APD联合RCT分级对胎儿肾盂扩张及新生儿肾功能的预测价值

doi:10.11958/20253139

天津医药 ›› 2026, Vol. 54 ›› Issue (5): 489-493.doi: 10.11958/20253139

APD联合RCT分级对胎儿肾盂扩张及新生儿肾功能的预测价值

庞静(), 焦艳, 朱海丽, 高芳, 李俊杰, 李雪凤^△()

秦皇岛市妇幼保健院超声科（邮编066001）

收稿日期:2025-10-14 修回日期:2025-11-14 出版日期:2026-05-15 发布日期:2026-05-13
通讯作者: ^△E-mail：18633518358@163.com
作者简介:庞静（1984），女，副主任医师，主要从事妇产科和儿科超声方面研究。E-mail：ququanfu876770@163.com
基金资助:
秦皇岛市科学技术研究与发展计划(202301A210)

Prediction value of APD combined with RCT grading for fetal renal pelvis dilatation and neonatal renal function

PANG Jing(), JIAO Yan, ZHU Haili, GAO Fang, LI Junjie, LI Xuefeng^△()

Department of Ultrasound, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao 066001, China

Received:2025-10-14 Revised:2025-11-14 Published:2026-05-15 Online:2026-05-13
Contact: ^△E-mail：18633518358@163.com

庞静, 焦艳, 朱海丽, 高芳, 李俊杰, 李雪凤. APD联合RCT分级对胎儿肾盂扩张及新生儿肾功能的预测价值[J]. 天津医药, 2026, 54(5): 489-493.

PANG Jing, JIAO Yan, ZHU Haili, GAO Fang, LI Junjie, LI Xuefeng. Prediction value of APD combined with RCT grading for fetal renal pelvis dilatation and neonatal renal function[J]. Tianjin Medical Journal, 2026, 54(5): 489-493.

摘要/Abstract

摘要：

目的探讨肾盂前后径（APD）联合肾皮质厚度（RCT）分级对胎儿肾盂扩张及新生儿肾功能的预测价值。方法回顾性纳入产前超声诊断为肾盂扩张的186例胎儿；根据产后随访分为肾功能正常组（146例）与肾功能异常组（40例）；采用Logistic回归分析危险因素，构建APD-RCT联合分级标准，通过受试者工作特征（ROC）曲线及Kappa检验评估其预测效能及一致性。结果肾功能异常组的APD更高、RCT更低，且肾实质回声增强、膀胱壁增厚、羊水过少比例更高（P<0.05）；多因素Logistic回归分析结果显示，APD上升、RCT下降、肾实质回声增强、膀胱壁增厚、羊水过少为肾盂扩张胎儿肾功能异常的危险因素[OR（95%CI）分别为2.369（1.753~3.204）、0.734（0.557~0.968）、3.394（1.696~6.793）、2.089（1.344~3.247）、2.774（1.938~3.971）；随APD-RCT分级升高（Ⅰ—Ⅳ级），肾功能异常率逐级递增（2.6%、10.5%、40.0%、92.9%，P<0.01）；ROC曲线分析显示，APD-RCT分级系统预测肾功能异常的曲线下面积为0.922（95%CI：0.874~0.956），加权Kappa值为0.86，一致性较高。结论 APD-RCT联合分级系统能有效预测胎儿肾盂扩张的新生儿肾功能异常，具有良好的临床应用价值。

关键词: 肾盂扩张, 肾功能试验, 超声检查, 产前, 肾盂前后径, 肾皮质厚度

Abstract:

