多种超声指标评分与胎儿肾积水产前诊断及预后评估相关性分析

Analysis of the Correlation between Multi-Parameter Ultrasound Scoring and Prenatal Diagnosis and Prognosis Evaluation of Fetal Hydronephrosis

摘要: 目的：研究分析多种超声指标评分(MPUS)系统与胎儿肾积水的产前诊断及预后评估中的相关性，提高诊断评估准确率。方法：选取2023年12月至2024年12月期间在我院就诊的产前B超检查有胎儿肾盂积水的孕产妇53例，采用彩超检查，对肾盂前后径(APD)、肾实质厚度(RPT)、肾动脉血流阻力指数(RI)进行检测，依据肾积水的严重程度，将分数设定在0至3分之间，记录这3个指标的多普勒功率谱(MPUS)参数数值，并对病理性肾积水、生理性肾积水在APD、RPT、RI及MPUS方面的参数数值进行比较，评估其对胎儿肾积水鉴别的诊断价值。结果：53例肾积水胎儿共有62只肾积水，其中9例胎儿是双侧肾积水，47只是由生理因素所致，15只是由病理因素导致。而病理因素患肾组APD、RI和MPUS指数较生理因素患肾组高，RPT指数则低(P < 0.05)。MPUS对胎儿肾积水的检出灵敏度(93.33%)、特异度(95.74%)和准确度(95.16%)、阳性预测值(87.50%)均要优于APD、RPT、RI (P < 0.05)。综上，采用MPUS可以提高孕期超声检查对于胎儿肾积水的产前诊断以及预后评估的准确性。

Abstract: Objective: Study and analyze the correlation between multi-parameter ultrasound scoring (MPUS) and prenatal diagnosis and prognosis evaluation of fetal hydronephrosis, to improve the accuracy in diagnosis and evaluation. Methods: 53 pregnant women with fetal hydronephrosis treated in our hospital from December 2023 to December 2024 were selected as study subjects. They were examined by using color ultrasound. Measurements included renal pelvis anterior-posterior dimension (APD), cortical tissue thickness (RPT), and vascular impedance index (RI) of renal arteries. Hydronephrosis severity was graded on a 0-3 scale. Composite MPUS scores were derived from APD, RPT, and RI measurements. Comparative analysis was performed between structural and functional hydronephrosis cases regarding these parameters. The diagnostic performance of each measurement was subsequently evaluated. Results: Out of 53 fetuses with hydronephrosis, 62 had hydronephrosis, of which 9 had bilateral hydronephrosis, 47 were solely caused by physiological factors, and 15 were solely caused by pathological factors. Comparative analysis revealed significantly elevated APD, RI, and MPUS measurements alongside reduced RPT values in the pathological cohort when contrasted with physiological cases (P < 0.05). The sensitivity (93.33%), specificity (95.74%), accuracy (95.16%) and positive predictive value (87.50%) of MPUS in diagnosis of fetal hydronephrosis were higher than those of APD, RPT and RI (P < 0.05). Conclusion: MPUS can improve the accuracy of prenatal diagnosis and prognosis assessment of fetal hydronephrosis.