妊娠期糖尿病孕妇脐血流S/D比值和超声参数Z-评分对宫内生长受限胎儿的预测价值

Predictive value of umbilical blood flow S/D ratio and ultrasonic parameters z-scoreson fetal intrauterinegrowth restriction of pregnant women with gestational diabetes mellitus

目的:探讨妊娠期糖尿病(GDM)孕妇脐血流收缩期最大血流峰值/舒张期最小血流峰值(S/D)比值和超声参数Z-评分对宫内生长受限胎儿(FGR)的预测价值。方法:回顾性分析110例FGR孕妇临床资料,根据孕妇是否合并GDM分为GDM组(n=36)和非GDM组(n=74),并收集同期正常妊娠孕妇110例临床资料作为对照组。比较各组不同孕周时孕妇脐S/D比值、超声生长参数(腹围、头腹围比值、腹围的Z-评分、头腹围比值的Z-评分),评估S/D比值对单纯FGR、GDM合并FGR的诊断效能,并绘制ROC曲线。结果:(1)GDM组和非GDM孕妇合并FGR者总S/D比值及28~32周、>32周时S/D比值均高于对照组(P<0.05),GDM组孕妇合并FGR者总S/D比值及不同孕周时S/D比值均高于非GDM孕妇合并FGR者(P<0.05);(2)GDM组孕妇合并FGR者、非GDM组孕妇合并FGR者及对照组不同孕周时腹围、头腹围比值、腹围Z-评分、头腹围比值Z-评分比较,差异均有统计学意义(P<0.05);(3)S/D比值诊断GDM合并FGR的灵敏度、阴性预测值高于S/D比值诊断FGR,准确率、阳性预测值均低于S/D比值诊断FGR,两者诊断特异度相同;(4)S/D比值诊断FGR的曲线下面积最高为0.935(95%CI:0.894~0.964),S/D比值诊断FGR合并GDM的曲线下面积最高为0.826(95%CI:0.769~0.873)。结论:脐血流S/D比值及超声参数Z-评分均是预测单纯FGR和GDM孕妇FGR的有效指标,脐血流S/D比值预测效能良好。

Objective:To explore the predictive value of maximum blood flow peak/diastolic minimum blood flow peak(S/D)ratio in uterine blood flow and ultrasonic parameters z-scoresonfetal intrauterinegrowth fetal growth retardation(FGR)of pregnant women with gestational diabetes mellitus(GDM).Methods:The clinical data of 110 pregnant women with FGR were retrospectively analyzed.According to whether pregnant women were combined with GDM,they were divided into GDM group(n=36)and non-GDM group(n=74).The clinical data of 110 pregnant women were used as the control group.The umbilical S/D ratio and ultrasonic growth parameters(abdominal circumference,head-abdominal circumference ratio,abdominal circumference Z-score,Z-score of head-abdominal circumference ratio)were compared among pregnant women at different gestational weeks,and the diagnostic efficacy of S/D ratio on simple FGR and GDM with FGR was evaluated,and the ROC curve was drawn.Results:The total S/D ratio and S/D ratios at 28 w^32 w and>32 w in GDM group and non-GDM pregnant women with FGR were higher than those in control group(P<0.05).The total S/D ratio and S/D ratios at different gestational weeks in GDM pregnant women with FGR were higher than those in non-GDM pregnant women with FGR(P<0.05).There were statistically significant differences in the abdominal circumference,head-abdominal circumference ratio,abdominal circumference Z-score and Z-score of head-abdominal circumference ratio among GDM pregnant women with FGR,non-GDM pregnant women with FGR and control group at different gestational weeks(P<0.05).The sensitivity and negative predictive value of S/D ratio diagnosis of GDM with FGR were higher than those of S/D ratio diagnosis of FGR while the accuracy rate and positive predictive value were lower than those of S/D ratio diagnosis of FGR,and the diagnostic specificity was the same.The values of area under the curve of S/D ratio diagnosis of FGR and GDM with FGR were 0.935(95%CI:0.894~0.964)and 0.826(95%CI:0.769~0.873).Conclusion:Umbilical blood flow S/D ratio and ultrasonic parameters z-scores were effective indexes for predicting simple FGR and pregnant women with FGR and GDM,and umbilical blood flow S/D ratiohas good predictive efficacy.