Wang Zhan, Tang Daxing, Tian Hongjuan, Yang Fang, Wen Hong, Wang Junmei, Tao Chang
The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
Department of Obstetrics and Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Jul 25;48(5):493-498. doi: 10.3785/j.issn.1008-9292.2019.10.05.
To assess the value of fetal anteroposterior renal pelvic diameter (APD) in predicting antenatal hydronephrosis requiring surgical treatment after birth.
A total of 525 cases of antenatal hydronephrosis detected by prenatal ultrasonography (ultrasound index APD ≥ 4 mm in the second trimester and APD ≥ 7 mm in the third trimester) in Zhejiang Prenatal Diagnosis Center from June 2007 to June 2018 were retrospectively analyzed. ROC curve was used to analyze the relationship between these ultrasound indicators and the requirement for surgical treatment after birth.
There were 162 cases (30.9%) diagnosed in the second trimester and 363 cases (69.1%) diagnosed in the third trimester; 131 cases were diagnosed pathologically after birth, of which 121 finally underwent surgical treatment. The area under ROC curve (AUC) of APD in middle pregnancy for prediction of requiring surgery 1-12 years after birth was 0.910; the cut-off value of APD was 8.45 mm with a sensitivity of 97.1%, specificity of 70.9%, positive predictive value (PPV) of 47.9%, and negative predictive value (NPV) of 98.9%. The AUC of APD in late pregnancy for prediction of requiring surgery 1-12 years after birth was 0.800; the cut-off value of APD was 12.25 mm with a sensitivity of 66.7%, specificity of 81.2%, PPV of 51.7%, and NPV of 89.1%.
APD in pregnancy can be used to predict whether the fetus with hydronephrosis needs surgical treatment after birth, and the prediction value of APD in the middle pregnancy is better.
评估胎儿肾盂前后径（APD）在预测出生后需手术治疗的产前肾积水方面的价值。
回顾性分析2007年6月至2018年6月在浙江省产前诊断中心经产前超声检查发现的525例产前肾积水病例（超声指标：孕中期APD≥4mm，孕晚期APD≥7mm）。采用ROC曲线分析这些超声指标与出生后手术治疗需求之间的关系。
孕中期诊断出162例（30.9%），孕晚期诊断出363例（69.1%）；出生后131例经病理诊断，其中121例最终接受了手术治疗。孕中期APD预测出生后1至12年需手术治疗的ROC曲线下面积（AUC）为0.910；APD的截断值为8.45mm，敏感性为97.1%，特异性为70.9%，阳性预测值（PPV）为47.9%，阴性预测值（NPV）为98.9%。孕晚期APD预测出生后1至12年需手术治疗的AUC为0.800；APD的截断值为12.25mm，敏感性为66.7%，特异性为81.2%，PPV为51.7%，NPV为89.1%。
孕期APD可用于预测肾积水胎儿出生后是否需要手术治疗，且孕中期APD的预测价值更好。
