四维彩超联合性激素水平诊断孕中期胎儿生长受限的价值研究

Value of four-dimensional color Doppler ultrasound combined with sex hormone level in diagnosing fetal growth restriction in the second trimester of pregnancy

目的:研究孕中期四维彩超联合性激素水平诊断胎儿生长受限(FGR)的价值。方法:选择医院收治的113例孕中期孕妇,对其进行电话随访至胎儿娩出为止,根据是否发生FGR将其分为FGR组(18例)和健康对照组(95例)。比较孕14~27周时两组四维超声检查结果,以及血管化指数(VI)、血流指数(FI)、血管化-血流指数(VFI)、性激素水平中雌二醇(E2)、绒毛膜促性腺激素β亚单位(β-hCG)、游离雌三醇(uE3)、甲胎蛋白(AFP)水平;采用受试者工作特征(ROC)曲线分析四维超声与性激素水平诊断FGR的价值。结果:FGR组VI、FI及VFI值与健康对照组相比较小,差异有统计学意义(t=5.607,t=4.247,t=5.397;P<0.05),FGR组β-hCG、AFP水平高于健康对照组,uE3水平低于健康对照组,差异有统计学意义(t=2.949,t=2.095,t=2.033,P<0.05)。两组E2水平差异无统计学意义;经ROC曲线分析,VI、FI、VFI、β-hCG、uE3和AFP诊断胎儿生长受限的ROC曲线下面积分别为0.989、0.907、0.967、0.886、0.715和0.743;四维超声联合性激素水平诊断胎儿生长受限的灵敏度、特异度和准确率分别为88.9%、95.7%和为94.7%,阳性预测值为0.800,阴性预测值为0.978。经一致性分析,四维超声与性激素水平诊断胎儿生长受限具有较好的一致性(Kappa=0.810)。结论:孕中期四维彩超联合性激素水平诊断FGR具有较高的准确率,可将其用于FGR的诊断或预测。

Objective:To study the value of four-dimensional(4D)color Doppler ultrasound combined with sex hormone level in diagnosing fetal growth restriction(FGR)in the second trimester of pregnancy.Methods:A total of 113 pregnant women in the second trimester who admitted to hospital were selected as subjects.They were followed up by telephone until the birth of their fetuses.According to the incidence of FGR,they were divided into FGR group(18 cases)and health control group(95 cases).The results of 4D color Doppler ultrasound examination,as well as vascularization index(VI),blood flow index(FI),vascularization-blood flow index(VFI)were compared between the two groups during 14-27 weeks of gestation.The levels of sex hormones,including estradiol(E2),chorionic gonadotropinβ-subunit(β-hCG),free estriol(uE3)and alpha-fetoprotein(AFP)were compared between the two groups during 14-27 weeks of gestation.The receiver operating characteristics(ROC)curve was used to analyze the value of 4-D color Doppler ultrasound and sex hormone levels in diagnosing FGR.Results:Compared with the healthy control group,the VI,FI and VFI values of FGR group were smaller,and the differences were statistically significant(t=5.607,t=4.247,t=5.397,P<0.05),and the levels ofβ-hCG and AFP of FGR group were higher,and the uE3 levels of that were lower,and the differences of them were statistically significant(t=2.949,t=2.095,t=2.033,P<0.05).There was no significant difference in E2 level between the two groups.According to ROC analysis,the areas under curve(AUC)values of VI,FI,VFI,β-hCG,uE3 and AFP were respectively 0.989,0.907 and 0.967,0.886,0.715,0.743 in diagnosing FGR.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 4D ultrasound combined with sex hormone level were 88.9%,95.7%and 94.7%,0.800 and 0.978 as the consistency analysis.The consistent analysis between 3D color Doppler ultrasound and sex hormone level indicated Kappa=0.810 in diagnosing FGR.Conclusion:In the second trimester of pregnancy,4D color Doppler ultrasound combined with sex hormone level has higher accuracy in diagnosing FGR,which can be used to diagnose or predict FGR.