一种用于产前肾积水管理的新分级系统。
A New Grading System for the Management of Antenatal Hydronephrosis.
作者信息
Dos Santos Joana, Parekh Rulan S, Piscione Tino D, Hassouna Tarek, Figueroa Victor, Gonima Paula, Vargas Isis, Farhat Walid, Rosenblum Norman D
机构信息
Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children.
Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, Division of Nephrology, Department of Medicine, University Health Network, and.
出版信息
Clin J Am Soc Nephrol. 2015 Oct 7;10(10):1783-90. doi: 10.2215/CJN.12861214. Epub 2015 Jul 31.
BACKGROUND AND OBJECTIVES
Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+).
RESULTS
The combination of APD≥6-9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD≥6-9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD≥9-15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD≥9-15 mm alone. The LR+ for surgery for diffuse caliectasis and APD≥6-9 mm was higher than for APD≥6-9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD≥9-15 mm and diffuse caliectasis than APD≥9-15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD≥6-9 mm or ≥9-15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05).
CONCLUSIONS
These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.
背景与目的
标准临床评估无法预测中度上尿路积水患者是否需要手术干预。本研究调查了出生后首次超声检查时肾盂肾盏扩张及肾盂前后径（APD）的联合测量指标，是否比APD的标准评估或胎儿泌尿外科学会（SFU）分级系统更能预测手术干预。
设计、地点、参与者及测量方法：对2003年至2013年随访的348例产前肾积水患儿进行回顾性队列研究。采用Cox回归分析，计算出生后首次超声检查时根据APD、SFU及联合分级进行手术干预的风险。通过计算阳性似然比（LR+）来确定每个分级系统对手术的预测能力。
结果
APD≥6 - 9 mm且伴有弥漫性肾盏扩张时，风险比（HR）为19.5（95%置信区间[95%CI]，3.94至96.9），而单独APD≥6 - 9 mm时HR为0.59（95%CI，0.05至6.53），SFU 3级的风险为8.9（95%CI，3.84至20.9）。APD≥9 - 15 mm且伴有弥漫性肾盏扩张时，HR为18.7（95%CI，4.36至80.4），而单独APD≥9 - 15 mm时HR为1.75（95%CI，0.29至10.5）。弥漫性肾盏扩张且APD≥6 - 9 mm时手术的LR+高于单独APD≥6 - 9 mm时（HR = 2.62；95%CI，0.87至7.94 对比 HR = 0.04；95%CI，0.01至0.32），APD≥9 - 15 mm且伴有弥漫性肾盏扩张时的LR+高于单独APD≥9 - 15 mm时（HR = 2.0；95%CI，1.15至3.45 对比 HR = 0.14；95%CI，0.04至0.43）。两组中度肾积水（APD≥6 - 9 mm或≥9 - 15 mm且伴有弥漫性肾盏扩张）的LR+仅略高于SFU 3级（HR = 1.89；95%CI，1.17至3.05）。
结论
这些结果表明，结合APD和弥漫性肾盏扩张的分级系统能够区分出中度上尿路积水且手术风险较高的患儿。
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