肾盂前后径对肾积水胎儿出生后是否手术的预测价值  

Fetal anteroposterior renal pelvic diameter for predicting antenatal hydronephrosis requiring postnatal surgery

作　　者：王展[1] 唐达星[1] 田红娟[1] 杨帆 温弘 王军梅[3] 陶畅[1] WANG Zhan;TANG Daxing;TIAN Hongjuan;YANG Fang;WEN Hong;WANG Junmei;TAO Chang(The Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China;Department of Obtetrics and Gynecology,Women's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Ultrasonography,Women’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属儿童医院国家儿童健康与疾病临床医学研究中心,浙江杭州310052 [2]浙江大学医学院附属铂产科医院饴产科,浙江杭州310006 [3]浙江大学医学院附属妇产科医院超声科,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2019年第5期493-498,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：国家重点研发计划(2018YFC1002700)

摘　　要：目的:评估肾盂前后径(APD)预测肾积水胎儿出生后是否需要手术的价值。方法:回顾性分析2007年6月至2018年6月在浙江省产前诊断中心产前超声检查发现的肾积水胎儿(孕中期超声指标APD≥4 mm,孕晚期APD≥7 mm)525例的资料,采用ROC曲线评估孕中期、孕晚期APD值预测患儿出生后是否需要手术的敏感度、特异度等指标。结果:妊娠中期确诊162例(30.9%),妊娠晚期确诊363例(69.1%)。131例患儿出生后确诊病理性肾积水,121例进行了手术治疗。孕中期APD值预测患儿出生1~12岁是否需要手术的ROC曲线下面积为0.910,当APD临界值为8.45 mm时,预测的敏感度为97.1%,特异度为70.9%,阳性预测值为47.9%,阴性预测值为98.9%。孕晚期APD值预测患儿出生1~12岁是否需要手术的ROC曲线下面积为0.800,当APD临界值为12.25 mm时,预测的敏感度为66.7%,特异度为81.2%,阳性预测值为51.7%,阴性预测值为89.1%。结论:孕期APD值可用于预测肾积水胎儿出生后是否需要手术治疗,且以孕中期APD值的预测效果为佳。Objective: To assess the value of fetal anteroposterior renal pelvic diameter(APD) in predicting antenatal hydronephrosis requiring surgical treatment after birth. Methods: A total of 525 cases of antenatal hydronephrosis detected by prenatal ultrasonography(ultrasound index APD≥4 mm in the second trimester and APD≥7 mm in the third trimester) in Zhejiang Prenatal Diagnosis Center from June 2007 to June 2018 were retrospectively analyzed. ROC curve was used to analyze the relationship between these ultrasound indicators and the requirement for surgical treatment after birth. Results: There were 162 cases(30.9%) diagnosed in the second trimester and 363 cases(69.1%) diagnosed in the third trimester;131 cases were diagnosed pathologically after birth, of which 121 finally underwent surgical treatment. The area under ROC curve(AUC) of APD in middle pregnancy for prediction of requiring surgery 1-12 years after birth was 0.910;the cut-off value of APD was 8.45 mm with a sensitivity of 97.1%, specificity of 70.9%, positive predictive value(PPV) of 47.9%, and negative predictive value(NPV) of 98.9%. The AUC of APD in late pregnancy for prediction of requiring surgery 1-12 years after birth was 0.800;the cut-off value of APD was 12.25 mm with a sensitivity of 66.7%, specificity of 81.2%, PPV of 51.7%, and NPV of 89.1%. Conclusion: APD in pregnancy can be used to predict whether the fetus with hydronephrosis needs surgical treatment after birth, and the prediction value of APD in the middle pregnancy is better.

关 键 词：超声检查 产前 肾盂积水/胚胎学 肾盂积水/诊断 肾盂积水/外科学 回顾性研究 

分 类 号：R726[医药卫生—儿科]