中晚期妊娠正常胎儿脐静脉内径、血流量和标化血流率正常范围以及Z-评分的研究  

Normal ranges and Z-scores analysis of the normal fetal umbilical vein diameter,blood volume flow and normalized volume blood flow in the second and third trimesters of pregnancy

作　　者：徐赣琼[1] 周启昌[1] 周春慧 王季青 龙白果 胡立 彭杨 刘玉婵 刘冬梅 于佳丽 王玲 Xu Ganqiong;Zhou Qichang;Zhou Chunhui;Wang Jiqing;Long Baiguo;Hu Li;Peng Yang;Liu Yuchan;Liu Dongmei;Yu Jiali;Wang Ling(Department of Ultrasound Diagnosis,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Women and Children Healthcare Hospital of Zhuzhou,Zhuzhou 412008,China)

机构地区：[1]中南大学湘雅二医院超声诊断科,长沙410011 [2]株洲市妇幼保健院,株洲412008

出　　处：《中华超声影像学杂志》2022年第5期386-393,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目(81801721);湖南省自然科学基金项目(2019JJ50880,2017JJ4060);湖南省卫生计生委科研计划课题(B2017159)。

摘　　要：目的探讨超声检测胎儿脐静脉内径、血流量的方法,建立正常胎儿脐静脉内径、血流量和标化血流率的参考值范围以及脐静脉内径和血流量的Z-评分。方法前瞻性研究2019年3月至2020年12月中南大学湘雅二医院和株洲市妇幼保健院的907例正常胎儿(20~39周),收集游离段(FUV)及腹腔段(IUV)脐静脉内径(Duv)、血流量(Quv)及标化血流率(nQ=Quv/估测胎儿体重),计算不同节段脐静脉Duv、Quv和nQ的均值以及90%可信区间,并对比不同节段脐静脉的参数。最后以孕周(GA)为自变量建立Duv和Quv的Z-评分。结果成功获得858例(94.6%)正常胎儿脐静脉Duv、Quv和nQ的均值以及90%可信区间。FUV和IUV的Duv和Quv随孕周增长而增加,以Quadratic曲线和Linear线性拟合度最高(r=0.951、0.941、0.986、0.982,均P<0.001)。而nQ与GA呈双相模式,以Quadratic曲线拟合度最高(r=0.610、0.611,均P<0.001)。Duv-FUV>Duv-IUV(P<0.001),nQ-FUV>nQ-IUV(P=0.001),而Quv-FUV与Quv-IUV差异无统计学意义(P=0.133)。成功建立Duv和Quv的Z-评分模型,所有Z-评分呈高斯分布。结论脐静脉参数正常范围和Z-评分的建立有利于完善胎盘循环的评估,为不良妊娠的监测和预后评估提供有力依据。选用FUV或IUV评估胎盘循环可依据临床应用中的实际情况而定。Objective To explore the method of ultrasonography for detecting the fetal umbilical vein diameter,blood flow volume and normalized volume blood flow and establish normal reference ranges with umbilical vein diameter,blood flow volume and normalized blood flow and Z-scores for umbilical vein diameter and blood volume flow.Methods This was a prospective study on 907 normal fetuses in the Second Xiangya Hospital,Central South University and Women and Children Healthcare Hospital of Zhuzhou from March 2019 to December 2020.The umbilical vein diameter(Duv),umbilical vein blood flow volume(Quv)and normalized volume blood flow(nQ=Quv/estimated fetal weight)of the free loop of umbilical vein(FUV)and fetal intra-abdominal umbilical vein(IUV)were collected.And the mean values and 90%confidence intervals of Duv,Quv and nQ in two segments of umbilical veins at different gestational ages were calculated.Regression analysis of Duv,Quv and nQ were performed with gestational age(GA),and the parameters of umbilical vein in different segments were compared.Finally,with gestational age(GA)as the independent variable,Z-scores of the Duv and Quv were built.Results The mean values and 90%confidence intervals of Duv,Quv,and nQ in 858(94.6%)normal fetal umbilical veins were successfully obtained.The Duv,Quv of the FUV and IUV increased as pregnancy progressed.The Quadratic curve of Duv and Linear curve of Quv were of the highest fitnesses,respectively(r=0.951,0.941,0.986,0.982;all P<0.001).While nQ increased with GA followed by a decreased trend,and the Quadratic curve was the highest fitting curve of nQ(r=0.610,0.611;all P<0.001).Duv-FUV was greater than Duv-IUV(P<0.001),nQ-FUV was bigger than Quv-IUV(P=0.001),and he difference was not statistically significant between Quv-FUV and Quv-IUV(P=0.133).Z-scores models of Duv and Quv were successfully established,and all Z-scores were Gaussian distribution.Conclusions The normal ranges and Z-scores of umbilical vein parameters are useful to improve the evaluation of placental circulation an

关 键 词：超声检查 胎儿脐静脉 胎盘灌注 血流量 

分 类 号：R714.5[医药卫生—妇产科学]