孕中晚期胎儿超声生物学指标Z-评分值评估胎儿生长发育的应用研究

Application of fetal ultrasonic biometric parameter Z-scores in assessing fetal growth in the mid and late stage of pregnancy

目的探讨孕中、晚期超声生物学指标的Z-评分值评估胎儿生长发育的应用价值。方法选取我院分娩的单胎孕妇中,筛查出巨大儿103例(A组),胎儿生长受限48例(B组),合并妊娠期糖尿病(GDM)而血糖控制满意、出生体质量正常儿169例(C组),另选正常妊娠、胎儿体质量正常的196例为正常对照组。回顾分析各组中孕期(20+1~24周)、晚孕早期(28+1~33周)、晚孕晚期(34+1周~分娩)的生长参数,包括胎儿双顶径、头围、腹围、股骨长、头腹围比值、腹围的Z-评分及头腹围比值的Z-评分,比较各组间上述参数的差异。结果在中孕期、晚孕早期、晚孕晚期三个阶段,A组腹围的Z-评分值明显大于正常对照组,B组腹围的Z-评分值明显小于正常对照组,差异均有统计学意义(均P<0.05),且随孕周的增加,A、B组腹围的Z-评分值与正常对照组的偏离度进行性加大。C组在中孕期、晚孕早期腹围的Z-评分值与正常对照组比较差异均无统计学意义,仅在晚孕晚期高于正常对照组,差异有统计学意义(P=0.045)。A组的GDM与非GDM胎儿在体型上存在差异,表现为晚孕后期GDM胎儿头腹围比的Z-评分值小于非GDM胎儿,差异有统计学意义(P<0.05)。中孕期A组的腹围与正常对照组比较差异有统计学意义(P<0.05);晚孕早期和晚孕晚期A、B组双顶径、头围、腹围、股骨长及头腹围比值与正常对照组比较,差异均有统计学意义(均P<0.05),但无法直观判断各指标与正常对照组的偏离程度。结论超声生物学指标的Z-评分有助于准确定量评估胎儿宫内生长发育状况,在诊断胎儿宫内生长发育异常及动态观察随访中有一定临床应用价值。

Objective To explore the application value of fetal ultrasonic biometric parameter Z-scores in assessing fetal growth in the mid and late stage of pregnancy.Methods One hundred and three cases of macrosomic fetuses（group A）,48 cases of fetal growth retardation（group B）,and 169 cases of normal birth weight infants（mothers with GDM had their blood sugar controlled well,and were selected for GDM-normal weight（group C）.Other 196 cases of normal birth weight infants had normal pregnany were selected as control group.The fetal abdominal circumference（AC）,head circumference（HC）,biparietal diameter（BPD）,femoral length（FL）,ratio of AC and HC,Z-scores of AC and HC were measured at 20＋1~24,28＋1~33 and 34＋1 pregnant weeks,the difference among three groups was compared.Results At 20＋1~24,28＋1~33 and 34＋1 pregnant weeks,the Z-scores of AC in group A were higher than that in control group,while Z-scores of AC in group B were lower than that in control group（all P〈0.05）.The Z-scores of AC in group A showed a progressive increase,and the Z-scores of AC in group B declined progressively.The Z-scores of AC had no significant difference between group C and the control group at 20＋1~24 and 28＋1~33 pregnant weeks,the significant difference was found between these two groups at 34＋1 pregnant weeks（P=0.045）.At 34＋1 pregnant weeks,the Z-scores of HC/AC ratio in group A was higher than that of normal-macrosomia group（P〈0.05）.As to traditional ultrasonic biological parameters,only the AC in group A was different from that of the control group at 20＋1~24 weeks（P〈0.05）.At 28＋1~33 weeks and 34＋1 weeks to delivery,the BPD,HC,AC,FL,HC/AC of group A and group B were different from those of the control group（all P〈0.05）.But the degree of data values deviating from the means could not be shown visually with traditional ultrasonic biological parameters.Conclusion The fetal ultrasonic biometric Z-scores could provide quantitative evidence in fetal growth,and evaluate fetal developmental outcomes more accurately and effectively.