三维能量多普勒联合超低速血流胎盘灌注对胎儿生长受限的预测效能分析

Analysis of early prediction efficiency of three-dimensional power Doppler combined withultra-low blood flow placental perfusion on fetal growth restriction

目的分析三维能量多普勒(3D-PDU)联合超低速血流胎盘灌注(SMI)对胎儿生长受限(FGR)的预测效能。方法纳入687例孕妇为研究对象,均接受3D-PDU和SMI检查。对所有孕妇进行随访直至胎儿娩出,根据出生时生长是否受限分为受限组和非受限组。对比2组一般资料、3D-PDU检查参数以及SMI参数。采用多因素logistic回归分析影响胎儿受限的预测因子并构建预测模型,分析其预测效能。结果随访结束后18例孕妇失访,共计纳入669例,受限组51例,非受限组618例。受限组胎盘体积(PV)、血管化指数(VI)、血流指数(FI)、血管化-血流指数(VFI)均低于非受限组(P<0.05);受限组搏动指数(PI)、阻力指数(RI)、收缩/舒张期速度比(S/D)、时间平均流速(TAV)均高于非受限组(P<0.05);多因素logistic回归方程分析显示PV、VI为FGR的独立保护因素(OR值为0.90和0.92),PI、RI为独立危险因素(OR值为5.46和36.82)(P<0.05);PV联合PI的预测效能(AUC=0.98)显著高于PI、RI、PV以及VI单独的预测效能(AUC=0.97、0.75、0.84、0.63)(P<0.05)。结论3D-PDU以及SMI均可对FGR的发生进行预测且两种方式联合预测效能更高。

Objective To analyze the early prediction effect of three-dimensional power Doppler(3D-PDU)combined with ultra-low blood flow placental perfusion(SMI)on fetal growth restriction(FGR).Methods A total of 687 pregnant women were selected in the study,and all of pregnant women were examined by 3D-PDU and SMI at the time of admission.All pregnant women were followed until the fetus was delivered,and the patients were divided into restricted group and unrestricted group according to whether their growth was restricted at birth.3D-PDU inspection parameters and SMI parameters were compared between two groups.The predictive factors of fetal restriction were analyzed by Multi-factor logistic regression and build a predictive model analyzed its predictive efficiency.Results 669 cases were followed-up,18 pregnant women lost their follow-up.And 51 cases in restricted group and 618 cases in unrestricted group.The placenta volume(PV),vascularization index(VI),blood flow index(FI)and vascularization-blood flow index(VFI)in the restricted group were lower than those in the unrestricted group(P<0.05).The pulse index(PI),resistance index(RI),systolic/diastolic velocity ratio(S/D)and time average velocity(TAV)in the restricted group were higher than those in the unrestricted group(P<0.05).Multivariate logistic regression analysis showed that PV and VI were independent protective factors of FGR(OR values were 0.90 and 0.92),while PI and RI were independent risk factors(OR values were 5.46 and 36.82)(P<0.05).The predictive efficiency of PV combined with PI(AUC=0.98)is significantly higher than PI,RI,PV and VI alone(AUC=0.97,0.75,0.84 and 0.63)(P<0.05).Conclusion Both 3D-PDU and SMI can predict the occurrence of FGR,and the combination of the two methods is more effective.