大脑中动脉联合静脉导管血流指数对妊娠期糖尿病胎儿宫内缺氧的预测价值

Predictive Value of Blood Flow Indicators of Middle Cerebral Artery Combined with Ductus Venosus on Fetal Intrauterine Hypoxia in Gestational Diabetes Mellitus

目的:探讨大脑中动脉(MCA)与静脉导管(DV)血流指数诊断妊娠期糖尿病(GDM)胎儿宫内缺氧的临床价值。方法:选取2019年7月至2020年7月于我院就诊且住院分娩的GDM胎儿宫内缺氧孕妇48例为病例组,正常单胎孕妇48例为对照组。均对胎儿MCA和DV血流指数进行检测,指标含有搏动指数(PI)、阻力指数(RI)、收缩期峰值流速与舒张末期流速比值(S/D),并进行对比分析。结果:相比对照组,病例组MCA的RI、PI及S/D值均显著降低(P<0.05),DV的RI、PI及S/D值均显著增高(P<0.05),RIMCA/RIDV、PIMCA/PIDV和(S/D)MCA/(S/D)DV也显著降低(P<0.05)。Logistic回归分析显示,RIMCA/RIDV、PIMCA/PIDV和(S/D)MCA/(S/D)DV的比值比分别为1.385、1.602、1.480,均是GDM胎儿宫内缺氧的独立预测因素(P<0.05)。ROC曲线分析显示,RIMCA/RIDV、PIMCA/PIDV、(S/D)MCA/(S/D)DV及三者联合预测GDM胎儿宫内缺氧的曲线下面积分别为0.869、0.870、0.897和0.975,以三者联合的诊断效能最高。结论:MCA与DV血流指数联合检测对GDM胎儿宫内缺氧有较高诊断价值。

Objective:To investigate the predictive value of blood flow indicators of middle cerebral artery(MCA)combined with ductus venosus(DV)on fetal intrauterine hypoxia in gestational diabetes mellitus(GDM).Methods:48 GDM pregnant women with fetal intrauterine hypoxia who were treated and delivered in our hospital between July 2019 and July 2020 were selected as the case group,and 48 normal singleton pregnant women were selected as the control group.Color Doppler ultrasound was applied to detect the fetal MCA and DV blood flow indicators in the two groups of fetuses,including resistance index(RI),pulsatility index(PI)and peak systolic velocity/end diastolic velocity(S/D),and comparative analysis was conducted.Results:Compared with the control group,the RI,PI and S/D values of MCA in the case group were significantly decreased(P<0.05),the RI,PI and S/D values of DV were significantly increased(P<0.05),and the RIMCA/RIDV,PIMCA/PIDV and(S/D)MCA/(S/D)DV were also significantly decreased(P<0.05).Logistic regression analysis showed that the ratios of RIMCA/RIDV,PIMCA/PIDV and(S/D)MCA/(S/D)DV were 1.385,1.602 and 1.480 respectively,which were independent predictors of fetal intrauterine hypoxia in GDM(P<0.05).ROC curve analysis showed that the areas under the curves of RIMCA/RIDV,PIMCA/PIDV,(S/D)MCA/(S/D)DV and the combination of the three in predicting fetal intrauterine hypoxia in GDM were 0.869,0.870,0.897 and 0.975 respectively,and the predictive value of the combination of the three was the largest.Conclusion:MCA combined with DV blood flow indicators have important reference value in predicting fetal intrauterine hypoxia in GDM.