)여PAPD( 0.897)、신실질후도(0.957)、신우신잔형태(0.944)적곡선하면적비교차이유통계학의의(P＜0.05).결론 초성평분법비PAPD、신실질후도、신우신잔형태등단인소능경유효지감별진단태인생이성여병이성신적수,시일충평고태인신적수예후적적신방법.
Objective To determine whether prenatal ultrasonography (US) score is more effective than renal pelvic anterior posterior diameter (PAPD) for the prognostic evaluation of fetal hydronephrosis.Methods Fetuses with hydronephrosis (PAPD≥ 10 mm) were examined by prenatal US in the third trimester.PAPD,renal parenchyma thickness (RPT) and pelvicaliceal morphology (PM) were measured and graded from 0 to 3 score on the basis of severity of hydronephrosis,then the total US score of each kidney was obtained.According to the follow-up results after birth,all the cases were divided into two groups:physiological and pathological hydronephrosis.Via Z test,paired comparison was made to analyze area under the curve (AUC) of US score and each of the other three factors.Results Confirmed by postnatal US and other clinical examinations,of 198 kidneys (158 cases ) with hydronephrosis,139 (70.20％ ) were physiological hydronephrosis and 59 (29.80％ ) were pathological hydronephrosis.AUC of PAPD,RPT,PM,US score was 0.897 (minimum),0.957,0.944 and 0.982 (maximum) respectively,and there was significant difference between AUC of US score and each of the other three ( P ＜0.05).US score was the best approach for differential diagnosis of fetal hydronephrosis.Conclusions Prenatal US score is more effective and accurate than the single factor (PAPD,RPT,PM) to differentiate fetal physiological and pathological hydronephrosis.It was a new quantitative method to evaluate the prognosis of fetal hydronephrosis,and should be disseminated and applied clinically.