超声评分法及肾动脉阻力指数对胎儿肾积水预后的研究价值

目的探讨超声评分法及肾动脉阻力指数(RI)对评价胎儿肾积水预后的价值。方法晚孕期136例肾积水胎儿,测定其肾盂前后径(APD)、肾实质厚度、肾盂肾盏形态并分别赋予0~3分,累计其分值;胎儿超声检查时测定每个积水肾脏肾门处肾动脉的RI值。以上结果与出生后的超声检查及临床诊断对照。结果超声评分≤3、4、5、6、7及≥8分的胎儿,其病理性肾积水者所占比例为0、17.6%、33.3%、55.5%、81.8%及100%。以综合评分5分为诊断胎儿病理性肾积水的最佳截断值,其灵敏度、特异度分别为94.0%、87.9%。超声评分≤5分的肾积水患儿,肾动脉RI的数值范围为0.62~0.68,而5分的肾积水患儿,肾动脉RI范围为0.70~0.79。结论超声评分法及肾血管RI对胎儿肾积水预后的评价都有较高的指导实用价值。

Research value of ultrasonic evaluation method and renal vascular index for prognosis in fetal with hydronephrosis

Objective To explore the value of evaluating prognosis in fetal with hydronephrosis using ultrasonic evaluation method and renal vascular resistance index.Methods The renal pelvis anteroposterior diameter,renal parenchyma thickness,morphology of renal pelvis and calyces in 136 fetus with hydronephrosis during late pregnancy were measured and scored from 0 to 3 points,and cumulative scores were calculated.Resistance index（RI）of renal artery in renal hilus of hydrops kidney was measured using fetus ultrasonography.The above results were compared with clinical diagnosis and ultrasonography after birth.Results Pathological hydronephrosis accounted for the proportions of 0,17.6%,33.3%,55.5%,81.8% and 100%,respectively,according to ultrasonic scores for ≤3,4,5,6,7 and ≥ 8 points.Five points was the best cutoff value for the diagnosis of fetal pathological hydronephrosis,and its sensitivity and specificity were 94.0% and 87.9%,respectively.Conclusion Ultrasonic evaluation method and renal vascular RI for the evaluation of fetal hydronephrosis prognosis have great guiding and practical value.