基于超声血流参数评估晚发型胎儿宫内生长受限的研究

Evaluation of late-onset fetal intrauterine growth restriction based on ultrasound blood flow parameters

目的分析超声血流参数对晚发型胎儿宫内生长受限(FGR)的预测价值。方法选取2020年6月至2022年6月青海大学附属医院收治的82例晚发型FGR孕产妇作为研究对象。根据新生儿妊娠结局分为结局良好组(51例)与结局不良组(31例)。另选取同期在青海大学附属医院产检且胎儿生长正常的32例孕产妇作为对照组。比较3组基线资料及分娩前最后1次超声的大脑中动脉搏动指数(MCA-PI)、脐动脉搏动指数(UA-PI)、脑-胎盘血流比(CPR)、心血管整体评分(CVPS)、Hadlock胎儿体质量估测(EFW),绘制受试者工作特征(ROC)曲线评估上述超声血流参数对晚发型FGR孕产妇不良妊娠结局的预测价值。结果结局不良组新生儿出生体质量均低于结局良好组及对照组,且结局良好组低于对照组,差异均有统计学意义(P<0.05)。结局不良组分娩孕周短于对照组和结局良好组,差异均有统计学意义(P<0.05)。结局不良组MCA-PI、CPR、CVPS、EFW均低于结局良好组及对照组,且结局良好组低于对照组,差异均有统计学意义(P<0.05)。结局不良组UA-PI高于结局良好组及对照组,且结局良好组高于对照组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,MCA-PI、UA-PI、CPR、CVPS、EFW单独预测晚发型FGR孕产妇不良妊娠结局的曲线下面积分别为0.667、0.792、0.762、0.820、0.917。结论超声血流参数MCA-PI、UA-PI、CPR、CVPS、EFW均对晚发型FGR孕产妇不良妊娠结局有一定预测价值,其中CVPS及EFW预测价值较高,可为临床治疗及判断分娩时机提供重要依据。

Objective To analyze the predictive value of ultrasonic blood flow parameters for late-onset fetal intrauterine growth restriction(FGR).Methods A total of 82 pregnant women with late-onset FGR admitted to the Affiliated Hospital of Qinghai University from June 2020 to June 2022 were selected as the research objects.According to the neonatal pregnancy outcome,they were divided into good outcome group(51 cases)and poor outcome group(31 cases).Another 32 pregnant women with normal fetal growth in the Affiliated Hospital of Qinghai University during the same period were selected as the control group.The baseline data,middle cerebral artery pulsatility index(MCA-PI),umbilical artery pulsatility index(UA-PI),cerebroplacental flow ratio(CPR),Global Cardiovascular Score(CVPS)and Hadlock estimating fetal weight(EFW)within last ultrasound were compared among the three groups.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the above ultrasound blood flow parameters for poor pregnancy outcomes of pregnant women with late-onset FGR.Results The neonatal birth weight of the poor outcome group was lower than that of the good outcome group and the control group,and the neonatal birth weight of good outcome group was lower than that the control group,and the differences were statistically significant(P<0.05).The gestational age at delivery in the poor outcome group was shorter than that in the control group and the good outcome group,and the differences were statistically significant(P<0.05).The MCA-PI,CPR,CVPS and EFW of the poor outcome group were lower than those of the good outcome group and the control group,and the MCA-PI,CPR,CVPS and EFW of the good outcome group were lower than those of the control group,and the differences were statistically significant(P<0.05).The UA-PI of the poor outcome group was higher than that of the good outcome group and the control group,and the UA-PI of the good outcome group was higher than that of the control group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curves of MCA-PI,UA-PI,CPR,CVPS and EFW for predicting poor pregnancy outcomes of late-onset FGR pregnant women were 0.667,0.792,0.762,0.820 and 0.917,respectively.Conclusion MCA-PI,UA-PI,CPR,CVPS and EFW all have certain predictive value for the poor pregnancy outcome of late-onset FGR pregnant women,among which CVPS and EFW have higher predictive value,which can provide important basis for clinical treatment and estimating delivery timing.