Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Stirnemann J J, Guimiot F, Heidet L, Favre R, Salomon L J, Oury J F, Ville Y, Muller F
Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, AP-HP, Paris, France.
University Paris Descartes and Sorbonne Paris-Cité, Paris, France.
Ultrasound Obstet Gynecol. 2017 May;49(5):617-622. doi: 10.1002/uog.15968. Epub 2017 Mar 29.
Fetal serum β2-microglobulin has been shown to predict postnatal renal outcome in cases of fetal obstructive uropathy. We assessed the value of serial measurements of fetal serum β2-microglobulin in the prediction of postnatal renal outcome.
We retrospectively studied renal outcome in 42 fetuses with bilateral or low urinary tract obstruction that had fetal blood sampling on at least two occasions to assay serum levels of β2-microglobulin. Amniotic fluid volume at the time of each sampling was recorded. We classified renal outcome as either favorable (when postnatal renal function was normal) or adverse (when postnatal chronic renal failure occurred or when renal dysplasia at autopsy was noted). A β2-microglobulin cut-off of 5 mg/L and amniotic fluid index of 5 cm were used to predict postnatal renal outcome.
Renal outcome was adverse in 28 cases and favorable in 14. In 12 (28.6%) cases, fetal serum β2-microglobulin concentration differed between the first and last measurement. Prediction of postnatal renal outcome was correct in 11 of these cases based on the last β2-microglobulin measurement. The sensitivity of β2-microglobulin in predicting renal outcome was significantly higher (P = 0.005) when using the last rather than the first measurement (96.4% vs 64.3%), with similar specificity for both measurements (85.7% vs 78.6%, non-significant). The sensitivity of amniotic fluid volume was also significantly higher (P = 0.005) when using the last rather than the first measurement (75.0% vs 35.7%), with similar specificity for both measurements (64.3% vs 71.4%, non-significant).
Sequential measurement of serum β2-microglobulin, performed for adverse ultrasound findings, such as renal parenchymal abnormality or decreasing amniotic fluid volume, predicts postnatal renal outcome more accurately than does a single assay. This may be due to possible worsening of renal injury with increasing duration of urinary tract obstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
胎儿血清β2微球蛋白已被证明可预测胎儿梗阻性肾病病例的产后肾脏结局。我们评估了连续测量胎儿血清β2微球蛋白在预测产后肾脏结局中的价值。
我们回顾性研究了42例双侧或下尿路梗阻胎儿的肾脏结局，这些胎儿至少有两次进行了胎儿血样采集以检测血清β2微球蛋白水平。每次采样时记录羊水体积。我们将肾脏结局分为良好（产后肾功能正常）或不良（产后发生慢性肾衰竭或尸检时发现肾发育异常）。使用5 mg/L的β2微球蛋白临界值和5 cm的羊水指数来预测产后肾脏结局。
28例肾脏结局不良，14例良好。在12例（28.6%）病例中，首次和末次测量的胎儿血清β2微球蛋白浓度不同。基于末次β2微球蛋白测量，其中11例病例对产后肾脏结局的预测是正确的。使用末次而非首次测量时，β2微球蛋白预测肾脏结局的敏感性显著更高（P = 0.005）（96.4%对64.3%），两次测量的特异性相似（85.7%对78.6%，无显著差异）。使用末次而非首次测量时，羊水体积的敏感性也显著更高（P = 0.005）（75.0%对35.7%），两次测量的特异性相似（64.3%对71.4%，无显著差异）。
对于超声检查发现的不良结果，如肾实质异常或羊水减少，连续测量血清β2微球蛋白比单次检测更能准确预测产后肾脏结局。这可能是由于尿路梗阻时间延长导致肾损伤可能加重。版权所有© 2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
