Zhang Dan, Sun Xielu, Chen Xiaole, Yu Beibei, Li Tianran, Cheng Yueyue, Ye Manjing, Lin Lingling, Ma Lie, Zhao Yaping, Li Pihong
Department of Ultrasonography, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China.
Department of General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China.
Exp Ther Med. 2019 Aug;18(2):1399-1406. doi: 10.3892/etm.2019.7683. Epub 2019 Jun 18.
Fetal hydronephrosis (HY) is a frequent congenital condition, which may be detected by prenatal ultrasound. Society for Fetal Urology (SFU) and anterior-posterior diameter (APD) grading are two major grading systems based on ultrasonography. The present study aimed to assess the predictive value of the SFU and APD grades in patients with fetal HY. A total of 162 patients with 234 kidneys affected by HY were included in the present study. The SFU and APD grades were determined from the ultrasound images at 38 gestational weeks, and a 12-month follow-up was performed after birth. The associations of the SFU and APD grades with the outcome of fetal HY, including HY regression, and post-partum surgery were examined. In the present study, 16 patients with 17 kidneys were diagnosed with pathological HY, and stenosis at the ureteropelvic junction was demonstrated to be a leading cause of pathological HY. Among the 234 kidneys affected by HY, 161 kidneys were scored as SFU grade I, 57 as SFU grade II, 7 as SFU grade III and 9 kidneys as SFU grade IV. According to the APD grading system, 112 kidneys were determined as having low, 104 as having moderate and 18 as having severe HY. The SFU and APD grades were demonstrated to be independently associated with the occurrence of pathological HY by logistic regression analysis with a high diagnostic accuracy to distinguish pathological and physiological HY cases as evidenced by the results of ROC analysis. In addition, univariate and multivariate logistic regression analysis indicated that patients with spontaneous HY regression usually had low SFU and APD grades. Furthermore, the rate of surgery was increased in the group of patients with high SFU or APD grades, and these two systems were identified as independent predictors for the requirement of surgery by Kaplan-Meier analysis. Patients with pathological HY had high SFU and APD grades, and these two grading systems may be used as reliable predictors for the outcome of fetal HY, including HY regression, and post-partum surgery.
胎儿肾积水（HY）是一种常见的先天性疾病，可通过产前超声检测出来。胎儿泌尿外科学会（SFU）分级和前后径（APD）分级是基于超声检查的两种主要分级系统。本研究旨在评估SFU和APD分级对胎儿HY患者的预测价值。本研究共纳入162例患者，其234个肾脏受到HY影响。在孕38周时根据超声图像确定SFU和APD分级，并在出生后进行12个月的随访。研究了SFU和APD分级与胎儿HY结局的相关性，包括HY消退和产后手术情况。在本研究中，16例患者的17个肾脏被诊断为病理性HY，输尿管肾盂连接处狭窄被证明是病理性HY的主要原因。在234个受HY影响的肾脏中，161个肾脏被评为SFU I级，57个为SFU II级，7个为SFU III级，9个肾脏为SFU IV级。根据APD分级系统，112个肾脏被确定为轻度，104个为中度，18个为重度HY。通过逻辑回归分析表明，SFU和APD分级与病理性HY的发生独立相关，ROC分析结果证明其具有较高的诊断准确性，能够区分病理性和生理性HY病例。此外，单因素和多因素逻辑回归分析表明，自发HY消退的患者通常具有较低的SFU和APD分级。此外，SFU或APD分级高的患者组手术率增加，通过Kaplan-Meier分析确定这两个系统是手术需求的独立预测因素。病理性HY患者的SFU和APD分级较高，这两个分级系统可作为胎儿HY结局的可靠预测指标，包括HY消退和产后手术情况
