孕早期二维联合三维超声预测胎儿生长受限的应用价值

Application Value of Two-dimensional Combined Three-dimensional Ultrasound in Predicting Fetal Growth Restriction in Early Pregnancy

目的:探讨孕早期二维联合三维超声预测胎儿生长受限(FGR)的应用价值。方法:选取2021年4月—2022年4月在福建医科大学附属漳州市医院规律产检的处于孕早期的单胎妊娠孕妇404例,根据胎儿是否存在生长受限分为FGR组(n=47)和非FGR组(n=357),分析两组二维子宫螺旋动脉(SA)血流搏动指数(PI)及三维胎盘体积(PV)、血管形成-血流指数(VFI)指标的差异性。采用受试者工作特征(ROC)曲线分析不同指标预测FGR的诊断效能,并采用多因素logistic回归分析来构建联合预测模型。结果:FGR组的SA-PI高于非FGR组,VFI、PV低于非FGR组,差异有统计学意义(P<0.05)。VFI预测FGR的曲线下面积(AUC)高于SA-PI和PV,且SA-PI预测FGR的AUC高于PV。三者联合预测FGR的AUC为0.894,敏感度为0.809,特异度为0.852,均高于SA-PI、VFI、PV各指标单一检测,其中VFI截断值为4.121,SA-PI截断值为0.665,PV截断值为59.322 cm3。多因素logistic回归分析显示,SA-PI、VFI、PV均是导致FGR的独立影响因素(P<0.001)。结论:孕早期二维联合三维超声可以提高预测FGR的诊断效能,为临床提供量化指标,指导临床早期对高危孕妇进行干预,对保障围生儿健康有重要意义。

Objective:To explore the application value of two-dimensional and three-dimensional ultrasoud in predicting fetal growth restriction(FGR)in early pregnancy.Method:A total of 404 single pregnancy pregnant women who underwent regular prenatal examinations in early pregnancy at Zhangzhou Hospital Affiliated to Fujian Medical University from April 2021 to April 2022 were selected and divided into FGR group(n=47)and non FGR group(n=357)based on the presence of fetal growth restriction.The differences in two-dimensional uterine spiral artery(SA)pulsation index(PI),three-dimensional placental volume(PV),and vascular formation flow index(VFI)between the two groups were analyzed.Using receiver operating characteristic(ROC)curve analysis to predict the diagnostic efficacy of different indicators for FGR,and using multivariate logistic regression analysis to constructed a joint prediction model.Result:The SA-PI of the FGR group was higher than that of the non FGR group,while VFI and PV were lower than those of the non FGR group,the differences were statistically significant(P<0.05).The area under the curve(AUC)predicted by VFI for FGR was higher than that of SA-PI and PV,and SA-PI predicts that the AUC of FGR was higher than that of PV.The AUC of the combined prediction of FGR by the three methods was 0.894,the sensitivity was 0.809 and specificity was 0.852,all of which were higher than the single detection of SA-PI,VFI,and PV indicators.Among them,the VFI cutoff value was 4.121,the SA-PI cutoff value was 0.665,and the PV cutoff value was 59.322 cm3.Multivariate logistic regression analysis showed that SA-PI,VFI,and PV were all independent influencing factors leading to FGR(P<0.001).Conclusion:The combination of two-dimensional and three-dimensional ultrasound in early pregnancy can improve the diagnostic efficiency of predicting FGR,provide quantitative indicators for clinical practice,guide early intervention in high-risk pregnant women,and have important significance in ensuring the health of perinatal infants.