孕早期三维超声检测胎盘体积联合血清学指标对胎儿生长受限的预测价值  

Predictive value of placental volume combined with serological markers by three-dimensional ultrasonography in early pregnancy for fetal growth restriction

作　　者：张茂春[1] 张红薇[1] 陈娇[1] 郭媛媛[1] ZHANG Maochun;ZHANG Hongwei;CHEN Jiao;GUO Yuanyuan(Department of Obstetrics and Gynecology Ultrasound Room,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 6370o,China)

机构地区：[1]川北医学院附属医院妇产科超声室,四川南充637000

出　　处：《中国优生与遗传杂志》2022年第8期1406-1411,共6页Chinese Journal of Birth Health & Heredity

基　　金：2019年市校合作科研专项资金(19SXHZ0275)。

摘　　要：目的探讨孕早期三维超声检测胎盘体积(PV)联合血清学指标对胎儿生长受限(FGR)的预测价值。方法选择2019年2月至2021年1月于川北医学院附属医院妇产科规律产检的单胎孕妇83例,根据新生儿出生后是否存在FGR分为FGR组(n=31)和非FGR组(n=52)。比较两组患者的临床资料,采用多因素Logistic回归分析FGR的影响因素;Pearson检验分析各影响因素间的相关性;绘制受试者操作特征(ROC)曲线,分析孕早期PV和相关血清学指标在孕早期预测FGR中的诊断效能。构建风险预测模型,并评价其预测效能。结果低PV、低PAPP-A以及高β-hCG是FGR的独立影响因素(P<0.05)。PV和PAPP-A之间均呈明显正相关(P<0.05),二者分别与β-hCG呈明显负相关(P<0.05)。PV预测FGR的ROC曲线下面积(AUC)高于PAPP-A和β-hCG,三者联合预测的AUC为0.821(95%CI:0.801~0.837,P<0.001),预测价值均高于各单一指标。依据独立影响因素以及其他相关血清学指标构建预测模型,模型的AUC为0.843(95%CI:0.826~0.854,P<0.001),模型预测的区分度和有效性均较好。结论孕早期三维超声测量PV对于FGR具有重要的早期预测价值,可作为早期预测FGR的客观量化指标,联合血清PAPP-A和β-hCG水平能够提高这一预测效果。Objective To investigate the predictive value of placental volume(PV)combined with serological indicators in early pregnancy by three-dimensional ultrasonography in fetal growth restriction(FGR).Methods A total of 83singleton pregnant women who received regular obstetric examinations in Affiliated Hospital of North Sichuan Medical College from February 2019 to January 2021 were selected and divided into FGR group(n=31)and non-FGR group(n=52)according to whether the newborn had FGR after birth.The clinical data of the two groups of patients were compared,and multivariate Logistic regression was used to analyze the influencing factors of FGR.Pearson test to analyze the correlation between the influencing factors;the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of PV and related serological indicators in early pregnancy in predicting FGR.Build a risk prediction model and evaluate its predictive performance.Results Neonatal body weight,head-rump length(CRL),PV and uterine artery pulsatility index(UtA-PI)in the FGR group were significantly lower than those in the non-FGR group(P<0.05),and the uterine artery resistance index(UtA-RI)was significantly higher than those in the non-FGR group.FGR group(P<0.05).In terms of serological indexes,AFP,β-hCG and VEGF in the FGR group were significantly higher than those in the non-FGR group(P<0.05),and PAPP-A was significantly lower than that in the non-FGR group(P<0.05).Multivariate Logistic regression analysis showed that low PV,low PAPP-A and highβ-hCG were independent influencing factors of FGR(P<0.05).Pearson analysis showed that there was a significant positive correlation between PV and PAPP-A(P<0.05),and both were significantly negatively correlated withβ-hCG(P<0.05).The ROC curves of PV,PAPP-A andβ-hCG in predicting FGR showed that the area under the ROC curve(AUC)of PV for predicting FGR was higher than that of PAPP-A andβ-hCG,and the combined AUC of the three predicted FGR was 0.821(95%CI:0.801-0.837,P<0.001),the predicti

关 键 词：胎盘体积 三维超声检测 血清学指标 胎儿生长受限 预测模型 

分 类 号：R714.5[医药卫生—妇产科学]