超声评分法与肾动脉阻力指数对胎儿肾积水预后综合评估的临床价值
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摘要
目的探讨超声评分法与肾动脉阻力指数(RI)对胎儿肾积水预后的综合评估价值。方法选取在我院经超声检查发现的孕晚期肾积水胎儿117例,分别测定胎儿的肾实质厚度、肾盂前后径以及肾盂肾盏形态并给予评分,累计计算分值,同时测定积水肾脏肾门处的肾动脉RI值。结果 117例胎儿中经超声检查共计检出146只肾脏积水,胎儿出生后1年超声复查结果证实病理性肾积水28只(19.2%),非病理性肾积水118只(80.8%);超声评分≤3分均为非病理性肾积水,超声评分≥8分均为病理性肾积水,病理性肾积水与非病理性肾积水超声评分之间的差异具有明显的统计学意义(Z=9.279,P<0.01);超声评分≤5分的肾积水胎儿肾动脉RI值在0.61～0.69,超声评分>5分肾积水胎儿肾动脉RI值在0.70～0.81。结论超声评分法与肾动脉阻力指数对胎儿肾积水预后评估具有重要价值,可在临床推广应用。
Objective To explore the value of ultrasound scoring and renal artery resistance index(RI) in the comprehensive evaluation of the prognosis of fetal hydronephrosis.Methods 117 cases of fetal hydronephrosis in the third trimester of pregnancy detected by ultrasound in our hospital were selected.The renal parenchyma thickness,anterior and posterior diameter of the renal pelvis,and the morphology of renal pelvis and renal calices were measured and scored.The cumulative score was calculated and the renal artery RI value at the renal hilum of the affected kidney was measured.Results A total of 146 cases of hydronephrosis were detected by ultrasonography in 117 fetuses.The results of ultrasound examination 1 year after birth confirmed 28 cases of pathological hydronephrosis(19.2%) and 118 cases of non-pathological hydronephrosis(80.8%).Ultrasound score ≤3 points was considered as non-pathological hy-dronephrosis,ultrasound score ≥8 points was considered as pathological hydronephrosis,and the difference of ultrasound scores of pathological hydronephrosis and non-pathological hydronephrosis was statistically significant(Z=9.279,P<0.01).The RI values of fetal renal artery in patients with ultrasound scores ≤5 points were 0.61～0.69,and the RI values in those with ultrasound scores>5 points were 0.70-0.81.Conclusion Ultrasound scoring and renal artery resis tance index have important value in evaluating the prognosis of fetal hydronephrosis,which can be applied and promoted.
Objective To explore the value of ultrasound scoring and renal artery resistance index(RI) in the comprehensive evaluation of the prognosis of fetal hydronephrosis.Methods 117 cases of fetal hydronephrosis in the third trimester of pregnancy detected by ultrasound in our hospital were selected.The renal parenchyma thickness,anterior and posterior diameter of the renal pelvis,and the morphology of renal pelvis and renal calices were measured and scored.The cumulative score was calculated and the renal artery RI value at the renal hilum of the affected kidney was measured.Results A total of 146 cases of hydronephrosis were detected by ultrasonography in 117 fetuses.The results of ultrasound examination 1 year after birth confirmed 28 cases of pathological hydronephrosis(19.2%) and 118 cases of non-pathological hydronephrosis(80.8%).Ultrasound score ≤3 points was considered as non-pathological hy-dronephrosis,ultrasound score ≥8 points was considered as pathological hydronephrosis,and the difference of ultrasound scores of pathological hydronephrosis and non-pathological hydronephrosis was statistically significant(Z=9.279,P<0.01).The RI values of fetal renal artery in patients with ultrasound scores ≤5 points were 0.61～0.69,and the RI values in those with ultrasound scores>5 points were 0.70-0.81.Conclusion Ultrasound scoring and renal artery resis tance index have important value in evaluating the prognosis of fetal hydronephrosis,which can be applied and promoted.
引文
[1]詹韶华.超声检查对胎儿肾积水的产前诊断及预后评估中的应用[J].现代诊断与治疗,2017,28(1):112-113.
[2]郑伯禄,林涛,林珊,等.不同频率的超声随访方案在胎儿期肾积水患儿随访的应用价值[J].吉林医学,2018,39(3):498-500.
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[5]李雪风,孙萍,张步蕊.彩色多普勒超声对预测胎儿肾集合系统分离转归的应用价值[J].河北医药,2011,33(10):1505-1507.
