超声多参数Z-评分联合模型评估胎儿生长受限的价值研究

Value of an ultrasound multiparametric Z-score combined model to assess fetal growth restriction

目的探讨超声多参数Z-评分联合预测模型评估胎儿生长受限(FGR)的价值。方法回顾性分析2017年1月~2020年12月我院收治的88例单胎、孕22~29周且婴儿出生后确诊为FGR的孕妇临床资料,并以同期年龄、产次、妊娠期合并症等一般资料基本匹配的108例非FGR孕妇资料作为对照。采用Logistic回归方程建立胎儿体质量测定(EFW)、脐动脉(UA)、大脑中动脉(MCA)、脑-胎盘比(CPR)、腹围(AC)和头-腹围比值(HC/AC)等参数的单参数模型和多参数联合模型,并绘制受试者工作特征曲线(ROC),通过与Hadlock-EFW百分位数(Hadlock-EFWc)比较,以评估不同模型预测FGR的价值。结果FGR组EFW、EFWc及CPR、AC、HC/AC的Z-评分均明显低于非FGR组,UA-PI、MCA-PI的Z-评分高于非FGR组(P<0.001)。联合模型预测FGR的灵敏度为82.95%、特异度为70.37%、约登指数为0.533、ROC曲线下面积(AUC)为0.897,95%CI为(0.795,0.956),其预测效能优于Hadlock-EFWc及各超声单参数(P<0.05)。结论超声多参数Z-评分联合模型预测FGR相较Hadlock-EFWc和超声单参数更为准确且诊断价值更高。

Objective To investigate the value of the combined prediction model of ultrasound multi-parameter Z-score in assessing fetal growth restriction(FGR).Methods The clinical data of 88 pregnant women with single pregnancy,22-29 weeks of pregnancy,and FGR infants born after delivery in our hospital from January 2017 to December 2020 were retrospectively analyzed.The general information such as age,parity,pregnancy comorbidity was basically matched with that of 108 non-FGR pregnant women.The single parameter model and the multi-parameter combined model of fetal body mass measurement(EFW),umbilical artery(UA),middle cerebral artery(MCA),cerebral-placental ratio(CPR),abdominal circumference(AC)and head-abdominal circumference ratio(HC/AC)were established by using logistic regression equation.The receiver operating characteristic curve(ROC)was plotted,and the value of different models in predicting FGR was evaluated by comparing with Hadlock-EFW percentile(Hadlock-EFWc).Results The Z-scores of EFW,EFWc,CPR,AC and HC/AC in the FGR group were significantly lower than those in the non-FGR group,while the Z-scores of UA-PI and MCA-PI were higher than those in the non-FGR group(P<0.001).The sensitivity,specificity,Youden index and area under the ROC curve(AUC)of the combined model for predicting FGR were 82.95%,70.37%,0.533 and 0.897,respectively,with 95%CI of(0.795,0.956).Its predictive performance was better than that of Hadlock-EFWc and each single ultrasound parameter(P<0.05).Conclusion The combined model of ultrasound multi-parameter Z-score is more accurate and has higher diagnostic value than Hadlock-EFWc and each single ultrasound parameter in predicting FGR.