彩色多普勒超声监测胎儿大脑中动脉及脐动脉参数对羊水过少胎儿妊娠结局的预测价值  

The predictive value of fetal middle cerebral artery and umbilical artery parameters monitored by color Doppler ultrasound in the evaluation of pregnancy outcome of fetus with oligohydramnios

作　　者：孙全红 贾绘 钱露 钱晓凤 张静 SUN Quanhong;JIA Hui;QIAN Lu;QIAN Xiaofeng;ZHANG Jing(Department of Ultrasound,Lishui Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu 211299,China)

机构地区：[1]东南大学附属中大医院溧水分院超声医学科,江苏南京211299

出　　处：《中国优生与遗传杂志》2022年第11期1995-2001,共7页Chinese Journal of Birth Health & Heredity

摘　　要：目的 探讨彩色多普勒超声监测胎儿大脑中动脉(MCA)及脐动脉(UA)参数对羊水过少胎儿妊娠结局的预测价值。方法 选择2015年1月至2022年5月于东南大学附属中大医院溧水分院产科超声检查羊水过少的单胎孕妇137例作为羊水过少组,另选择同期产检正常的孕妇152例为正常组,对比两组一般资料、MCA和UA血流参数,并统计两组胎儿的妊娠结局。依据妊娠结局,将羊水过少组再分为妊娠不良组(n=32)和妊娠良好组(n=105)。对比两组产妇及新生儿的一般资料,采用多因素Logistic回归分析影响羊水过少组产妇妊娠结局的因素。采用ROC曲线分析UA和MCA各参数以及各参数联合检测对羊水过少组产妇妊娠不良的预测价值。依据独立影响因素构建列线图预测模型,并评价模型效能。结果 羊水过少组胎儿的UA-RI、UA-PI、UA-S/D水平高于正常组(P<0.05),MCA-RI、MCA-PI、MCA-S/D)水平低于正常组(P<0.05)。UA-RI、UA-PI、UA-S/D是导致羊水过少组产妇妊娠不良的独立危险因素(P<0.05),MCA-RI、MCA-PI、MCA-S/D是保护因素(P<0.05)。MCA和UA六项参数联合预测产妇妊娠不良的AUC为0.813(95%CI:0.784~0.856,P<0.001),显著高于单一指标的预测价值。根据独立影响因素构建预测模型,模型的AUC为0.827(95%CI:0.802~0.843,P<0.001),模型预测的区分度和有效性均较好,具有临床应用价值。结论 羊水过少胎儿UA的RI、PI、S/D水平升高,MCA的RI、PI、S/D水平降低,是不良妊娠结局的独立影响因素。产前超声监测UA和MCA有助于预测羊水过少胎儿结局。Objective To explore the predictive value of fetal middle cerebral artery(MCA) and umbilical artery(UA)parameters monitored by color Doppler ultrasound in the evaluation of pregnancy outcome of fetus with oligohydramnios.Methods 137 singleton pregnant women with oligohydramnios examined by obstetric ultrasound in Lishui Branch of Zhongda Hospital Affiliated to Southeast University from January 2015 to May 2022 were selected as the oligohydramnios group, and 152 pregnant women with normal prenatal examination in the same period were selected as the normal group. The general data,MCA, UA and maternal uterine artery(UTA) blood flow parameters of the two groups were compared, and the pregnancy outcomes of the two groups were counted. According to the pregnancy outcome, the oligohydramnios group was divided into poor pregnancy group(n=32) and good pregnancy group(n=105). The general data of pregnant women and newborns in the two groups were compared, and the factors affecting the pregnancy outcome of pregnant women in oligohydramnios group were analyzed by multivariate logistic regression. ROC curve was used to analyze the predictive value of UA and MCA parameters and the combined detection of these parameters on poor pregnancy in oligohydramnios group. The nomogram prediction model is constructed according to the independent influencing factors, and the effectiveness of the model is evaluated.Results The levels of UA-RI, UA-PI and UA-S/D of fetuses in oligohydramnios group were higher than those in normal group(P<0.05), the levels of MCA-RI, MCA-PI and MCA-S/D were lower than those in normal group(P<0.05). UTA RI, UTA PI and UTA-S/D were independent risk factors for poor pregnancy in oligohydramnios group(P<0.05), while MCA-RI, MCA-PI and MCA-S/D were protective factors(P<0.05). The AUC of six parameters of MCA and UA in predicting poor pregnancy was 0.813(95%CI: 0.784-0.856, P<0.001), which was significantly higher than the predictive value of single index. The prediction model was constructed according to independe

关 键 词：大脑中动脉 脐动脉 彩色多普勒超声监测 不良妊娠 预测模型 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]