彩色多普勒超声联合血清学检测诊断晚发型胎儿生长受限的临床价值

Clinical value of color Doppler ultrasound combined with serological detection in the diagnosis of late-onset fetal growth restriction

目的探讨彩色多普勒超声联合血清学检测诊断晚发型胎儿生长受限(FGR)的临床价值。方法选取我院确诊为FGR的孕晚期孕妇46例为FGR组,以及同期46例胎儿发育正常的孕晚期孕妇为对照组。应用彩色多普勒超声检测脐动脉收缩期峰值流速与舒张期最小流速比值(S/D)、大脑中动脉和脐动脉搏动指数,计算脑胎盘率(CPR);收集临床资料,检测血清胎盘生长因子(PLGF)、可溶性血管内皮因子受体-1(sFlt-1),比较两组上述参数的差异。采用多因素Logistic回归分析晚发型FGR的独立影响因素;绘制受试者工作特征(ROC)曲线分析超声及血清学参数单独及联合应用对晚发型FGR的诊断效能。结果FGR组合并妊娠期高血压占比、脐动脉S/D、血清sFlt-1均高于对照组,CPR、血清PLGF均低于对照组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,脐动脉S/D、CPR、血清PLGF、血清sFlt-1均为晚发型FGR的独立影响因素(均P<0.05)。ROC曲线分析显示,脐动脉S/D、CPR、血清PLGF、血清sFlt-1诊断晚发型FGR的曲线下面积(AUC)分别为0.783、0.835、0.874、0.841,脐动脉S/D联合血清PLGF、sFlt-1的AUC为0.971,CPR联合血清PLGF、sFlt-1的AUC为0.981,四项联合的AUC为0.990,均高于各参数单独应用(均P<0.05)。结论彩色多普勒超声及血清学检测对晚发型FGR均有较高的诊断效能,二者联合应用的诊断效能更高。

Objective To explore the clinical value of color Doppler ultrasound combined with serological detection in the diagnosis of late-onset fetal growth restriction(FGR).Methods A total of 46 late pregnant women with confirmed FGR(FGR group)and 46 late pregnant women with normal fetal development(control group)were selected from our hospital.Color Doppler ultrasound was used to measure the ratio of systolic and diastolic(S/D)of the umbilical artery,the pulsatility index of the middle cerebral artery and umbilical artery,and the cerebroplacental ratio(CPR)was calculated.Clinical data were collected,and serum placental growth factor(PLGF),soluble vascular endothelial factor receptor-1(sFlt-1)were detected.The differences of above parameters between the two groups were compared.The independent influencing factors of late-onset FGR were analyzed by multivariate Logistic regression analysis.The diagnostic efficiency of ultrasound and serum parameters used alone and combined for predicting late-onset FGR was analyzed by receiver operating characteristic(ROC)curve.Results The proportion of gestational hypertension,umbilical artery S/D and serum sFlt-1 in the FGR group were higher than those in the control group,while CPR and serum PLGF were lower than those in the control group(all P<0.05).Multivariate Logistic regression analysis showed that umbilical artery S/D,CPR,serum PLGF and sFlt-1 were independent influencing factors for late-onset FGR(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of umbilical artery S/D,CPR,serum PLGF and sFlt-1 for predicting late-onset FGR were 0.783,0.835,0.874 and 0.841,respectively.AUC for umbilical artery S/D ratio combined with serum PLGF and sFlt-1,CPR combined with serum PLGF and sFlt-1 were 0.971 and 0.981,respectively,while the AUC for the combination of all four parameters was 0.990,which was higher than each single parameter(all P<0.05).Conclusion Color Doppler ultrasound combined with serological detection has high diagnostic efficiency for late-onset FGR,with the combined application providing higher diagnostic value.