超声评估心肌做功指数和血流频谱对胎儿生长受限及妊娠结局的预测价值

Ultrasound evaluation of MPI and related blood flow spectrum in fetal growth restriction and pregnancy outcome

目的探讨超声评估心肌做功指数(MPI)和大脑中动脉、脐动脉、静脉导管血流频谱预测胎儿生长受限(FGR)及妊娠结局的价值。方法采用回顾性研究方法,选取2018年1月至2019年12月于南京市妇幼保健院收治、产检及分娩后或引产后确诊胎儿为FGR的256例孕妇为FGR组,胎儿正常的256例孕妇为对照组。比较两组孕妇孕32~36周彩色多普勒超声对胎儿以下参数的检测结果:MPI、大脑中动脉和脐动脉血流频谱参数[血管搏动指数(PI)、阻力指数(RI)和收缩期血流速度峰值(S)/舒张期血流速度峰值(D)]、静脉导管血流频谱参数[心室收缩峰值流速/心房收缩谷值流速比值(S/a)];比较不同妊娠结局者的MPI、血流频谱参数和1 min Apgar评分并分析其相关性;采用受试者工作特征(ROC)曲线分析MPI、血流频谱参数对FGR妊娠结局的预测效能。结果 FGR组MPI、脐动脉PI、RI、S/D及静脉导管S/a均高于对照组,大脑中动脉PI、RI、S/D均低于对照组(P<0.01)。脐动脉S/D预测FGR的AUC最大,为0.835,截断值为3.07时,敏感度、特异度分别为75.29%、81.18%。FGR组妊娠结局不良者MPI、脐动脉PI、RI、S/D及静脉导管S/a高于妊娠结局良好者,1 min Apgar评分、大脑中动脉PI、RI、S/D低于妊娠结局良好者(P<0.01)。MPI、静脉导管S/a、脐动脉PI、RI、S/D与1 min Apgar评分呈负相关,大脑中动脉PI、RI、S/D与1 min Apgar评分呈正相关(P<0.01)。脐动脉S/D预测FGR胎儿妊娠结局的AUC最大,为0.843,其次为大脑中动脉S/D(0.801)和MPI(0.796)。结论 FGR胎儿的MPI、脐动脉及静脉导管血流频谱参数升高,大脑中动脉血流频谱参数下降,并与1 min Apgar评分存在良好线性关系;孕32周或更早采用彩色多普勒超声检查,有助于指导临床预测FGR及其妊娠结局,及时实施有效干预。

Objective To explore the value of ultrasound assessment of myocardial performance indexes(MPI),middle cerebral artery(MCA),umbilical artery(UA),ductus venosus blood flow spectrum in predicting fetal growth restriction(FGR) and pregnancy outcome.Methods From January 2018 to December 2019,256 women whose fetus was diagnosed as FGR by prenatal ultrasound examination and delivery or induced labor were selected as FGR group, and 256 pregnant women with normal fetuses were served as control group.MPI,blood flow spectrum parameters of middle cerebral artery and umbilical artery [pulse index(PI)],resistance index(RI),peak systolic blood flow velocity(S)/peak diastolic blood flow velocity(D)] and venous catheter blood flow spectrum parameters [peak ventricular systolic velocity trough atrial systolic velocity(S/a)] were compared between two groups.MPI,blood flow spectrum parameters, neonatal Apgar scores at 1-min and their correlation were analyzed and compared in women with different pregnancy outcomes.Receiver operating characteristic(ROC) curve was used to analyze the predictive effect of MPI and blood flow spectrum parameters on pregnant women with FGR fetuses.Results MPI,PI,RI and S/D ratio of UA and S/a ratio in FGR group were higher than those in control group, and PI,RI,S/D ratio of MCA were lower than those in control group(P<0.01).AUC of UA S/D ratio in predicting FGR was the largest(0.835),and its sensitivity and specificity were 75.29% and 81.18%,respectively, as the cut-off value was 3.07.In FGR group, MPI,PI,RI,S/D ratio of UA and S/a ratio in poor pregnancy outcome were higher than those in good pregnancy outcome, and 1 min Apgar score, PI, RI, S/D rario of MCA were lower than those in good pregnancy outcome(P<0.01).MPI,S/a, PI, RI and S/D ratio of UA were negatively correlated with 1-min Apgar score, meanwhile, PI, RI, S/D ratio of MCA were positively correlated with 1-min Apgar score(P<0.01).AUC of UA S/D ratio was the largest(0.843),followed by MCA S/D ratio(0.801) and MPI(0.796) in prediction of FGR.Conclusions In FGR fetuses, MPI,blood flow spectrum parameters of UA and venous catheter increase, while blood flow spectrum parameters of MCA decrease, and there is a good linear relationship between them and 1-min Apgar score.Color Doppler ultrasound examination at 32 weeks of gestation or earlier is helpful to guide the clinical prediction of FGR and pregnancy outcome and timely implementation of intervention.