早发性胎儿宫内生长受限的相关因素分析及对妊娠结局的影响

Analysis of factors associated with intrauterine growth restriction in early-onset fetuses and its impact on pregnancy outcome

目的 回顾性研究早发性胎儿宫内生长受限(FGR)的相关因素分析及对妊娠结局的影响。方法 回顾性分析2021年1月—2022年12月本院接收的妊娠早期妇女共131例的临床资料,依据病历系统记录是否发生FGR分为发生组、未发生组,发生FGR的孕妇划分为FGR组,未发生FGR的孕妇划分为对照组,收集对比两组研究对象一般资料及子宫动脉超声参数[双侧阻力指数(UtA-RI)、双侧搏动指数(UtA-PI)以及收缩期峰值流速(PSV)/舒张末期流速(EDV)的(S/D)],针对存在差异的指标开展Logistic回归分析,分析发生FGR的影响因素,构建Logistic回归风险预测模型,利用受试者工作特征曲线(ROC曲线)评价预测模型的价值,构建校准曲线与决策曲线。并对两组患者妊娠结局情况,分析FGR对妊娠结局的影响。结果 FGR发生的独立危险因素为是否进行产前检查、羊水过少、子宫异常、UtA-RI、UtA-PI、S/D,OR值均>1。绘制ROC曲线,发现AUC是0.753,95%CI(0.639~0.838)。风险预测模型的校准曲线和参考曲线相近,证明FGR发生的预测风险和实际风险存在较高的一致性;同时阈值范围中预测模型的净获益率较高,证明该预测模型的适用性较好。FGR组新生儿出生质量、胎龄低于对照组,但新生儿疾病、窒息的发生率均高于对照组(P<0.05)。结论 是否进行产前检查、羊水过少、子宫异常、UtA-RI、UtA-PI、S/D均为FGR发生的危险因素,将上述因素作为基础构建起有关风险预测模型,有利于有助于在妊娠早期孕妇中筛选FGR发生患者,降低异常妊娠结局风险。

Objective To retrospectively study the factors associated with early-onset intrauterine fetal growth restriction(FGR)and its impact on pregnancy outcome.Methods The clinical data of a total of 131 cases of women in early pregnancy who were admitted to our hospital from January 2021 to December 2022 were analyzed retrospectively.According to the medical record system records,based on whether FGR occurred,they were divided into the occurrence group and the non-occurrence group.Pregnant women with FGR were divided into the FGR group,and pregnant women without FGR were divided into the control group.The general data and uterine artery ultrasonographic parameters[bilateral resistance index(UtA-RI),bilateral pulsatility index(UtA-RI)and peak systolic flow velocity(PSV)/end diastolic flow velocity(EDV)(S/D)]of the study subjects in the two groups were collected and compared.Logistic regression analysis was carried out for the indicators with differences,to analyze the influencing factors of FGR.Logistic regression risk prediction model was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the value of the prediction model,and the calibration curve and decision curve were constructed.The pregnancy outcomes of the two groups were compared,and the effect of FGR on pregnancy outcomes was analyzed.Results The independent risk factors for the occurrence of FGR were whether prenatal checkups were performed,low amniotic fluid,uterine anomalies,UtA-RI,UtA-PI,and S/D,all their OR value over 1.The ROC curve was plotted,and the AUC was found to be 0.753,with a 95%CI(0.639~0.838).The calibration curve of the risk prediction model was similar to the reference curve,which proved that there was a high consistency between the predicted risk and the actual risk of the occurrence of FGR.Meanwhile,the net benefit rate of the prediction model within the threshold range was high,which proved that the applicability of the prediction model was preferably.The birth quality and gestational age of newborns in the FGR group were lower than that of the control group,but the rates of neonatal diseases and asphyxia were higher than that of the control group(P<0.05).Conclusions Prenatal examination,low amniotic fluid,uterine abnormalities,UtA-RI,UtA-PI,and S/D are risk factors of FGR,the risk prediction model constructed based on them is beneficial for early screening of pregnant women at risk of FGR and reducing the likelihood of abnormal pregnancy outcomes.