三维超声评估宫内生长受限胎儿肾上腺体积的改变及其与不良围生期结局的相关性

Application of the fetal adrenal volume evaluated by three-dimensional ultrasound in fetuses with intrauterine growth restriction and its correlation with adverse perinatal outcomes

目的评估宫内生长受限(IUGR)胎儿肾上腺体积(AGV)及经胎儿体质量(EFW)校正的肾上腺体积(cAGV)的变化,并探究IUGR胎儿cAGV与不良围生期结局的关系。方法前瞻性选取2021年2月至2022年8月于中南大学湘雅二医院行胎儿超声检查的32例IUGR胎儿作为IUGR组,选取同期与之孕周相匹配的正常胎儿32例作为对照组。应用三维超声获取两组胎儿肾上腺容积图像,使用VOCAL法测量AGV,并计算cAGV,比较IUGR组与对照组AGV和cAGV的差异。记录围生期结局,将孕妇年龄和胎儿脑胎盘比(CPR)作为协变量以控制混杂因素,采用多因素Logistic回归分析确定IUGR胎儿cAGV与不良围生期结局的关系。结果成功测量32例IUGR胎儿及32例正常胎儿的AGV。IUGR组AGV与对照组比较差异无统计学意义(P=0.417)。IUGR组cAGV显著大于对照组(P=0.034)。多因素Logistic回归分析显示,调整孕妇年龄及胎儿CPR后,IUGR胎儿cAGV与胎儿宫内窘迫有显著相关性(校正OR=0.005,95%CI=0.000~0.587,P=0.029),IUGR胎儿cAGV与总不良围生期结局也有显著相关性(校正OR=0.014,95%CI=0.000~0.475,P=0.018)。结论IUGR胎儿cAGV大于正常胎儿,且与胎儿不良围生期结局相关。评估胎儿cAGV可能有利于IUGR胎儿的监测和管理。

Objective To evaluate the fetal adrenal gland volume(AGV)and corrected adrenal gland volume(cAGV)in intrauterine growth restriction(IUGR)fetuses and observe their associations with the adverse perinatal outcomes.Methods From February 2021 to August 2022,32 IUGR fetuses who underwent fetal ultrasound examination in the Second Xiangya Hospital of Central South University were prospectively selected as the IUGR group,and 32 normal fetuses matched for gestational age during the same period were selected as the control group.Three-dimensional ultrasound was used to obtain fetal adrenal volume images,and the virtual organ computer-aided analysis(VOCAL)was used to measure AGV,then the cAGV was calculated.The values of AGV and cAGV were appropriately compared between the IUGR and the control groups.The pregnancy outcomes were noted.Multiple logistic regression analysis was employed to evaluate the relationship between the cAGV and adverse perinatal outcomes in IUGR fetus,with maternal age and the CPR included as covariates to control for confounding factors.Results A total of 32 fetuses with IUGR and 32 controls were involved in this prospective study.There was no significant difference in the AGV between these two groups(P=0.417).The cAGV of the IUGR fetus was substantially larger than that of the normal fetus(P=0.034).In the multivariate logistic regression analysis,after adjusting for maternal age and fetal CPR,the fetal cAGV was noticeably associated with the fetal distress(adjusted OR=0.005,95%CI=0.000-0.587,P=0.029)and the total adverse perinatal outcomes(adjusted OR=0.014,95%CI=0.000-0.475,P=0.018).Conclusions The value of cAGV is increased in the IUGR fetuses and associated with adverse perinatal outcomes.The evaluation of fetal AGV could be beneficial to monitoring and managing IUGR fetuses.