妊娠11~13^(+6)周子宫动脉多普勒参数对低危人群不良妊娠结局的预测价值

Value of uterine artery Doppler parameters at the gestation of 11~13^(+6) weeks in predicting adverse pregnancy outcomes in low risk population

目的建立妊娠11~13^(+6)周子宫动脉多普勒参数在低危人群的正常参考值,同时评估其对不良妊娠结局的预测价值。方法收集2019年6月至2021年6月于我院行产前超声检查的妊娠11~13^(+6)周孕妇,根据妊娠结局分为正常妊娠结局组和不良妊娠结局组。收集两侧子宫动脉多普勒参数包括搏动指数、阻力指数、是否有舒张早期切迹,以及孕妇基本临床资料和胎儿出生信息,比较两组上述参数的差异;分析两侧子宫动脉多普勒参数的变化情况。绘制受试者工作特征(ROC)曲线分析各参数预测不良妊娠结局的效能。结果最终纳入800例孕妇,包括正常妊娠结局组740例和不良妊娠结局组60例。两组孕妇体质量指数(BMI)、分娩孕周和胎儿出生体质量比较,差异均有统计学意义(均P<0.05)。随着孕周的增加,两侧子宫动脉平均搏动指数(mPI)、平均阻力指数(mRI)和两侧舒张早期切迹检出率均呈逐渐下降趋势。ROC曲线分析显示,mPI、mRI及两侧舒张早期切迹预测妊娠结局的曲线下面积(AUC)分别为0.542、0.574、0.521,三者联合应用预测不良妊娠结局的AUC为0.648;孕妇BMI、年龄、mPI、mRI及两侧舒张早期切迹联合应用预测不良妊娠结局的AUC为0.751。结论建立了低危人群在妊娠11~13^(+6)周子宫动脉多普勒参数的正常参考值范围。在妊娠11~13^(+6)周单纯应用子宫动脉多普勒参数预测不良妊娠结局的价值有限,子宫动脉参数联合临床相关指标可提高对不良妊娠结局的预测价值。

Objective To establish the normal reference values of uterine artery Doppler parameters at the gestation of 11~13^(+6) weeks in low risk population,and to evaluate the predictive value for adverse pregnancy outcomes.Methods Pregnant women with 11~13^(+6) gestational weeks underwent prenatal ultrasound examination in our hospital from June 2019 to June 2021 were collected and divided into normal pregnancy outcome group and adverse pregnancy outcome group according to pregnancy outcome.The Doppler parameters of bilateral uterine artery including pulsatility index,resistance index,early diastolic notch and basic clinical data of pregnant women and fetal birth information were collected.The differences of the above parameters between the two groups were compared,the changes of the Doppler parameters of the bilateral uterine arteries were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of each parameter in predicting the adverse pregnancy outcome.Results A total of 800 pregnant women were involved in this study,including 740 cases in the normal pregnancy outcome group and 60 cases in the adverse pregnancy outcome group.There were statistically significant differences in maternal body mass index(BMI),gestational age at delivery and fetal birth weight between the two groups(all P<0.05).With the increase of gestational age,the mean pulsatility index(mPI),mean resistance index(mRI)and the detection rate of bilateral early diastolic notch of uterine arteries gradually decreased.ROC curve analysis showed that the area under the curve(AUC)of mPI,mRI and bilateral early diastolic notch for predicting pregnancy outcome were 0.542,0.574 and 0.521,respectively,and the AUC of the combination of the three parameters for adverse predicting adverse pregnancy outcome was 0.648.The AUC of combined application of maternal BMI,age,mPI,mRI and bilateral early diastolic notch for predicting adverse pregnancy outcome was 0.751.Conclusion The normal reference range of uterine artery Doppler parameters are established in the low risk population at the gestation of 11~13^(+6) weeks.There is limited value in using only uterine artery Doppler parameters to predict pregnancy outcomes at 11~13^(+6) gestational weeks,and the combination of uterine arterial clinical related indicators can improve the predictive value of adverse pregnancy outcomes.