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文献速递母胎医学产科

孕中期与孕晚期诊断后尿道瓣膜的肾功能差异

Prenatal Diagnosis of Posterior Urethral Valves: Timing of Diagnosis and Mid-Term Renal Function When Second and Third Trimester Ultrasounds Are Systematically Performed.
PubMed 文献 · Prenat Diagn · 2026-04-21

该回顾性队列纳入72例产前疑似、产后确诊的后尿道瓣膜男婴，均在孕中期和孕晚期接受系统超声检查。51%在孕28周前（孕中期）确诊，其最低肌酐更高、中期eGFR更低，提示孕中期诊断与更差的肾功能相关。

要点

  • 孕中期诊断的PUV患儿最低肌酐中位数38 μmol/L，高于孕晚期的26 μmol/L（p<0.05）。
  • 孕中期诊断者中期随访eGFR中位数85 mL/min/1.73 m2，低于孕晚期的105 mL/min/1.73 m2（p<0.05）。
  • PUV产前诊断报告建议按孕中期与孕晚期二分，以区分预后。

核心结论

  • 孕中期疑似PUV与更差的最低肌酐和中期肾功能相关，显著差于孕晚期疑似者。
  • PUV产前诊断报告应区分孕中期与孕晚期诊断。

研究设计与样本

  • 回顾性分析前瞻性队列，纳入产前疑似且产后确诊的PUV男婴72例。
  • 按产前超声发现泌尿道异常的时间分为孕中期组与孕晚期组。
  • 比较最低肌酐和随访超过5年的中期eGFR。

主要发现

  • 孕中期组最低肌酐中位数38 μmol/L，孕晚期组26 μmol/L（p<0.05）。
  • 孕中期组中期eGFR中位数85 mL/min/1.73 m2，孕晚期组105 mL/min/1.73 m2（p<0.05）。

关键数值与推荐

  • 孕中期组最低肌酐中位数38 μmol/L，孕晚期组26 μmol/L（p<0.05）。
  • 孕中期组中期eGFR中位数85 mL/min/1.73 m2，孕晚期组105 mL/min/1.73 m2（p<0.05）。
  • PUV产前诊断报告应分为孕中期与孕晚期诊断。
  • PUV真正可产前诊断的比率高于预期。

临床怎么用

  • 对孕中期超声怀疑PUV的胎儿应加强产后肾功能监测与随访。
  • 产前咨询中应告知孕中期诊断可能预示更差的中期肾功能。
  • PUV产前诊断报告建议按孕中期与孕晚期分层记录。

以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。

原文

OBJECTIVE: The impact of prenatal diagnosis timing in posterior urethral valves is unclear. We aimed to compare renal function between patients with suspected PUV diagnosed before or after 28 weeks of gestation in a population who underwent systematic T2 and T3 ultrasounds. METHODS: We performed a retrospective analysis of a prospective cohort of patients with prenatally suspected and postnatally confirmed PUV. Patients were stratified by timing of prenatal ultrasound detection of urinary tract abnormalities (T2 vs T3). We compared nadir creatinine and mid-term eGFR (> 5 years of follow-up). RESULTS: 72 boys with postnatally confirmed PUV were included. Thirty-seven patients (51%) were diagnosed before 28 weeks' gestation (T2 group). This early group had significantly higher NC values (median 38 vs. 26 μmol/L, p < 0.05) and lower eGFR at mid-term follow-up (median 85 vs. 105 mL/min/1.73 m2, p < 0.05) compared to the T3 group. CONCLUSIONS: PUV suspected during the second trimester of gestation is associated with significantly worse NC and mid-term renal function compared with those suspected later in pregnancy (T3). Reports of prenatal diagnosis of PUV should dichotomize between T2 and T3 diagnoses. The true rate of PUV that could be diagnosed prenatally is higher than expected.

来源：Prenat Diagn，查看原文。版权归原作者所有。

引用

  1. Pecorelli S, Glenisson M, Peycelon M, et al. Prenatal Diagnosis of Posterior Urethral Valves: Timing of Diagnosis and Mid-Term Renal Function When Second and Third Trimester Ultrasounds Are Systematically Performed. Prenat Diagn. 2026. PMID: 42012795. doi:10.1002/pd.70155
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供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。