胎儿血流动力学参数对胆汁淤积导致胎儿窘迫的诊断价值

The value of fetal hemodynamic parameters by ultrasound for dignosing fetal distress caused by intrahepatic cholestasis during pregnancy

目的:探讨超声检测胎儿血流动力学参数对妊娠期胆汁淤积症(ICP)导致胎儿窘迫的诊断价值。方法:选取2017年10月-2018年10月本院收治的300例孕妇,其中100例正常孕妇为对照组,200例ICP根据胆汁淤积程度分为轻度组、重度组。测量所有胎儿胎儿脐动脉(UA)及大脑中动脉(MCA)阻力指数(RI),搏动指数(PI)及收缩期最大血流速度(Vs)与舒张末期血流速度(Vd)的比值(S/D),计算胎儿UA和MCA的阻力比值。绘制ROC曲线。结果:重度组UA的血流动力学参数RI、PI、S/D最高,各参数ROC曲线下面积均>0.7(P<0.05),其中RI敏感度、特异性、曲线下面积均最高;胎儿MCA血流参数RI、PI、S/D最高,各参数ROC曲线下面积均>0.8(P<0.05),其中PI的敏感度、特异性、曲线下面积均最高。结论:超声检测UA及MCA可用于预测ICP胎儿窘迫,其中UA的RI及MCA的PI更适宜于临床检测。

Objective:To investigate the value of fetal hemodynamic parameters by ultrasound for dignosing fetal distress caused by intrahepatic cholestasis during pregnancy(ICP).Methods:100 normal pregnant women were selected in group A,and 200 pregnant women with ICP were were selected in group B(women with mild ICP)and in group C(women with severe ICP)from October 2017 to October 2018.The values of resistance index(RI),Pulsatility index(PI),and the ratio of systolic blood pressure and diastolic blood pressure(S/D)of UA and MCA of women were determined and compared among the three groups.The ROC curve was drawn by RI,PI and S/D of UA and MCA.Results:There was significant different in RI,PI and S/D of UA between the three groups.The value of RI,PI or S/D of UA of women in group C was the highest(P<0.05).The area under ROC curve of RI,PI or S/D of UA was over 0.7(P<0.05).The sensitivity,specificity,and area under ROC curve of RI of UA were the highest.The value of RI,PI or S/D of MCA of women in group C was the highest(P<0.05).The area under ROC curve of RI,PI or S/D of MCA was over 0.8(P<0.05).The sensitivity,specificity,and area under ROC curve of PI of UA were the highest.Conclusion:UA and MCA examination by ultrasound can be used for predicting fetal distress of women with ICP.The RI of UA and PI of MCA were more preferably used in clinical diagnose.