胎盘三维彩色能量多普勒血管超声成像在早孕期预测胎儿生长受限中的应用价值

Application value of placenta three-dimensional color power Doppler vascular ultrasoundimaging in predicting fetal growth restriction in early pregnancy

目的 采用胎盘三维彩色能量多普勒血管超声成像(3D-CPA)检测早孕期产妇的胎盘三维能量多普勒指数,并分析其预测胎儿生长受限(FGR)的临床价值。方法 选取2022年1月—2023年1月于湖州市妇幼保健院行早孕期胎儿结构筛查的300名孕妇为研究对象,分娩后确诊为FGR的胎儿纳入研究组(150例),确诊为正常的胎儿纳入对照组(150例)。对比2组血流指数(FI)、血管化指数(VI)、血管化-血流指数(VFI)和妊娠结局,将差异有统计学意义的指标纳入多因素logistic回归分析模型,绘制ROC曲线分析相关指标预测FGR的价值。结果 研究组早产、剖宫产及胎儿窘迫发生率明显高于对照组,住院时间长于对照组,FI、VI及VFI均低于对照组,差异均有统计学意义(P<0.05)。多因素logistic回归模型分析显示,FI(OR=0.919)、VI(OR=0.860)、VFI(OR=0.703)均是FGR的影响因素(P<0.05)。ROC曲线显示,FI、VI及VFI的AUC分别为0.653、0.702及0.802。结论 与胎儿正常生长发育相比,存在FGR的胎盘内血流灌注减弱,且导致早产、剖宫产及胎儿窘迫等不良妊娠结局发生率升高;早孕期3D-CPA对FGR有重要的预测价值,可作为FGR诊断的辅助检查手段。

Objective The placental three-dimensional color power angiographic(3D-CPA)was used to detect the placental three-dimensional power Doppler index of early pregnant women,and its clinical value in predicting fetal growth restriction(FGR)was analyzed.Methods From January 2022 to January 2023,300 pregnant women who underwent fetal structure screening in Huzhou Maternal and Child Health Hospital were selected as the research objects.Fetuses diagnosed as FGR after delivery were included in the study group(n=150)and normal fetuses were included in the control group(n=150).The blood flow index(FI),vascularization index(VI),vascularization-flow index(VFI)and pregnancy outcome were compared between the two groups,and a multivariate logistic regression analysis model was constructed with statistically significant indicators,and the ROC curve was drawn to analyze the value of related indicators in predicting FGR.Results The incidence of premature delivery,cesarean section and fetal distress in the study group were significantly higher than those in the control group,while the FI,VI and VFI were lower than those in the control group,with statistical significance(P<0.05).Multivariate logistic regression model analysis showed that FI(OR=0.919),VI(OR=0.860)and VFI(OR=0.703)were the influencing factors of FGR(P<0.05).The ROC curve showed that the AUC of FI,VI and VFI were 0.653,0.702 and 0.802,respectively.Conclusion Compared with normal fetal growth and development,placental blood perfusion with FGR is weakened,and the incidence of adverse pregnancy outcomes such as premature delivery,cesarean section and fetal distress is increased.3D-CPA in early pregnancy has important predictive value for FGR,and can be used as an auxiliary examination method for FGR diagnosis.