血清妊娠相关蛋白A联合子宫动脉多普勒超声在妊娠早期预测胎儿生长受限的临床价值

Clinical value of serum pregnancy associated protein A combined with uterine artery Doppler ultrasound in predicting fetal growth restriction in early pregnancy

背景胎儿生长受限(fetal growth restriction,FGR)是围生期的主要并发症之一,其不仅影响胎儿的生长发育,还可能导致围生胎儿的患病率及病死率增高,是导致胎儿宫内死亡或新生儿死亡的重要原因。如何在孕早期预测FGR的发生,进而有效控制疾病的进展及并发症,成为当前产科领域的研究重点之一。目的探讨血清妊娠相关蛋白A联合子宫动脉多普勒超声在妊娠早期预测胎儿生长受限的临床价值。方法回顾性分析2016年1月-2018年12月于临沂市中心医院产科接受产前检查的1437例单胎妊娠孕妇的临床资料,入组孕妇均于孕早期(11~13^(+6)周)接受子宫动脉超声多普勒检查,并检测妊娠血清相关蛋白A(pregnancy-associated plasma protein A,PAPP-A)。根据妊娠结果将研究对象分为胎儿生长受限组和正常对照组。比较两组孕早期子宫动脉超声多普勒指标和血清妊娠相关蛋白A浓度。结果1328例产妇为正常妊娠(对照组),109例产妇发生胎儿生长受限现象(FGR组)。FGR组与对照组孕妇的一般资料差异无统计学意义(P>0.05)。FGR组孕早期的子宫动脉搏动指数(uterine artery pulsatility index,UtA-PI)(1.92±0.41 vs 1.78±0.63)、子宫动脉阻力指数(uterine artery resistance index,UtA-RI)(0.75±0.11 vs 0.71±0.14)、发生子宫动脉舒张早期切迹的百分比(62.4%vs 46.9%)均显著高于对照组(P均<0.05)。FGR组孕早期PAPP-A浓度(MoM)显著低于对照组(0.86±0.17 vs 1.29±0.32)。此外,PAPP-A联合UtA-PI预测FGR的AUC和敏感度分别为0.793、81.6%,低于PAPP-A+UtA-PI+舒张早切迹预测FGR的AUC和敏感度(0.814,82.1%),但差异无统计学意义(P>0.05)。结论孕早期超声多普勒监测UtA-PI联合检测血清PAPP-A浓度是预测胎儿生长受限的有效方法,两者联合舒张早切迹指标可略提高预测FGR的能力。

Background Fetal growth restriction(FGR)is one of the main complications in perinatal period.It not only affects the growth and development of fetus,but also increases the morbidity and mortality of perinatal fetus,which is an important cause of fetal intrauterine death or neonatal death.How to predict the occurrence of FGR in early pregnancy,and then effectively control the progress of the disease and complications,has become one of the research focuses in the field of obstetrics.Objective To discuss the clinical value of serum pregnancy associated protein A(PAPP-A)combined with uterine artery Doppler ultrasound in predicting fetal growth restriction in early pregnancy.Methods Clinical data about 1437 women with singleton pregnancy who received prenatal examination in Linyi Central Hospital from January 2016 to December 2018 were analyzed retrospectively.All the pregnant women received ultrasound Doppler examination of uterine artery and testing of PAPP-A at the early stage of pregnancy(11-13^(+6)weeks).According to the pregnancy results,they were divided into the fetal growth restriction group(FGR group)and the normal control group.The data of general information,ultrasonic Doppler of uterine artery and PAPP-A were compared between the two groups.Results There were 1328 cases in the normal control group,and 109 cases in the FGR group.No significant difference in generalconditions was found between the FGR group and the normal control group(all P>0.05).The FGR group had higher levels of UtAPI(1.92±0.41 vs 1.78±0.63)and UtA-RI(0.75±0.11 vs 0.71±0.14),and greater percentage of early uterine artery diastolic notch(62.4%vs 46.9%)compared to the control group(all P<0.05).The concentration of PAPP-A(MoM)in the FGR group was significantly lower than that in the control group(0.86±0.17 vs 1.29±0.32,P<0.05).In addition,the AUC and sensitivity of PAPPA combined with UtA-PI in predicting FGR were 0.793 and 81.6%respectively,which were lower than those of PAPP-A+UtA-PI+diastolic early notch(AUC:0.814,sensitivity:82.1%)without significant differences(P>0.05,respectively).Conclusion Monitoring UtA-PI by Doppler ultrasound combined with PAPP-A testing in the early stage of pregnancy is an effective method in predicting fetal growth restriction.And the predicting ability can be slightly improved by combining with the index of early diastolic notch.