妊娠期糖尿病患者胎儿主动脉峡部血流参数联合血清游离雌三醇、脂联素水平预测胎儿窘迫的价值

Value of fetal aortic isthmus blood flow parameters combined with serum levels of free estradiol and adiponectin in predicting fetal distress in gestational diabetes mellitus patients

目的探讨妊娠期糖尿病(GDM)患者胎儿主动脉峡部(AOI)血流参数联合血清游离雌三醇(FE3)、脂联素(ADP)水平预测胎儿窘迫(FD)的价值。方法选取我院300例GDM患者,根据是否发生FD分为FD组74例和非FD组226例,另选同期正常妊娠者75例为对照组,比较各组胎儿AOI血流参数[血流指数(IFI)、收缩指数(ISI)]及血清FE3、ADP水平的差异。应用Pearson相关分析法分析血清FE3、ADP水平与胎儿IFI、ISI的关系;绘制受试者工作特征(ROC)曲线分析GDM患者胎儿IFI、ISI和血清FE3、ADP水平单独及联合应用预测FD的效能。结果FD组血清FE3、ADP水平及胎儿IFI均低于非FD组和对照组,胎儿ISI高于非FD组和对照组,差异均有统计学意义(均P<0.05);非FD组血清FE3、ADP水平及胎儿IFI均低于对照组,胎儿ISI高于对照组,差异均有统计学意义(均P<0.05)。Pearson相关分析显示,GDM患者血清FE3水平与胎儿IFI呈正相关(r=0.553,P<0.01),与胎儿ISI呈负相关(r=-0.488,P<0.01);血清ADP水平与胎儿IFI呈正相关(r=0.547,P<0.01),与胎儿ISI呈负相关(r=-0.464,P<0.01)。ROC曲线分析显示,GDM患者胎儿IFI、ISI和血清FE3、ADP水平单独及联合应用预测FD的曲线下面积(AUC)分别为0.711、0.642、0.690、0.811、0.947,血清ADP水平的AUC高于血清FE3水平和胎儿ISI(Z=3.511、3.185,均P<0.05),联合应用预测的AUC高于血清FE3水平和胎儿IFI、ISI(Z=6.952、6.019、9.078,均P<0.05)。结论GDM患者胎儿AOI血流参数IFI、ISI联合血清FE3、ADP水平在预测FD中具有重要价值。

Objective To explore the value of fetal aortic isthmus(AOI)blood flow parameters combined with serum levels of free estradiol(FE3)and adiponectin(ADP)in predicting fetal distress(FD)in gestational diabetes mellitus(GDM)patients.Methods A total of 300 GDM patients were divided into the FD group(74 cases)and the non-FD group(226 cases)according to the occurrence of FD.Additionally,75 pregnant women with normal gestation during the same period were selected as the control group.The differences of fetal AOI blood flow parameters[isthmus flow index(IFI),isthmus systolic index(ISI)]and serum levels of FE3 and ADP were compared among the groups.Pearson correlation analysis was used to analyze the relationship between serum levels of FE3,ADP and fetal IFI,ISI.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of fetal IFI,ISI and serum levels of FE3,ADP alone and in combination for FD in GDM patients.Results In the FD group,serum levels of FE3,ADP and fetal IFI were lower than those in the non-FD group and the control group,while fetal ISI was higher(all P<0.05).In the non-FD group,serum levels of FE3,ADP and fetal IFI were lower than those in the control group,while fetal ISI was higher(all P<0.05).Pearson correlation analysis showed a positive correlation between serum level of FE3 and fetal IFI(r=0.553,P<0.01),and a negative correlation between serum level of FE3 and fetal ISI(r=-0.488,P<0.01).Serum level of ADP was positively correlated with fetal IFI(r=0.547,P<0.01),and negatively correlated with fetal ISI(r=-0.464,P<0.01).ROC curve analysis showed that the area under the curve(AUC)for predicting FD in GDM patients by fetal IFI,ISI,and serum levels of FE3,ADP alone and in combination were 0.711,0.642,0.690,0.811,0.947,respectively.The AUC of ADP was higher than that of seurm level of FE3 and fetal ISI(Z=3.511,3.185,both P<0.05),and the AUC of combined prediction was higher than that of seurm level of FE3,and fetal IFI,ISI(Z=6.952,6.019,9.078,all P<0.05).Conclusion Fetal AOI blood flow parameters(IFI,ISI)combined with serum levels of FE3 and ADP have important value in predicting FD in GDM patients.