胎儿大脑中动脉血流动力学指标联合孕妇ACR和HIF-1α检测在预测胎儿宫内缺氧中的临床价值

Clinical value of fetal middle cerebral artery hemodynanic parameters combined with maternal urinary ACR and HIF-1αlevels in predicting fetal intrauterine hypoxia

目的探讨胎儿大脑中动脉(MCA)血流动力学指标联合孕妇尿微量蛋白肌酐比值(ACR)和血缺氧诱导因子-1α(HIF-1α)检测在预测胎儿宫内缺氧中的临床价值。方法选择2019年1月至2020年12月在该院就诊的疑似胎儿宫内缺氧孕妇163例为研究对象,根据胎儿宫内缺氧诊断标准分为宫内缺氧组(98例)和无宫内缺氧组(65例)。观察两组胎儿MCA的搏动指数(PI)、阻力指数(RI)和收缩期最大血流速度/舒张期最小血流速度(S/D),以及孕妇ACR和HIF-1α水平变化,并分析胎儿MCA的PI、RI和S/D,以及孕妇ACR和HIF-1α水平与孕周、新生儿窒息严重程度的关系,以及其各项指标在预测胎儿宫内缺氧中的临床价值。结果宫内缺氧组胎儿MCA的PI、RI和S/D水平较无宫内缺氧组明显降低(P<0.05),而宫内缺氧组孕妇ACR和HIF-1α水平较无宫内缺氧组明显升高(P<0.05)。宫内缺氧组胎儿MCA的PI、RI和S/D水平随着孕周和新生儿窒息严重程度增加而降低(P<0.05),而孕妇ACR和HIF-1α水平随着孕周和新生儿窒息严重程度增加而升高(P<0.05)。胎儿MCA的PI、RI和S/D,以及孕妇ACR和HIF-1α联合检测预测胎儿宫内缺氧的灵敏度为95.9%,特异度为89.2%,曲线下面积(AUC)为0.959,其AUC明显高于PI、RI、S/D、ACR、HIF-1α单项指标检测(P<0.05),而各单项指标之间AUC比较,差异无统计学意义(P>0.05)。结论胎儿MCA血流动力学指标联合孕妇ACR和HIF-1α检测在预测胎儿宫内缺氧中具有重要的临床意义,联合检测明显优于单项指标检测,值得在临床上推广应用。

Objective To investigate the clinical value of fetal middle cerebral artery(MCA)hemodynanic parameters combined with maternal urinary albumin creatinine ratio(ACR),blood hypoxia inducible factor-1α(HIF-1α)levels in predicting fetal intrauterine hypoxia.Methods A total of 163 pregnant women who were diagnosed with suspected fetal intrauterine hypoxia in Qingpu Branch of Zhongshan Hospital,Fudan University from January 2019 to December 2020 were divided into intrauterine hypoxia group(98 cases)and non-intrauterine hypoxia group(65 cases)according to the diagnostic criteria of fetal intrauterine hypoxia.The RI,PI and S/D of fetal MCA,urinary ACR and serum HIF-1αin pregnant women were observed in the two groups,the relationships between the RI,PI,S/D of fetal MCA,urinary ACR,serum HIF-1αin pregnant women and gestational weeks,the severity of neonatal asphyxia were compared,and their clinical value in predicting intrauterine hypoxia was also observed.Results The levels of PI,RI and S/D of fetal MCA in intrauterine hypoxia group were significantly lower than those in non-intrauterine hypoxia group(P<0.05),and the levels of urinary ACR and blood HIF-1αof pregnant women were significantly higher than those in non-intrauterine hypoxia group(P<0.05).The levels of PI,RI and S/D of fetal MCA in intrauterine hypoxia group decreased with the increase of gestational weeks and the severity of neonatal asphyxia(P<0.05),and the levels of urinary ACR and blood HIF-1αof pregnant women increased with the increase of gestational weeks and the severity of neonatal asphyxia(P<0.05).The sensitivity of combined detection of levels of PI,RI and S/D of fetal MCA,urinary ACR and blood HIF-1αlevels of pregnant women in predicting intrauterine hypoxia was 95.9%,the specificity was 89.2%,and the area under the ROC curve(AUC)was 0.959(P<0.05),the AUC was significantly higher than those of PI,RI,S/D,ACR and HIF-1α,but there was no significant difference among each single maker(P>0.05).Conclusion The fetal MCA hemodynanic parameters combined with maternal urinary ACR and blood HIF-1αhas important clinical significance in predicting fetal intrauterine hypoxia.Combined detection is significantly better than single index,which is worthy of clinical application.