超声检测脐动脉和大脑中动脉阻力指数对胎儿窘迫的预测价值

Predictive value of umbilical artery and middle cerebral artery resistance index by ultrasonography in fetal distress

目的探讨超声检测脐动脉和大脑中动脉(MCA)阻力指数(RI)对胎儿窘迫的预测价值。方法选取胎儿窘迫孕妇100例(窘迫组)和同期正常孕妇100例(对照组),应用超声检测两组胎儿脐动脉和MCA的RI(RI_(UA)、RI_(MCA)),并计算其比值(RI_(UA/MCA)),结果进行对比分析;绘制ROC曲线分析RIUA、RIMCA及RI_(UA/MCA)对胎儿窘迫的预测价值。结果窘迫组RI_(UA)和RI_(UA/MCA)均明显高于对照组,RIMCA明显低于对照组,差异均有统计学意义(均P<0.05)。ROC曲线显示,以RIUA>0.68为截断值,其预测胎儿窘迫的敏感性、特异性、准确性及曲线下面积(AUC)分别为84%、82%、83%及0.624;以RIMCA<0.87为截断值,其预测胎儿窘迫的敏感性、特异性、准确性及AUC分别为88%、84%、86%及0.668;以RI_(UA/MCA)>0.70为截断值,其预测胎儿窘迫的敏感性、特异性、准确性及AUC分别为96%、94%、95%及0.783。RI_(UA/MCA)预测胎儿窘迫的敏感性、特异性及准确性明显高于RI_(UA)和RI_(MCA),差异均有统计学意义(均P<0.05)。结论 RI_(UA)和RI_(MCA)可作为预测胎儿窘迫的重要参考指标,联合检测指标RI_(UA/MCA)诊断效能更高,值得临床推广应用。

Objective To explore the predictive value of umbilical artery(UA)and middle cerebral artery(MCA)resistance index(RI)detected by ultrasonography in fetal distress.Methods One hundred pregnant woman with fetal distress were selected as distress group,and 100 normal pregnant woman were selected as control group at the same time.UA’s RI(RIUA)and MCA’s RI(RIMCA)were detected by ultrasonography in all pregnant woman,and their ratio(RIUA/MCA)was calculated,the results of two groups were compared and analyzed.The predictive value of RIUA,RIMCA and RIUA/MCA for fetal distress were analyzed by ROC curve.Results The RIUA and RIUA/MCA in distress group were significantly higher than those in control group(all P<0.05),and RIMCA in distress group was significantly lower than that in control group(P<0.05).ROC curve showed that taken RIUA>0.68 as the critical value,the sensitivity,specificity,accuracy and area under the curve(AUC)of predicting fetal distress were 84%,82%,83%,0.624,respectively.Taken RIMCA<0.87 as the critical value,the sensitivity,specificity,accuracy and AUC were 88%,84%,86%,0.668,respectively.Taken RIUA/MCA>0.70 as the critical value,the sensitivity,specificity,accuracy and AUC were 96%,94%,95%,0.783,respectively.The sensitivity,specificity and accuracy of RIUA/MCA were significantly higher than those of RIUA and RIMCA in predicting fetal distress(all P<0.05).Conclusion RIUA and RIMCA detected by ultrasonography can be used as the important reference indexes for predicting fetal distress.The combined detection index RIUA/MCA has higher diagnostic efficiency,it’s worth for further clinical promotion.