三维超声容积测量联合二维超声在妊娠早期胎儿宫内生长受限诊断中的应用

Application of Three-dimensional Ultrasound Volume Measurement Combined with Two-dimensional Ultrasound in the Diagnosis of Fetal Intrauterine Growth Restriction in Early Pregnancy

目的:探讨三维超声容积测量联合二维超声在妊娠早期胎儿宫内生长受限(FGR)诊断中的应用效果。方法:回顾性分析2019年5月—2020年2月在珠海市斗门区妇幼保健院行规律产检的189例孕妇临床资料,所有孕妇于孕11~13周接受二维超声联合三维超声容积测量检查,根据新生儿出生后是否发生FGR分为发生组与未发生组,比较两组孕妇年龄、孕周等基线资料差异,并比较二维超声与三维超声容积测量指标差异。绘制ROC曲线,分析头臀长(CRL)、胎盘容积(PV)、子宫动脉阻力指数(UtA-RI)单独及联合诊断FGR的临床价值。结果:189例孕妇中,15例发生FGR,发生率7.94%。发生组新生儿体质量小于未发生组,差异有统计学意义(t=4.517,P<0.05)。发生组CRL较未发生组短,PV较未发生组小,UtA-RI较未发生组高,差异有统计学意义(t=2.840、3.235、4.073,P<0.05)。绘制ROC曲线,结果显示CRL、UtA-RI、PV单独、联合诊断妊娠早期FGR的AUC分别为0.823、0.866、0.816、0.922,联合诊断具有更高诊断价值。结论:三维超声容积测量与二维超声检测在妊娠早期胎儿FGR中均具有一定诊断价值,且联合检测诊断价值更高,能够提高诊断灵敏度、特异度,减少漏诊、误诊的发生,为临床早期干预提供重要指导。

Objective: To investigate the application effect of three-dimensional ultrasound volume measurement combined with two-dimensional ultrasound in the diagnosis of fetal growth restriction(FGR) in early pregnancy. Methods: The clinical data of 189 pregnant women who underwent regular obstetric examination in the hospital from May 2019 to February 2020 were retrospectively analyzed. All pregnant women received two-dimensional ultrasound combined with three-dimensional ultrasound volume measurement at 11-13 weeks of gestation, and were divided into the occurrence group and the non-occurrence group according to whether FGR occurred after birth. The differences in baseline data such as age and gestational age, and the differences in volume measurement between two-dimensional ultrasound and three-dimensional ultrasound were compared between the two groups. ROC curves were drawn to analyze the clinical value of head-rump length(CRL), placental volume(PV), and uterine artery resistance index(UtA-RI) alone and in combination in the diagnosis of FGR. Results: Among the 189 pregnant women, FGR occurred in 15cases, and the incidence rate was 7.94%. The weight of newborns in the occurrence group was smaller than that in the non-incidence group, and the difference was statistically significant(t=4.517, P<0.05). The CRL in the occurrence group was shorter than that in the non-occurring group, the PV was smaller than that in the non-occurring group, and the UtA-RI was higher than that in the non-occurring group, and the differences were statistically significant(t=2.840, 3.235, 4.073, P<0.05). The ROC curve was drawn, and the results showed that the AUCs of CRL, UtA-RI, and PV alone and combined to diagnose FGR in early pregnancy were 0.823, 0.866, 0.816, and 0.922, respectively, and the combined diagnosis had higher diagnostic value. Conclusion: Both three-dimensional ultrasound volume measurement and two-dimensional ultrasound detection have certain diagnostic value in fetal FGR in early pregnancy, and the combined detection has higher diagnostic value, which can improve the diagnostic sensitivity and specificity, reduce the occurrence of missed diagnosis and misdiagnosis, and provide important guidance for early clinical intervention.