孕中期多普勒超声联合血清学标志物检测预测胎儿宫内生长受限的研究  

Prediction of intrauterine growth restriction by Doppler ultrasonography combined with serological marker detection in the second trimester

作　　者：王波[1] 吴腊梅 王凤琴[1] 张琴[3] WANG Bo;WU Lamei;WANG Fengqin;ZHANG Qin(Department of Obstetrics,The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China;Department of Obstetrics,Maternal and Child Health Care and Hospital,Huaian District,Huaian City,Huaian,Jiangsu 223299,China;The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院产科,江苏淮安223300 [2]淮安市淮安区妇幼保健院产科,江苏淮安223299 [3]南京医科大学附属淮安第一医院超声科,江苏淮安223300

出　　处：《中国优生与遗传杂志》2022年第11期1948-1952,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的探究孕中期多普勒超声联合血清学标志物预测胎儿宫内生长受限(FGR)的价值。方法收集南京医科大学附属淮安第一医院及淮安区妇幼保健院孕妇560例,均于孕中期行超声子宫动脉血流参数[搏动指数(PI)、阻力指数(RI)、收缩期末流速与舒张期末流速比值(S/D)]及血清学标志物[妊娠相关血浆蛋白A(PAPP-A)、胎盘生长因子(PLGF)、β-人绒毛膜促性腺激素(β-HCG)]检测,随访至妊娠结束,统计FGR发生情况,比较发生与未发生FGR孕妇一般资料、孕中期超声子宫动脉血流参数及血清学标志物水平,分析超声子宫动脉血流参数与血清学标志物水平的相关性,并分析超声子宫动脉血流参数及血清学标志物水平预测FGR的价值。结果本研究中FGR发生率为6.10%(34/557);发生FGR孕妇孕14周、孕16周、孕20周子宫动脉PI、RI、S/D均高于未发生FGR孕妇,血清PAPP-A、PLGF、β-HCG水平均低于未发生FGR孕妇(P<0.05);孕14周、孕16周、孕20周子宫动脉PI、RI、S/D均与血清PAPP-A、PLGF、β-HCG水平呈负相关(P<0.05);孕20周子宫动脉PI、RI、S/D、血清PAPP-A、PLGF、β-HCG水平联合预测FGR的曲线下面积(AUC)最大,为0.936。结论孕中期超声子宫动脉PI、RI、S/D及血清PAPP-A、PLGF、β-HCG水平均可预测FGR的发生,各指标联合可有效提高预测价值。Objective To explore the value of Doppler ultrasound combined with serological markers in the second trimester of pregnancy in fetal growth restriction(FGR).Methods A total of 560 pregnant women were collected from The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University and Huaian District Maternal and Child Health Care Hospital.Ultrasound was performed in the second trimester of uterine artery blood flow parameters[pulsatility index(PI),resistance index(RI),end-systolic velocity and diastolic flow rate.End-term flow rate ratio(S/D)]and serological markers[pregnancy-associated plasma protein A(PAPP-A),placental growth factor(PLGF),β-human chorionic gonadotropin(β-HCG)]detection,follow-up to the end of pregnancy,the incidence of FGR was counted,and the general data of pregnant women with and without FGR,the parameters of ultrasound uterine artery blood flow and the levels of serological markers in the second trimester were compared,and the correlation between the parameters of ultrasound uterine artery blood flow and the levels of serological markers was analyzed,and analyzed the value of ultrasound uterine artery blood flow parameters and serological marker levels in predicting FGR.Results The incidence of FGR in this study was 6.10%(34/557).The uterine artery PI,RI and S/D of pregnant women with FGR at 14,16 and 20 weeks of gestation were higher than those without FGR.The levels of-A,PLGF andβ-HCG were lower than those of pregnant women without FGR(P<0.05),uterine artery PI,RI and S/D at 14weeks,16 weeks and 20 weeks of pregnancy were significantly correlated with serum PAPP-A,PLGF,β-HCG levels were negatively correlated(P<0.05),the area under the curve(AUC)AUC of uterine artery PI,RI,S/D,serum PAPP-A,PLGF,β-HCG levels combined to predict FGR at 20 weeks of gestation was the largest,is 0.936.Conclusion Ultrasound uterine artery PI,RI,S/D and serum PAPP-A,PLGF,β-HCG levels in the second trimester of pregnancy can predict the occurrence of FGR,and the combination of each index can effect

关 键 词：胎儿宫内生长受限 子宫动脉 妊娠相关血浆蛋白A Β-人绒毛膜促性腺激素 胎盘生长因子 

分 类 号：R714.5[医药卫生—妇产科学]