胎儿宫内生长受限彩超血流动力学变化及不良妊娠结局预测模型构建

Hemodynamic changes of fetal intrauterine growth restriction and construction of prediction model for poor pregnancy outcomes

目的探究胎儿生长受限(FGR)脐动脉、大脑中动脉及静脉导管血流动力学变化,并构建FGR不良妊娠结局的预测模型。方法回顾性分析2019年2月至2022年1月于成都医学院第二附属医院·核工业四一六医院分娩的197例FGR孕妇(FGR组)及75例健康孕妇(对照组)的临床资料,所有孕妇均接受了彩色多普勒超声检查;均随访至妊娠结局,采用Logistic回归分析不良妊娠结局发生的危险因素,并建立预测模型,以ROC曲线分析该模型对不良妊娠结局的预测价值。结果FGR组脐动脉搏动指数(PI)、阻力指数(RI)、收缩期最大血流速度与舒张期末血流速度的比值(S/D)及静脉导管S/a值大于对照组,大脑中动脉PI、RI、S/D及静脉导管S峰流速、a峰流速小于对照组(P<0.05);纳入Logistic回归进行分析,发现不良妊娠史、脑胎盘率<1、静脉导管波谱异常、PLGF低于正常值、存在妊娠合并症、宫内感染是导致不良妊娠结局发生的危险因素(P<0.05),并获得FGR孕妇发生不良妊娠结局的风险预测模型,P=-1.053+0.492×不良妊娠史赋值+0.635×脑胎盘率赋值+0.473×静脉导管波谱赋值+0.614×PIGF赋值+0.535×妊娠合并症赋值+0.821×宫内感染赋值,ROC曲线显示,该模型预测FGR孕妇发生不良妊娠结局的AUC为0.929,SE为0.022,95%CI为0.886~0.973。结论FGR孕妇存在脐动脉、大脑中动脉及静脉导管血流异常现象,基于FGR孕妇不良结局的危险因素建立的预测模型,对不良妊娠结局的发生具有较高的预测价值。

Objective To explore the hemodynamic changes of umbilical artery,middle cerebral artery and venous duct in fetal growth restriction(FGR),and to construct a prediction model for poor pregnancy outcomes of FGR.Methods The clinical data of 197 pregnant women with FGR(FGR group)and 75 healthy pregnant women(control group)who gave birth in the 2nd Affiliated Hospital of Chengdu Medical College,Nuclear Industry 416 Hospital from February 2019 to January 2022 were retrospectively analyzed.All patients received color Doppler ultrasound.All pregnant women were followed up to the pregnancy outcome.Logistic regression analysis was used to analyze the risk factors for poor pregnancy outcomes,and the prediction model was established and ROC curve was adopted to analyze the predictive value of the prediction model on poor pregnancy outcomes.Results The pulsatility index(PI),resistance index(RI)and systolic phase/diastolic phase(S/D)of umbilical artery and venous duct S/a value in FGR group were higher while the PI,RI and S/D of middle cerebral artery and S peak flow velocity and a peak flow velocity of venous duct were lower than those in control group(P<0.05).Logistic regression analysis showed that poor pregnancy history,brain placenta rate<1,abnormal spectrum of venous duct,PLGF lower than normal value,presence of pregnancy complications and intrauterine infection were risk factors for poor pregnancy outcomes(P<0.05).The risk prediction model for poor pregnancy outcomes in pregnant women with FGR was obtained and represented as P=-1.053+0.492×poor pregnancy history+0.635×brain placental rate+0.473×abnormal spectrum of venous duct+0.614×PLGF+0.535×pregnancy complications+0.821×intrauterine infection.ROC curve revealed that the AUC,SE and 95%CI of the prediction model in predicting poor pregnancy outcomes in pregnant women with FGR were 0.929,0.022 and 0.886-0.973.Conclusions Pregnant women with FGR have abnormal blood flow phenomena in umbilical artery,middle cerebral artery and venous duct.The prediction model established according to the risk factors of poor outcomes in pregnant women with FGR has high predictive value on the occurrence of poor pregnancy outcomes.