孕中晚期胰岛素样生长因子水平及静脉血流改变与胎儿宫内生长受限关系

Correlation between the levels of insulin like growth factor and the venous blood flow changes of pregnant women during the second and the third trimesters of pregnancy and their fetal growth restriction

目的:研究孕中晚期胰岛素样生长因子-Ⅰ(IGF-Ⅰ)、胰岛素样生长因子-Ⅱ(IGF-Ⅱ)水平及静脉血流改变与胎儿宫内生长受限(FGR)的关系。方法:选取本院2018年4月-2021年3月诊治的53例孕中晚期胎儿FGR孕妇(FGR组)临床资料,同期产前检查健康孕中晚期孕妇62例(对照组)。收集孕妇一般资料,并检测血清和羊水中IGF-Ⅰ、IGF-Ⅱ水平,采用彩色多普勒超声检测胎儿静脉血流相关参数,分析IGF-Ⅰ、IGF-Ⅱ水平以及静脉血流变化与FGR的关系。结果:FGR组羊水IGF-Ⅰ、IGF-Ⅱ水平以及血IGF-Ⅰ水平均低于对照组(P<0.05),两组血IGF-Ⅱ水平无差异(P>0.05);FGR组胎儿S波流速(S)、A谷流速(A)均低于对照组,阻力指数(RI)RI、搏动指数(PI)PI以及收缩期、舒张期比值(S/D)S/D水平均高于对照组(均P<0.05);logistic回归分析,羊水IGF-Ⅰ、IGF-Ⅱ,及血流参数RI、PI、S/D是胎儿FGR发生的独立危险因素(P<0.05);Pearson相关性分析,羊水IGF-Ⅰ、IGF-Ⅱ分别与RI、PI、S/D均呈负相关(P<0.05);受试者工作特征曲线ROC曲线分析,羊水IGF-Ⅰ、IGF-Ⅱ,及血流参数RI、PI、S/D联合预测曲线下面积AUC(0.964)和敏感度(98.1%)最高(P<0.05)。结论:孕中晚期羊水IGF-Ⅰ、IGF-Ⅱ,以及胎儿静脉血流参数异常变化为胎儿FGR危险因素,临床可加以关注并可作为预测FGR的早期依据。

Objective:To study the correlation between the levels of insulin-like growth factor I(IGF I)and II(IGF II),and the venous blood flow changes of pregnant women during the second and the third trimesters of pregnancy and their fetal growth restriction(FGR).Methods:A total of 53 pregnant women with FGR during the second and the third trimesters of pregnancy were enrolled in study group between April 2018 and March 2021,while other 62 healthy preg-nant women during the same period were enrolled in control group.The general data of these women were collected.The levels of IGF I and IGF II of the women in the two groups were detected.The fetal venous blood flow parameters in both groups were detected by color Doppler ultrasound.The correlation between the levels of IGF I and IGF II,and the fetal venous blood flow changes of the women and their FGR was analyzed.Results:The IGF I and IGF I levels in amniotic fluid and the IGF I level in blood of the women in the study group were significantly lower than those of the women in the control group(P<0.05),there was no significant difference in the IGF II level in blood of the women between the two groups(P>0.05).The values of fetal venous blood flow S wave velocity(S)and A valley ve-locity(A)of the women in the study group were significantly lower than those of the women in the control group,and the values of resistance index(RI)RI,pulsation index(PD)PI,and systolic to diastolic ratio(S/D)of fetal venous blood flow of the women in the study group were significantly higher than those of the women in the control group(all P<0.05).Logistic regression analysis showed that the levels of IGF I and IGF II in amniotic fluid,and the blood flow parameters,such as RI,PI,and S/D of fetal venous blood were the independent risk factors of the development of FGR occurrence(P<0.05).Pearson correlation analysis showed that the levelsof IGF I and IGF II in amniotic flu-id were negatively correlated with the values of RI,PI,and S/D of the fetal venous blood(P<0.05).Receiver operat-ing characteristic(ROC)curve analysis showed that the area under the curve(AUC)and the sensitivity of the levels of IGF I and IGF II in amniotic fluid combined with the values of the fetal venous blood flow parameters,such as RI,PI,and S/D,for predicting their FGR were 0.964 and 98.1%,which were the highest(P<0.05).Conclusion:The levels of IGF I and IGF II in amniotic fluid and the values of the fetal venous blood flow parameters changes during the second and the third trimesters of pregnancy are the risk factors of FGR,which should be attained in clinic and can be as the evidences for predicting their FGR early.