胎盘血流状态及胎儿大脑中动脉血流和脑胎盘率预测晚发型FGR的超声研究

Ultrasonographic study on placental blood flow status,fetal middle cerebral artery blood flow and cerebroplacental ratio in predicting late-onset fetal growth restriction

目的研究胎盘血流状态及胎儿大脑中动脉血流和脑胎盘率预测晚发型胎儿生长受限。方法选择在本院分娩胎儿受限的产妇120例为病例组,同时选择同期产检、分娩正常胎儿的60例产妇为对照组。三维多普勒超声检测胎盘血流状态、脑胎盘率、大脑中动脉血流参数等,单因素分析临床基线资料,Logistic回归分析确定胎儿生长发生的影响因素,通过受试者工作特征曲线分析各指标及回归分析诊断效能。结果病例组孕妇血流指数(blood flow index,FI)、血管化指数(vascularization index,VI)和血管化-血流指数(vascularization-blood flow index,VFI)等胎盘血流状态参数明显低于对照组。病例组孕妇搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)和脑胎盘率(cerebroplacental ratio,CPR)明显低于对照组,病例组孕妇EDV明显高于对照组。CPR与FI、VI、VFI、PI和RI成正相关(r=0.185,0.594,0.854,0.696,0.701,P<0.05);CPR与EDV成负相关(r=-0.452,P<0.05)。Logistic回归分析结果表明,FI、VI、VFI、PI、RI、EDV和CPR是胎儿生长受限的影响因素。结论脑胎盘率、胎盘血流状态及大脑中动脉血流参数在胎儿生长受限孕妇中异常表达,且CPR、FI、VI、VFI、PI、RI及EDV等参数单独和Logistic回归分析可应用于胎儿生长受限的预测和诊断。

Objective To study placental blood flow status,fetal middle cerebral artery(MCA)blood flow and cerebroplacental ratio(CPR)in predicting late-onset fetal growth restriction.Methods A total of 120 women with limited fetal delivery in our hospital were selected as the case group,while 60 women with normal fetal delivery during the same period were selected as the control group.The placental blood flow status,CPR and MCA blood flow parameters were detected by three-dimensional Doppler ultrasound.The clinical baseline data were analyzed by univariate analysis.The influencing factors of fetal growth were determined by Logistic regression analysis.Receiver operating characteristics(ROC)curve was used to analyze various indicators and Logistic regression analysis was used to analyze the diagnostic efficacy.Results The parameters of placental blood flow state,including blood flow index(FI),vascularization index(VI)and vascularization-blood flow index(VFI),of the pregnant women in the case group were significantly lower than those of control group.Pulsatility index(PI),resistance index(RI)and CPR were significantly lower in the case group than in the control group,while EDV was significantly higher in the case group than in the control group.CPR was positively correlated with FI,VI,VFI,PI and RI(r=0.185,0.594,0.854,0.696,0.701,P<0.05),but negatively correlated with EDV(r=-0.452,P<0.05).Logistic regression analysis showed that FI,VI,VFI,PI,RI,EDV and CPR were the influencing factors of FGR.Conclusion CPR,placental blood flow status and MCA blood flow parameters are abnormal in pregnant women with FGR.CPR,FI,VI,VFI,PI,RI and EDV parameters alone and Logistic regression analysis can be applied to the prediction and diagnosis of FGR.