胎儿大脑中动脉联合主动脉峡部血流参数预测子痫前期胎儿窘迫的价值

The value of fetal aortic isthmus flow index combined with middle cerebral artery pulsatility index in predicting fetal distress in patients with preeclampsia

目的探讨胎儿大脑中动脉搏动指数(PI_(MCA))联合主动脉峡部血流指数(IFI)预测子痫前期(PE)胎儿窘迫的临床价值。方法选取121例PE孕妇,测量所有胎儿PI_(MCA)及IFI,并记录。随访所有胎儿出生结局,根据临床诊断标准将其分为窘迫组和非窘迫组。比较两组胎儿PI_(MCA)以及IFI有无差异,通过ROC曲线及Logistic回归分析PI_(MCA)、IFI对PE胎儿宫内窘迫的预测效能以及联合应用的价值。结果窘迫组较非窘迫组相比,胎儿PI_(MCA)及IFI均减低,差异均有统计学意义(P均<0.05);PI_(MCA)、IFI可以预测PE胎儿窘迫,截断值分别为1.30(灵敏度64.6%、特异度89.0%)、0.91(灵敏度68.8%、特异度80.8%),PI_(MCA)联合IFI预测PE胎儿窘迫的灵敏度为85.4%、特异度为72.6%;且Logistic回归分析得出PI_(MCA)<1.30、IFI<0.91对PE胎儿窘迫的发生有显著预测作用,OR值分别为12.889、6.706,均差异有统计学意义(P均<0.05);PI_(MCA)、IFI单独预测及联合预测PE胎儿窘迫曲线下面积分别为0.819(95%CI:0.738~0.883,P<0.001)、0.793(95%CI:0.710~0.861,P<0.001)、0.890(95%CI:0.820~0.939,P<0.001),相比单独预测,联合预测曲线下面积更高,差异均有统计学意义(P均<0.05)。结论胎儿PI_(MCA)、IFI可以用来预测PE胎儿窘迫,监测胎儿宫内状况,并且PI_(MCA)联合IFI有较高的预测效能。

Objective To explore the value of fetal aortic isthmus flow index(IFI)combined with the pulsatility index of middle cerebral artery(PI_(MCA))in predicting fetal distress in preeclampsia(PE).Methods 121cases of pregnant women with PE were selected.The IFI and the PI_(MCA)of all fetuses were measured.The birth outcomes of all fetuses were followed up and di-vided into distress group and non-distress group according to clinical diagnosis.The PI_(MCA)and IFI were compared between the two groups.ROC curve and Logistic regression were used to analyze the predictive efficacy of the PI_(MCA)and IFI in predicting fetal distress in PE and to analyze the value of their combined application.Results The PI_(MCA)of the fetuses in distress group was lower than that of the non-distress group,and the IFI of the fetuses in distress group was lower than that in the non-distress group,with statistical significance(P<0.05).PI_(MCA)and IFI can predict fetal distress in PE patients,with cut-off values of 1.30(sensitivity,64.6%,specificity,89.0%)and 0.91(sensitivity,68.8%,specificity,80.8%).The sensitivity and specificity of PI_(MCA)combined with IFI in predicting fetal distress were 85.4%and 72.6%.Logistic regression analysis showed that PI_(MCA)<1.30 and IFI<0.91 could significantly predict the occurrence of fetal distress in PE,and the OR values were 12.889 and 6.706,both of which were statistically significant(P<0.05).The area under the curve of IFI in predicting fetal distress was 0.793(95%CI:0.710~0.861)and the area under the curve of PI_(MCA)in predicting fetal distress was 0.819(95%CI:0.738~0.883).The area un-der the curve of IFI combined with PI_(MCA)in predicting fetal distress was 0.890(95%CI:0.820~0.939).The area under the curve of IFI combined with PI_(MCA)was higher than that both alone in predicting fetal distress,there was statistically significant(P<0.05).Conclusions The PI_(MCA)and IFI of fetus can be used to predict fetal distress and detect the condition of fetus.IFI combined with PI_(MCA)has high prediction efficiency for fetal distress in PE.