超声检测胎儿骨骺次级骨化中心和胎盘分级的临床意义

The clinical values of sonographic measurement of the epiphyseal second ossification centers and placental grading

目的:探讨超声测量胎儿骨骺次级骨化中心和胎盘分级对评估孕龄和胎肺成熟度的临床意义。方法:前瞻性研究从359例孕龄准确的单胎孕妇中获得的518人次超声检查结果,分析胎儿股骨远端次级骨化中心(DFSOC)、胫骨近端次级骨化中心(PTSOC)和胎盘分级与孕龄的关系。选取其中在分娩前1周内接受超声检查且资料完整的184例孕妇,根据新生儿是否发生呼吸窘迫综合征(RDS)分为RDS组(15例)和non-RDS组(169例)。比较两组的DFSOC和PTSOC显示率及胎盘分级情况,并采用Logistic回归分析校正孕周影响,了解DFSOC、PTSOC和胎盘分级与出生后发生RDS的相关性。结果:(1)DFSOC、PTSOC和胎盘分级与超声检查孕周之间均呈正相关,Spearman相关系数分别为0.831、0.716和0.859(P均<0.001)。(2)DFSOC、PTSOC和胎盘Ⅰ级以上分别预示胎儿至少已32周、37周和35周的准确度高达88.03%、89.58%和91.51%。(3)RDS组和non-RDS组的DFSOC、PTSOC显示率及胎盘分级比较,差异均有统计学意义(P均<0.001);但校正分娩孕周的影响后,三者与出生后的RDS的发生均无显著相关性(P>0.05)。结论:胎儿DFSOC、PTSOC和胎盘分级有助于临床上评估某些关键的孕龄,但并不是评估胎肺成熟度的可靠指标。

Objective： To explore the clinical values of sonographic measurement of the epiphyseal secondary ossification centers and placental grading in the estimation of gestational age and fetal lung maturity. Methods： 518 ultrasound examinations in 359 singleton pregnant women with accurately established gestational age was chosen in this prospective study to ex-SOC, PTSOC and placental grading were compared between two groups. Logistic regression analysis was used to explore the relationship between the development of RDS and DFSOC, PTSOC or placental grading. Results： （ 1 ） Fetal DFSOC, PTSOC and placental grading were positively correlated with gestational weeks （ spearman coefficient 0. 831,0. 716 and 0. 859, respectively, P〈0. 001）. （2）The presence of DFSOC or PTSOC,as well as grade Ⅱ or Ⅲ placenta had overall accuracy 88.03% ,g9.58% and 91.51% for indicating a fetus of at least 32,37 and 35 weeks of gestation, respectively. （3） There were significant differences in the rates of visibilities about DFSOC, PTSOC and placental grading between RDS group and non-RDS group （P 〈 0. 001 ）. However, these three parameters were not associated with the postnatal development of RDS by Binary Logistic regression analysis after adjustments for gestational age （P〉0. 05 ）. Conclusion：Fetal DFSOC, PTSOC and placental grading can be useful in estimating some specific and critical gestational age ,but may not be reliable markers to assess fetal lung maturity.