血栓弹力图联合超声定量参数对胎儿生长受限的诊断效能研究

Study on diagnostic efficacy of thromboelastography combined with ultrasonic quantitative parameters on fetal growth restriction

目的:研究血栓弹力图联合超声定量参数对胎儿生长受限(fetal growth restriction,FGR)的诊断效能。方法:收集2021年7月—2023年5月郑州市妇幼保健院收治的50例FGR孕妇(FGR组),并选取同期同年龄段胎儿发育正常的50例孕妇作为对照(对照组)。比较两组血栓弹力图指标[最大振幅(maximum amplitude,MA)、α角(Angle)、凝血时间(coagulation time,K)、凝血反应时间(coagulation response time,R)]、脐动脉与大脑中动脉阻力指数(resistance index,RI)、搏动指数(pulsation index,PI)、血流收缩末期/舒张末期峰值(end-systolic/end-diastolic peak value,S/D)、脑胎盘率(cerebroplacental rate,CPR)、体重、腹围,二元相关分析、偏相关分析研究血栓弹力图、超声定量参数与体重、腹围的关系,受试者工作特征(receiver operating characteristic,ROC)曲线分析血栓弹力图、超声定量参数及联合诊断FGR价值。结果:FGR组孕中期、孕晚期、分娩前R、K均低于对照组,Angle、MA高于对照组(P<0.05);FGR组孕中期、孕晚期、分娩前脐动脉S/D、脐动脉PI、脐动脉RI高于对照组,大脑中动脉S/D、大脑中动脉PI、大脑中动脉RI、CRP低于对照组(P<0.05);FGR组孕中期、孕晚期、分娩前体重、腹围低于对照组(P<0.05);二元相关分析显示,分娩前各血栓弹力图、超声定量参数与体重、腹围相关性更强(P<0.05);偏相关分析显示,分娩前R、K、大脑中动脉RI、CRP与体重、腹围呈正相关,Angle、MA、脐动脉S/D、脐动脉PI、脐动脉RI仍与体重、腹围呈负相关(P<0.05);分娩前血栓弹力图、超声定量参数联合诊断FGR的ROC曲线下面积高于各单一指标(P<0.05)。结论:FGR孕妇接受血栓弹力图联合超声定量检测,可有效监测孕产妇在不同时期凝血功能变化和胎儿血流动力学变化,其联合诊断FGR具有较高价值。

Objective:To study the diagnostic efficacy of thromboelastography combined with ultrasound quantitative parameters on fetal growth restriction(FGR).Methods:A total of 50 cases of pregnant women with FGR admitted to Zhengzhou Maternal and Child Health Hospital from July 2021 to May 2023 were collected as the FGR group,and 50 pregnant women with normal fetal development in the same period and age group were selected as controls(the control group).The thromboelastogram indicators[maximum amplitude(MA),Angle,coagulation time(K),coagulation response time(R)],umbilical and middle cerebral artery resistance index(RI),pulsation index(PI),end-systolic/end-diastolic peak value(S/D),cerebroplacental rate(CPR),weight,and abdominal circumference were compared between the two groups.Binary correlation and partial correlation analyses were performed to explore the correlation of thromboelastogram and ultrasound quantitative parameters with weight or abdominal circumference.The receiver operating characteristic(ROC)curve was performed to analyze the diagnostic value of thromboelastogram,ultrasound quantitative parameters,and the combined diagnosis of FGR.Results:Second-trimester,late-pregnancy,and before delivery the value of R and K were lower in the FGR group than in the control group,while the value of Angle and MA were higher(P<0.05).The value of Umbilical artery S/D,umbilical artery PI,and umbilical artery RI in the FGR group were higher than those in the control group during the second-trimester,late-pregnancy,and before delivery,while the value of middle cerebral artery S/D,middle cerebral artery PI,middle cerebral artery RI,and CRP were lower than those in the control group(P<0.05).The weight and abdominal circumference of the FGR group were lower than those of the control group in the second-trimester,late-pregnancy,and before delivery(P<0.05).The binary correlation analysis showed that the thromboelastography and ultrasound quantitative parameters before delivery were more strongly correlated with both body weight and abdominal circumference(P<0.05).Partial correlation analysis indicated that the value of R,K,middle cerebral artery RI,and CRP were positively correlated with body weight and abdominal circumference before delivery,while the value of Angle,MA,umbilical artery S/D,umbilical artery PI and umbilical artery RI remained negatively correlated with body weight and abdominal circumference(P<0.05).The combined diagnosis of FGR by using thromboelastography and ultrasound quantitative parameters before delivery had a higher area under curve(AUC)than each single index(P<0.05).Conclusion:The quantitative detection of thromboelastography combined with ultrasound in pregnant women with FGR can effectively monitor changes in coagulation function and fetal hemodynamics at different stages of pregnancy,which has a high value in the diagnosis of FGR.