超声诊断胎儿生长受限的研究进展

Advances Research in Fetal Growth Restriction

胎儿生长受限(fetal growth restriction,FGR)是一个复杂的多因素疾病,病因有母体因素、胎儿染色体或结构异常及胎盘功能不全,与围生儿发病率和死亡率相关,并可能对围生儿的预后有重要影响,影响儿童和青少年时期身体发育和神经发育,并可引起成人时期的心血管疾患,最危险因素为长期的神经学预后,但在何种程度上胎儿会出现神经发育不良尚未明确。多普勒无创血流动力学指标是诊断和监测FGR的主要手段,阐述FGR情况下脐动脉、大脑中动脉、静脉导管的多普勒血流变化,可提供重要的诊断和预后信息,而静脉导管多普勒参数被大多数欧洲围生协会认为是妊娠32周前管理FGR的有效参考手段。虽然多普勒测速仪在FGR领域已研究得很深入,但作为管理指南仍然是存在争议的,不建议单独管理FGR。未来研究方向应着眼于FGR的治疗,并预测出有FGR病史的儿童甚至成年后可能出现的疾患,进行一级预防降低发病率。

Fetal growth restriction（FGR） is a complex and multifactorial disease. The causes include maternal factors,fetal chromosomal or structural abnormalities, and placental dysfunction. It is significantly related to the morbidity and mortality of perinatal infants, and may have an important impact on the prognosis of perinatal infants, affecting the physical development and neuro development in children and adolescents, and causing adult cardiovascular disease. The most dangerous factor is long-term neurologic prognosis, but it is not clear that to what extent the fetus will have neurodevelopmental dysplasia. Doppler is noninvasive and its hemodynamic index is the main means to diagnose and monitor FGR. The changes in the Doppler blood flow of the umbilical artery, the middle cerebral artery, and the ductus venosus under the condition of FGR provide important diagnostic and prognostic information, while the Doppler parameters of ductus venosus is recommended by most European perinatal associations as effective means to manage FGR before 32 weeks. Though Doppler has been studied deeply in the field of FGR, it is still controversial in the management guide. It is not recommended to manage FGR alone. We should focus on the treatment of FGR, the prediction of the possible diseases of the children even adults with the history of FGR, and the primary prevention and reduction of the incidence of the disease in the future research.