[6] Zhan X,Tao G,Liu S,et al.Ultrasound score:A new method to differentiate fetal physiological and pathological hydronephrosis[J].Eur J Obstet Gynecol Reprod Biol,2010,(151):26-32.
[7]尤红霞,王芳芳.胎儿肾积水的产前诊断、产后转归及处理[J].中国生育健康杂志,2016,27(1):91-94.
[8]冯晓,段世玲,宋江虹,等.超声评估胎儿肾积水预后的研究进展[J].现代泌尿外科杂志,2018,23(3):234-236.
[9]王婧霖,刘雨函,吕卓.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[J].临床超声医学杂志,2014,16(12):824-826.
[10]张子宁,周菊英. RI指数联合超声对孕晚期胎儿肾积水预后预测价值的研究[J].北华大学学报(自然科学版),2015,16(3):342-344.
[11] Kachakova D,Mitkova A,Popov E,et al. Evaluation of the clinical value of the newly identified urine biomarker HIST1H4K for diagnosis and prognosis of prostate cancer in Bulgarian patients[J]. Official Journal of the Balkan Union of Oncology,2013,18(3):660-668.
[12]潘日安.多因素超声评分法对胎儿肾积水预后的评估价值[J].实用中西医结合临床,2017,17(5):108-109.
[13]吕宇涛,文建国,张艳,等.肾脏血流阻力指数比率在评估小儿肾积水肾脏功能中的价值[J].郑州大学学报(医学版),2003,38(2):182-184.
[14]乃赓,戚岩.重度肾积水及阻力指数改变的超声诊断[J].河北医药,2007,29(5):504.
[15]时博,李士星,张尧,等.应用段动脉阻力指数早期评价小儿肾积水手术后疗效[J].中国医学影像技术,2011,27(12):2498-2501.
[2]郑伯禄,林涛,林珊,等.不同频率的超声随访方案在胎儿期肾积水患儿随访的应用价值[J].吉林医学,2018,39(3):498-500.
[3]展新风,袁野,陶国伟,等.超声评分法与肾盂前后径对胎儿肾积水预后关系的研究[J].中国超声影像学杂志,2012,21(3):231-235.
[4]高伟,王腾春,罗娜,等.多参数超声评分法对评估胎儿肾积水预后的临床价值[J].医药卫生,2016,(2):96.
[5]李雪风,孙萍,张步蕊.彩色多普勒超声对预测胎儿肾集合系统分离转归的应用价值[J].河北医药,2011,33(10):1505-1507.
[6] Zhan X,Tao G,Liu S,et al.Ultrasound score:A new method to differentiate fetal physiological and pathological hydronephrosis[J].Eur J Obstet Gynecol Reprod Biol,2010,(151):26-32.
[7]尤红霞,王芳芳.胎儿肾积水的产前诊断、产后转归及处理[J].中国生育健康杂志,2016,27(1):91-94.
[8]冯晓,段世玲,宋江虹,等.超声评估胎儿肾积水预后的研究进展[J].现代泌尿外科杂志,2018,23(3):234-236.
[9]王婧霖,刘雨函,吕卓.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[J].临床超声医学杂志,2014,16(12):824-826.
[10]张子宁,周菊英. RI指数联合超声对孕晚期胎儿肾积水预后预测价值的研究[J].北华大学学报(自然科学版),2015,16(3):342-344.
[11] Kachakova D,Mitkova A,Popov E,et al. Evaluation of the clinical value of the newly identified urine biomarker HIST1H4K for diagnosis and prognosis of prostate cancer in Bulgarian patients[J]. Official Journal of the Balkan Union of Oncology,2013,18(3):660-668.
[12]潘日安.多因素超声评分法对胎儿肾积水预后的评估价值[J].实用中西医结合临床,2017,17(5):108-109.
[13]吕宇涛,文建国,张艳,等.肾脏血流阻力指数比率在评估小儿肾积水肾脏功能中的价值[J].郑州大学学报(医学版),2003,38(2):182-184.
[14]乃赓,戚岩.重度肾积水及阻力指数改变的超声诊断[J].河北医药,2007,29(5):504.
[15]时博,李士星,张尧,等.应用段动脉阻力指数早期评价小儿肾积水手术后疗效[J].中国医学影像技术,2011,27(12):2498-2501.