晚孕期多血管血流参数联合胎盘功能评估胎儿生长受限的价值  

Value of multi-vascular blood flow parameters combined with placental function in evaluation of fetal growth restri tion during late pregnancy

作　　者：朱家麒[1,2,3] 徐元元 倪雪君 ZHU Jia-qi;XU Yuan-yuan;NI Xue-jun(Medical School of Nantong University,Nantong 226006,Jiangsu,China;Department of Ultrasound,Nantong Maternal and Child Health Hospital,Nantong 226007,Jiangsu,China;Department of Ultrasound,Afiliated Hospital of Nantong University,Nantong 226006,Jiangsu,China)

机构地区：[1]南通大学医学院,江苏南通226006 [2]南通市妇幼保健院超声科,江苏南通226007 [3]南通大学附属医院超声科,江苏南通226006

出　　处：《生物医学工程与临床》2023年第3期298-303,共6页Biomedical Engineering and Clinical Medicine

基　　金：南通市科学技术局基金项目(通科资[2022]93号)。

摘　　要：目的探讨晚孕期多普勒超声技术测定多血管血流参数联合胎盘功能标评估胎儿生长受限(FGR)的价值。方法选择FGR孕妇42例作为FGR组,年龄23~35岁,平均年龄28.8岁(标准差3.35岁);孕周28~37+4周,平均孕周32+6.5周(标准差2+4.5周);孕前身体质量指数(BMI)18.6~23.8 kg/m^(2),平均BMI 21.5 kg/m^(2)(标准差1.43 kg/m^(2))。产前检查正常孕妇61例作为对照组,年龄23~36岁,平均年龄29.3岁(标准差3.49岁);孕周28^(+2)~38周,平均孕周31^(+4.5)周(标准差3^(+2.7)周);孕前BMI 18.2~23.6 kg/m^(2),平均BMI 21.4 kg/m^(2)(标准差1.39 kg/m^(2))。通过多普勒超声检测各组多血管参数,包括脐动脉(UA)、大脑中动脉(MCA)、子宫动脉(UtA)的搏动指数(PI)、阻力指数(RI)及收缩期最大血流速度与舒张末期血流速度之比(S/D),计算脑-胎盘比(CPR)。定量检测母体血清雌三醇(E3)、胎盘泌乳素(HPL),评估胎盘功能,分析多血管血流参数及母体血指标与FGR的相关性,采用受试者工作特性(ROC)曲线评价不同指标对FGR的诊断预测价值。结果FGR组不良妊娠结局的发生率显著高于对照组(61.9%vs 11.5%。P<0.001)。FGR组UA-PI高于对照组(1.06±0.33 vs 0.94±0.19。P<0.05),而两组UA-S/D及RI比较,差异无统计学意义(P>0.05);FGR组MCA各参数[(PI:1.53±0.33 vs 1.75±0.32;S/D:4.26(3.43~5.24)vs 5.12(4.25~6.72);RI:0.76±0.07 vs 0.81±0.06]、CPR(1.59±0.59 vs 1.91±0.44)及母体血清E3[7.79(4.91~11.30)ng/mL vs 12.00(10.20~13.95)ng/mL]和HPL[(9.00±2.80)mg/L vs(11.91±2.27)mg/L]水平低于对照组,FGR组UtA各参数高于对照组[PI:0.75(0.66~1.07)vs 0.56(0.50~0.67);S/D:2.11(1.80~2.78)vs 1.86(1.70~2.19);RI:0.55±0.12 vs 0.47±0.08。均P<0.05]。多普勒超声检测单一血管参数预测FGR的诊断效能普遍较低(AUC<0.7),多普勒超声检测多血管参数联合母体血指标评估FRG(AUC=0.883),可显著提高诊断效能。结论单一血管的多普勒血流参数预测FGR的准确性较低,联合多血管血流参数与胎盘功能�Objective To evaluate the value of multi-vascular blood flow parameters by Doppler ultrasound combined with placental function for evaluating fetal growth restriction(FGR)in late pregnancy.Methods A total of 42 pregnant women with FGR were selected as FCR group,which aged 23-35 years old with mean age of 28.8 years old(standard deviation 3.35 years old);gestational week was 28-37^(+4) weeks with mean gestational week of 32^(+6.5) weeks(standard deviation 2^(+4.5) weeks);pre-pregnancy body mass index(BMI)was 18.6-23.8 kg/m^(2)with mean BMI of 21.5 kg/m^(2)(standard deviation 1.43 kg/m^(2)).Meantime,61 pregnant women with normal prenatal examination were enrolled as control group,which aged 23-36 years old with mean age of 29.3 years old(standard deviation 3.49 years old);gestational week was 28+2-38 weeks with mean gestational week of 31+45 weeks(standard deviation 3+27 weeks);pre-pregnancy BMI was 18.2-23.6 kg/m^(2)with mean BMI of 21.4 kg/m^(2)(standard deviation 1.39 kg/m^(2)).The multiple vascular parameters in each group were detected by Doppler ultrasound,which included pulsatile index(PI),resistance index(RI),ratio of maximum systolic blood flow ve-locity to end-diastolic blood flow velocity(S/D)of umbilical artery(UA),middle cerebral artery(MCA)and uterine artery(UtA),and cerebroplacental ratio(CPR)was calculated.The serum level of estriol(E3)and human placental(HPL)in maternal were quantitatively detected,placental function was evaluated,and the correlations between FGR and multi-vascular blood flow parameters as well as maternal blood indexes were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate diagnostic and predictive value of different indexes for FCR.Results The incidence of adverse pregnancy outcomes in FGR group was significantly higher than that in control group(61.9%vs 11.5%.P<0.001).The UA-PI of FCR group was higher than that of control group(1.06±0.33 vs 0.94±0.19.P<0.05),but there was no significant difference in UA-S/D and RI between 2 groups(P>0.05);The parame

关 键 词：多普勒超声 胎儿生长受限 多血管参数 雌三醇 胎盘泌乳素 胎盘功能 

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]