早孕期三维超声预测胎儿生长受限的应用价值

目的应用三维能量多普勒超声测量早孕期胎盘体积及胎盘内血流参数,评估其预测胎儿生长受限(FGR)的临床价值.方法应用三维能量多普勒超声结合VOCAL技术测量200例孕11~13^(+6)周孕妇的胎盘体积(PV)、胎盘内的血管化指数(VI)、血流指数(FI)及血管化-血流指数(VFI),并计算胎盘商(PQ).最终纳入研究孕妇167例,FGR16例为FGR组,健康孕妇151例作为对照组.结果对照组胎盘的PQ、VI、FI、VIF值均明显大于FGR组,差异有统计学意义(P<0.05).经ROC曲线分析,VI与VFI的曲线下面积均>0.7,其预测FGR的准确度高于PQ与FI.当取最大截断值(VI=8.90、VFI=3.03)时,预测FGR的敏感度分别高达98.0%、97.4%,特异度均为56.2%.结论早孕期运用三维能量多普勒超声结合VOCAL技术测量胎盘体积及胎盘内血流参数,筛查排畸的同时预测胎儿生长受限的发生情况,而VI值预测敏感度最高可作为最佳评估指标.

Objective To estimate the clinical value in predicting fetal growth growth(FOR)in early pregnancy by using three-dimensional energy doppler ultrasound to measure the placental volume and the vascular flow indices.Methods Using three-dimensional power Doppler ultrasound combined with VOCAL technology to measure the placental volume(PV),intraplacental vascularization index(VI),blood flow index(FI)and vascularization-blood flow of 200 pregnant women at 11〜13^(+6) weeks of pregnancy Index(VFI)and the placental quotient(PQ)were calculated.Finally,167 cases of pregnant women were included in the study,16 cases of FGR were in the FGR group,and 151 cases of healthy pregnant women were used as the control group.Results The PQ,VI,FI,and VIF values of the placenta of the control group were significantly greater than those of the FGR group,and the difference was statistically significant(P<0.05).After ROC curve analysis,the area under the curve of VI and VFI were both>0.7,and the accuracy of predicting FGR was higher than that of PQ and FI.When the maximum cutoff value(VI=8.90,VFI=3.03)was taken,the sensitivity of predicting FGR was as high as 98.0%,97.4%,and the specificity was 56.2%.Conclusion During early pregnancy,three-dimensional power Doppler ultrasound combined with VOCAL technology is used to measure placental volume and intraplacental blood flow parameters,screening and removing malfonnations and predicting the occurrence of fetal growth restriction.The VI value prediction sensitivity can be the best evaluation index.