高危妊娠孕妇血清游离雌三醇联合胎儿大脑中动脉血流参数对母婴不良结局的预测价值

Value of Fetal Serum Free Estriol Combined with Middle Cerebral Artery Blood Flow Parameters in Predicting Adverse Outcomes of Mothers and Infants in High-Risk Pregnancies

【目的】探讨高危妊娠孕妇血清游离雌三醇(uE3)联合胎儿大脑中动脉血流参数对母婴不良结局的预测价值。【方法】选取2019年2月至2021年2月在本院定期产检的95例高危妊娠孕妇(观察组),根据孕妇妊娠结局分为不良组和良好组;另选取同期在本院定期产检的88例健康孕妇作为对照组。比较各组孕妇临床资料、血清游离雌三醇(uE3)水平及胎儿大脑中动脉血流参数[大脑中动脉搏动指数(PI)、阻力指数(RI)、收缩期末峰值/舒张期末峰值(S/D)];采用Logistic回归分析高危妊娠孕妇发生不良妊娠结局的危险因素;采用受试者工作特征(ROC)曲线分析胎儿大脑中动脉血流参数和孕妇血清uE3水平对高危妊娠孕妇发生不良妊娠结局的预测价值。【结果】观察组孕妇血清uE3水平及胎儿大脑中动脉PI、RI、S/D均低于对照组(P<0.05)。高危妊娠孕妇不良妊娠结局发生率为35.79%。不良组孕妇血清uE3水平和胎儿大脑中动脉PI、RI、S/D均低于良好组(P<0.05);不良组孕妇流产史、胎盘前置构成比与良好组比较,差异均有统计学意义(P<0.05)。Logistic多因素回归分析结果显示:胎儿PI、RI、S/D低及孕妇血清uE3水平低、胎盘前置均是高危妊娠孕妇发生不良妊娠结局的独立危险因素(P<0.05);ROC曲线分析结果显示,胎儿大脑中动脉PI、RI、S/D和孕妇血清uE3水平预测高危妊娠孕妇发生不良妊娠结局的最佳截断点分别为0.92、0.42、3.20、0.66 ng/mL,曲线下面积(AUC)分别为0.797、0.756、0.708、0.766,联合预测的特异度和AUC分别为98.33%和0.838。【结论】不良妊娠结局孕妇胎儿大脑中动脉PI、RI、S/D及孕妇血清uE3水平降低,监测高危妊娠孕妇胎儿大脑中动脉PI、RI、S/D和孕妇血清uE3水平对不良妊娠结局具有一定的预测价值。

【Objective】To investigate the predictive value of serum free estriol(uE3)and fetal middle cerebral artery blood flow parameters in maternal and infant adverse outcomes in high-risk pregnant women.【Methods】A total of 95 high-risk pregnant women(the observation group)who received regular antenatal check-up in our hospital from February 2019 to February 2021 were selected and divided into the poor group and the good group according to pregnancy outcomes.In addition,88 healthy volunteers who underwent regular birth examination in our hospital during the same period were selected as the control group.The clinical data,serum free estriol(uE3)levels and fetal middle cerebral artery blood flow parameters[middle cerebral artery pulsation index(PI),resistance index(RI),end-systolic peak/end-diastolic peak(S/D)]were compared between the two groups.Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes in high-risk pregnant women.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of fetal middle cerebral artery blood flow parameters and maternal serum uE3 level for adverse pregnancy outcomes in high-risk pregnant women.【Results】Fetal middle cerebral artery PI,RI,S/D and serum uE3 levels in observation group were lower than those in control group(P<0.05).The incidence of adverse pregnancy outcome was 35.79%.The levels of fetal middle cerebral artery PI,RI,S/D and serum uE3 in the adverse group were lower than those in the good group(P<0.05).The history of miscarriage and the proportion of placenta previa in the poor group were significantly different from those in the good group(P<0.05).Logistic multivariate regression analysis showed that fetal PI,RI,S/D,serum uE3 level and placental previa were independent risk factors for adverse pregnancy outcomes in high-risk pregnant women(P<0.05).ROC analysis results showed that the optimal cut-off points for fetal middle cerebral artery PI,RI,S/D and maternal serum uE3 levels to predict adverse pregnancy outcomes were 0.92,0.42,3.20 and 0.66 ng/mL,respectively.The area under the curve(AUC)were 0.797,0.756,0.708 and 0.766,respectively.and the joint prediction The specificity and AUC of combined measurements of middle cerebral artery and uE3 were 98.33%and 0.838,respectively.【Conclusion】The levels of fetal middle cerebral artery PI,RI,S/D and serum uE3 of pregnant women with adverse pregnancy outcomes are decreased.Monitoring the levels of PI,RI,S/D in the middle cerebral artery and serum uE3 of pregnant women with high-risk pregnancies has certain predictive value for adverse pregnancy outcomes.