胎儿脐动脉及大脑中动脉彩色多普勒超声血流动力学参数预测胎儿宫内窘迫的临床价值

Clinical value of hemodynamic parameters of fetal umbilical artery and middle cerebral artery with color Doppler ultrasound in predicting fetal intrauterine distress

目的探讨胎儿脐动脉(UA)及大脑中动脉(MCA)彩色多普勒超声血流动力学参数预测胎儿宫内窘迫的临床价值。方法选取2019年10月至2020年10月于本院就诊的82例胎儿宫内窘迫的孕妇作为宫内窘迫组,另选取同期50名产前检查正常的健康孕妇作为对照组,所有研究对象均经彩色多普勒超声检测UA及MCA。比较两组UA、MCA及MCA/UA的血流动力学参数,绘制ROC曲线分析彩色多普勒超声检查UA、MCA及MCA/UA的血流动力学参数对胎儿宫内窘迫的预测价值。结果宫内窘迫组UA的收缩期峰值流速舒张期流速比值(S/D)、阻力指数(RI)及搏动指数(PI)均高于对照组,MCA、MCA/UA的S/D、RI、PI均低于对照组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,UA的S/D截断值取2.79时,AUC、灵敏度、特异度为0.757、78.12%、82.14%;RI截断值取0.58时,AUC、灵敏度、特异度为0.725、78.12%、75.00%;PI截断值取1.44时,AUC、灵敏度、特异度为0.796、84.37%、82.14%;UA的S/D、RI、PI对宫内窘迫预测价值较高。MCA的S/D截断值取5.23时,AUC、灵敏度、特异度为0.804、81.20%、85.70%;RI截断值取0.69时,AUC、灵敏度、特异度为0.694、78.12%、78.57%;PI截断值取1.59时,AUC、灵敏度、特异度为0.790、81.25%、82.14%;MCA的S/D、PI对宫内窘迫预测价值较高,MCA的RI预测价值较低。MCA/UA的S/D截断值取1.18时,AUC、灵敏度、特异度为0.981、87.80%、100.00%;RI截断值取1.36时,AUC、灵敏度、特异度为0.970、91.46%、92.00%;PI截断值取0.847时,AUC、灵敏度、特异度为0.973、98.78%、86.00%;MCA/UA的S/D、RI、PI对宫内窘迫预测价值很高。结论单一血流动力参数对预测胎儿宫内窘迫具有一定局限性,MCA/UA血流动力学参数对胎儿宫内窘迫的预测价值更高。

Objective To investigate the clinical value of hemodynamic parameters of fetal umbilical artery(UA)and middle cerebral artery(MCA)with color Doppler ultrasound in predicting fetal intrauterine distress.Methods 82 pregnant women with intrauterine distress who visited our hospital from October 2019 to October 2020 were selected as the intrauterine distress group,and 50 healthy pregnant women with normal prenatal examination during the same period were selected as the control group.Color Doppler ultrasound was used to detect UA and MCA in all subjects.The hemodynamic parameters of UA,MCA and MCA/UA were compared between the two groups,and ROC curve was drawn to analyze the value of color Doppler ultrasonography in predicting fetal distress in UA,MCA and MCA/UA hemodynamic parameters.Results The peak systolic velocity/end diastolic velocity(S/D),resistance index(RI)and pulsation index(PI)of UA in the intrautrine distress group were higher than those in the control group,and the S/D,RI and PI of MCA and MCA/UA were lower than the control group,the differences were statistically significant(P<0.05).The ROC cure analysis results showed that when the S/D cut-off value of UA was 2.79,AUC,sensitivity and specificity were 0.757,78.12%and 82.14%;when RI cut-off value was 0.58,AUC,sensitivity and specificity were 0.725,78.12%and 75.00%;when PI cut-off value was 1.44,AUC,sensitivity and specificity were 0.796,84.37%and 82.14%;the S/D,RI and PI of UA had high predictive value for intrauterine distress;when the S/D cut-off value of MCA was 5.23,the AUC,sensitivity and specificity are 0.804,81.20%and 85.70%;when RI cut-off value was 0.69,AUC,sensitivity and specificity were 0.694,78.12%and 78.57%;when PI cut-off value was 1.59,AUC,sensitivity and specificity were 0.790,81.25%and 82.14%;the S/D and PI values of MCA were higher in predicting intrauterine distress,while the RI values of MCA were lower;when the S/D cut-off value of MCA/UA was 1.18,AUC,sensitivity and specificity were 0.981,87.80%and 100.00%;when RI cut-off value was 1.36,AUC,sensitivity and specificity were 0.970,91.46%and 92.00%;when PI cut-off value is 1.05,AUC,sensitivity and specificity are 0.973,98.78%and 86.00%;the S/D,RI and PI of MCA/UA were highly predictive of intrauterine distress.Conclusion Single hemodynamic parameter has certain limitations in predicting fetal distress,and MCA/UA hemodynamic parameters have higher predictive value for fetal distress.