胎儿脑-胎盘率对胎儿宫内生长受限临床预后研究

Cerebroplacental doppler ratio as a predictor of adverse perinatal outcome in intrauterine growth restriction

目的探索胎儿脑-胎盘率(cerebro-placental ratio,CPR)预测胎儿宫内生长受限(intra uterine growth restriction,IUGR)胎儿不良妊娠结局的价值。方法回顾分析2013年7月1日至2016年7月1日在广东省妇幼保健院超声诊断科行Ⅲ级产前超声检查诊断为胎儿宫内生长受限胎儿的CPR值,以CPR<1.08为异常,探索其对IUGR胎儿围产期发病率、死亡率、出生体重、阿普加评分、新生儿并发症等不良妊娠结局预测价值。结果在211例研究对象中,共有111例(52.3%)研究对象表现出至少1种不良胎儿结局。CPR<1.08预测小于胎龄儿(IUGR<10%)的灵敏度为75%,特异度为63%,阳性预测值为69%,阴性预测值为69%,ROC曲线AUC为74%。对早发性IUGR,CPR<1.08预测小于胎龄儿(<34周)(IUGR<10%)的灵敏度为87%,特异度为43%,阳性预测值为83%,阴性预测值为50%,ROC曲线AUC为80%。结论 CPR异常可作为IUGR高风险胎儿,尤其是早发性IUGR胎儿围产期结局的潜在指标,对IUGR胎儿不良妊娠结局有预测作用。

Objective The purpose of this study was to detect the impact of using the cerebro-placental Doppler ratio （CPR） in the prediction of adverse perinatal outcomes in growth-restricted pregnancies. Method A retrospective cohortstudy of cases of intrauterine growth restriction over a 3-year period was conducted. The umbilicalartery and middle cerebral artery pulsatility indices were converted to CPRs. The CPR of less than 1.08 was used in predicting adverse outcomes. Adverse perinatal outcomes evaluated included cesarean delivery for fetal distress, 5-minute Apgar scores less than 7.0, intraventricular hemorrhage, respiratory distress syndrome, and perinatal death. Results In 211 pregnancies meeting our inclusion criteria, there were 111 with at least 1 adverse outcome. With the use of a CPR ratio less than 1.08, the sensitivity, specificity, and positive and negative predictive values for predicting anadverse outcome were 75 %, 630%, 69% and 69%, respectively; area under the receiver operating characteristic curve, 0.74. With a CPR threshold of less than 1.08 for cases with IUGR at less than 34 weeks, the sensitivity, specificity, and positive and negative predictive values were 87%, 43%, 83%, and 50%; area under the receiver operating characteristic curve, 0.80. Conclusions An abnormal CPR is associated with adverse perinatal outcomes in growth-restricted fetuses, especially with IUGR at less than 34 weeks.