脐动脉舒张末期血流消失程度预测妊娠结局的价值分析  

Value Analysis of the Degree of Absent End-diastolic Flow in Umbilical Artery in Predicting Pregnancy Outcome

作　　者：王昭宇 栗河舟[1] 张君玲[1] 冯帆[1] 侯留杰 王漫琪 张恒静 Wang Zhaoyu;Li Hezhou;Zhang Junling;Feng Fan;Hou Liujie;Wang Manqi;Zhang Hengjing(Department of Ultrasound,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院超声科,郑州市450052

出　　处：《中国超声医学杂志》2023年第6期684-687,共4页Chinese Journal of Ultrasound in Medicine

基　　金：河南省医学适宜技术推广项目(No.SYJS2020080)。

摘　　要：目的分析胎儿脐动脉舒张末期血流消失程度(AEDF)对妊娠结局的预测价值。方法回顾性收集孕期超声检查出现AEDF的187例孕妇。根据单胎与双胎妊娠及妊娠结局,将其分为单胎组和双胎组,结局为存活与任何死亡(包括宫内死亡及新生儿死亡)。分别比较上述4组孕妇基本信息、超声多普勒参数,分析超声多普勒参数与胎儿宫内死亡及任何死亡(包括宫内死亡及新生儿死亡)的相关性并绘制ROC曲线。结果①胎儿最末次AEDF超声检查多普勒血流(Ta/Ttot、UA-PI、CPR、DV-a波消失或反向、脐静脉搏动)在单胎与双胎妊娠组无明显差异(P>0.05),而在存活与任何死亡有统计学意义(P<0.05)。②多因素Logistic回归分析显示,Ta/Ttot、最末次AEDF孕周、DV-a波消失或反向是胎儿宫内死亡和任何死亡的独立影响因子(P<0.05)。③与上述三者的单项指标预测相比,联合预测胎儿宫内死亡更为准确(AUC为0.900,灵敏度为0.842,特异度为0.846)。结论妊娠期间脐动脉舒张末期血流消失的程度与胎儿妊娠结局密切相关,建议联合应用Ta/Ttot、最末次AEDF的孕周及DV-a波消失或反向预测胎儿宫内死亡风险。Objective To evaluate the predictive value of fetal absent end-diastolic flow(AEDF)for pregnancy outcome.Methods A total of 187 pregnant women with AEDF detected by ultrasound during pregnancy were collected retrospectively.According to the single or twin pregnancy and pregnancy outcome,they were divided into single and twin pregnancy groups,survival group and all cause death group(including intrauterine stillbirth and neonatal death).The baseline information of the pregnant women and ultrasonic Doppler parameters were collected and compared retrospectively.The correlation between ultrasonic Doppler parameters and fetal intrauterine stillbirth and all cause death was analyzed and,and ROC curve was obtained.Results①The Doppler blood flow parameters(Ta/Ttot,UA PI,CPR,DV-a wave disappearance or reversal,umbilical vein pulsation)on the last AEDF ultrasound examination of the fetus had no significant difference between the single and the twin pregnancy group(P>0.05),but there was a statistically significant difference between the survival group and all cause death group(P<0.05).②Multivariate logistic regression analysis showed that Ta/Ttot,the last AEDF gestational week,DV-a wave disappearance or reversal were independent factors of fetal Intrauterine stillbirth and all cause death(P<0.05).③Compared with the single index predictive value of the above three indicators,the combined predictive value for fetal death was more accurate(AUC 0.900,sensitivity 0.842,specificity 0.846).Conclusions The degree of disappearance of umbilical artery diastolic blood flow during pregnancy is closely related to the outcome of pregnancy for fetus.It is suggested that the combined use of Ta/Ttot,the gestational week of the last AEDF and DV-a wave disappear or reversal provided the best predictive value for the risk of fetal intrauterine stillbirth.

关 键 词：脐动脉 舒张末期血流消失 超声多普勒 宫内死亡 妊娠结局 

分 类 号：R714[医药卫生—妇产科学] R445.1[医药卫生—临床医学]