孕中期血清学指标联合孕晚期脐血流S/D值预测胎儿生长受限的可行性分析

Predicting fetal growth restriction by serological indexes in the second trimester combined with cord blood flow S/D value in the third trimester

目的探讨孕中期血清中甲胎蛋白(alpha-fetoprotein,AFP)、β人绒毛膜促性腺激素(beta-human chorionic gonadotropin,β-hCG)、游离雌三醇(unconjugated estriol,uE3)等指标联合孕晚期多普勒超声探测脐动脉血流收缩期/舒张期峰值流速(peak systolic velocity/end diastolic velocity,S/D)对胎儿生长受限(fetal growth restriction,FGR)的预测能力。方法收集2018年1月1日-2018年12月31日在我院产检并分娩的孕产妇的孕中期唐氏筛查指标[表示为其中位数的倍数(multiple of the median,MoM)]和孕晚期多普勒超声检查指标,根据妊娠结局分为胎儿生长受限组(n=85)和正常对照组(n=809),应用受试者工作曲线评判各指标单独以及联合预测FGR的能力。结果FGR组与正常妊娠组新生儿在分娩时母亲体质量指数及性别方面无统计学差异(P>0.05)。FGR组AFP、β-hCG MoM值及S/D值对显著高于照组,uE3 MoM值较对照组明显降低(P均<0.05)。以AFP、β-hCG、uE3及S/D值单独预测FGR的AUC值分别为0.836、0.724、0.786、0.741,而四项指标联合预测FGR的AUC值为0.937,高于各指标单独预测AUC值(P均<0.05)。结论AFP、β-hCG、uE3及S/D值四个指标联合预测FGR的AUC明显高于各指标单独预测,孕中期血清学指标联合孕晚期多普勒超声检测脐血流S/D值对于FGR有较好的诊断价值。

Objective To explore the value of alpha-fetoprotein(AFP),beta-human chorionic gonadotropin(β-hCG)and uncon-jugated estriol(uE3)in serum during the second trimester combined with peak systolic velocity/end diastolic velocity(S/D)detected by doppler ultrasound in the third trimester in predicting fetal growth restriction(FGR).Methods The mid-pregnancy Down’s screening indicators(expressed as multiples of the median[MoM]),doppler ultrasound indexes in the third trimester of pregnant women who gave birth in our hospital from January 1,2018 to December 31,2018 were collected,then they were divided into fetal growth restriction(FGR)group(n=85)and normal control group(n=809)according to the pregnancy outcomes.The receiver operating curve was applied to evaluate the performance of each index in predicting FGR individually and jointly.Results There was no significant difference in BMI and gender between the FGR group and the normal pregnancy group(P>0.05).The values of AFP,β-hCG MoM and S/D in FGR group were significantly higher than those in the control group(all P<0.05),while the value of uE3 mom in FGR group was significantly lower than that in the control group(P<0.05).The AUC of FGR predicted by AFP,β-hCG,uE3 and S/D was 0.836,0.724,0.786 and 0.741,respectively,while the AUC of FGR predicted by four indexes combination was 0.937,which was higher than that predicted by each single index(P<0.05,respectively).Conclusion The combination of AFP,β-hCG,uE3 and S/D value is superior to each factor alone for predicting FGR,and is of great value in clinical diagnosis.