Objective To investingate the predictive value of a grading system based on the anteroposterior diameter of the renal pelvis (APD) combined with renal cortex thickness (RCT) for fetal renal pelvis dilation and neonatal renal function. Methods A retrospective study was conducted on 186 fetuses diagnosed with renal pelvis dilation by prenatal ultrasound at Qinhuangdao Maternal and Child Health Hospital. Based on postpartum follow-up, they were divided into the normal renal function group (n=146) and the abnormal renal function group (n=40). Logistic regression was used to analyze risk factors, and a combined APD-RCT grading standard was established. The predictive efficacy and consistency were evaluated using ROC curves and Kappa test. Results There were significantly higher APD, higher proportion of renal parenchyma echo enhancement, bladder wall thickening and oligohydramnios, while RCT was significantly lower in the abnormal renal function group (P<0.05). Multivariate Logistic regression analysis showed that increased APD, decreased RCT, renal parenchyma echo enhancement, bladder wall thickening and oligohydramnios were independent risk factors for abnormal renal function [OR(95%CI): 2.369 (1.753-3.204), 0.734 (0.557-0.968), 3.394 (1.696-6.793), 2.089 (1.344-3.247), 2.774 (1.938-3.971), respectively]. With the increase of APD-RCT grade (from I to IV), the rate of renal dysfunction increased progressively (2.6%, 10.5%, 40.0%, 92.9%, P<0.01). ROC analysis showed that the APD-RCT grading system predicted abnormal renal function with an AUC of 0.922. The weighted Kappa value was 0.86, indicating high consistency. Conclusion The combined APD-RCT grading system can effectively predict neonatal renal function abnormality in fetuses with renal pelvis dilation and demonstrate good clinical application value.

Key words: pyelectasis, kidney function tests, ultrasonography, prenatal, anteroposterior diameter of renal pelvis, renal cortex thickness

中图分类号:

R445.1

图/表 4

参考文献 17

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组别	n		年龄/岁		孕周/周	胎儿男性		APD/mm
肾功能正常组	146		28.5±4.2		38.4±1.1	77（52.7）		7.8±2.0
肾功能异常组	40		29.3±4.6		38.3±1.4	21（52.5）		12.9±3.4
t或χ²			1.045		0.479	0.001		12.074^＊＊
组别		RCT/mm		肾实质回声增强			膀胱壁增厚		羊水过少
肾功能正常组		4.2±0.6		18（12.3）			13（8.9）		10（6.8）
肾功能异常组		2.5±0.7		22（55.0）			17（42.5）		13（32.5）
t或χ²		15.301^＊＊		33.868^＊＊			26.197^＊＊		16.770^＊＊

组别	n		年龄/岁		孕周/周	胎儿男性		APD/mm
肾功能正常组	146		28.5±4.2		38.4±1.1	77（52.7）		7.8±2.0
肾功能异常组	40		29.3±4.6		38.3±1.4	21（52.5）		12.9±3.4
t或χ²			1.045		0.479	0.001		12.074^＊＊
组别		RCT/mm		肾实质回声增强			膀胱壁增厚		羊水过少
肾功能正常组		4.2±0.6		18（12.3）			13（8.9）		10（6.8）
肾功能异常组		2.5±0.7		22（55.0）			17（42.5）		13（32.5）
t或χ²		15.301^＊＊		33.868^＊＊			26.197^＊＊		16.770^＊＊

变量	β	SE	Wald χ²	P	OR	OR 95%CI
APD	0.862	0.154	31.365	<0.001	2.369	1.753~3.204
RCT	-0.309	0.141	4.812	0.028	0.734	0.557~0.968
肾实质回声增强	1.222	0.354	11.916	0.001	3.394	1.696~6.793
膀胱壁增厚	0.737	0.225	10.720	0.001	2.089	1.344~3.247
羊水过少	1.020	0.183	31.085	<0.001	2.774	1.938~3.971
常数项	2.586	6.989	1.178	0.278	70.408

变量	β	SE	Wald χ²	P	OR	OR 95%CI
APD	0.862	0.154	31.365	<0.001	2.369	1.753~3.204
RCT	-0.309	0.141	4.812	0.028	0.734	0.557~0.968
肾实质回声增强	1.222	0.354	11.916	0.001	3.394	1.696~6.793
膀胱壁增厚	0.737	0.225	10.720	0.001	2.089	1.344~3.247
羊水过少	1.020	0.183	31.085	<0.001	2.774	1.938~3.971
常数项	2.586	6.989	1.178	0.278	70.408

指标	最佳截断点	敏感度/ %	特异度/ %	AUC	95%CI
APD	10.6	77.5	83.6	0.797	0.732~0.852
RCT	3.4	80.0	78.8	0.713	0.642~0.777
APD-RCT联合分级		90.0	87.7	0.922	0.874~0.956

APD联合RCT分级对胎儿肾盂扩张及新生儿肾功能的预测价值

Prediction value of APD combined with RCT grading for fetal renal pelvis dilatation and neonatal renal function

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