孕晚期三维超声FLV参数预测妊娠期糖尿病巨大儿的价值  

Value of three-dimensional ultrasound FLV parameters of third trimester pregnancy in redicting gestational diabetes macrosomia

作　　者：姬亚妮 冯蕾 JI Ya-ni;FENG Lei(Department of Ultrasound,Tongchuan City Maternal and Child Health Care Hospital,Tongchuan 727000,Shaanxi,China)

机构地区：[1]铜川市妇幼保健院超声科,陕西铜川727000

出　　处：《生物医学工程与临床》2023年第5期627-632,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的探究孕晚期三维超声部分肢体体积(FLV)参数预测妊娠期糖尿病(GDM)巨大儿的价值。方法选择2018年1月至2021年12月在铜川市妇幼保健院规律产检并住院分娩活产儿的GDM孕妇239例,年龄24~34岁,平均年龄29.53岁;孕前身体质量指数18.9~27.9 kg/m^(2),平均身体质量指数23.05 kg/m^(2);孕周37~41周,平均孕周39.06周;病程3~5个月,平均病程4.11个月;血糖值5.04~7.02 mmol/L,平均血糖值5.40 mmol/L。根据胎儿分娩情况分为巨大儿组和非巨大儿组。所有孕妇均在孕晚期进行超声检查,并在分娩新生儿4 h内测定出生体质量。比较两组孕晚期孕妇临床资料、新生儿皮褶厚度(SSFT)。分析影响巨大儿的危险因素、超声指标与SSFT的相关性。采用受试者工作特性(ROC)曲线分析上臂中段50%体积(AVol)、大腿中段50%体积(TVol)预测巨大儿的价值。结果巨大儿组孕晚期孕妇孕前身体质量指数、增长体质量、空腹血糖、头围(HC)、双顶径(BPD)、腹围(AC)、股骨长(FL)、AVol、TVol较非巨大儿组孕晚期孕妇高(均P<0.05)。巨大儿组SSFT较非巨大儿组高[(5.09±1.02)mm vs(4.24±0.93)mm。P<0.05];将孕前身体质量指数、增长体质量、空腹血糖控制后,HC、BPD、AC、FL、AVol、TVol升高为巨大儿发生的危险因素(P<0.05);HC、BPD、AC、FL、AVol、TVol与SSFT呈正相关(r=0.532、0.587、0.501、0.548、0.785、0.801,P<0.05);ROC曲线显示,AVol、TVol联合预测GDM巨大儿的曲线下面积(AUC)值为0.856,高于单独预测(P<0.05)。结论三维超声FLV参数能更好地反映胎儿皮下脂肪情况,通过孕晚期测量可对GDM巨大儿情况进行预测,从而为临床实施针对性干预措施提供依据。Objective To explore the value of three-dimensional ultrasound partial limb volume(FLV)parameters in prediction of gestational diabetes mellitus(GDM)macrosomia.Methods From January 2018 to December 2021,a total of 239 GDM pregnant women with regular prenatal examination and hospitalized live births were enrolled,which aged 24-34 years old with mean age of 29.53 years old;the pre-pregnancy body mass index(BMI)was 18.9-27.9 kg/m^(2)with mean BMI of 23.05 kg/m^(2);gestational weeks of delivery were 37-41 weeks with mean gestational weeks of 39.06 weeks;course of disease was 3-5 months with mean course of 4.11 months;blood glucose was 5.04-7.02 mmol/L with mean of 5.40 mmol/L.According to the fetal delivery,they were divided into macrosomia group(n=46)and non-macrosomia group(n=193).All pregnant women were examined by ultrasound in the third trimester,and birth body mass was measured within 4-hour after delivery.The clinical data of pregnant women in the third pregnancy and neonatal skinfold thickness(SSFT)were compared between 2 groups,and the correlation between risk factors affecting macrosomia,ultrasound indexes and SSFT was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the value of 50%middle upper arm volume(AVol)and 50%volume of middle thigh volume(TVol)in predicting macrosomia.Results The pre-pregnancy body mass index,growth body mass,fasting blood glucose,head circumference(HC),biparietal diameter(BPD),abdominal circumference(AC),femur length(FL),AVol and TVol in macrosomia group were significantly higher than those in non-macrosomia group(P<0.05).SSFT in macrosomia group was significantly higher than in non-macrosomia group[(5.09±1.02)mm vs(4.24±0.93)mm,P<0.05].The elevation of HC,BPD,AC,FL,AVol and TVol were risk factors for macrosomia after controlling pre-pregnancy body mass index,growth body mass and fasting blood glucose(P<0.05);HC,BPD,AC,FL,AVol and TVol were positively correlated with SSFT(r=0.532,0.587,0.501,0.548,0.785,0.801.P<0.05).The ROC curve showed that the area

关 键 词：孕晚期 妊娠期糖尿病 三维超声部分肢体体积 预测价值 巨大儿 

分 类 号：R714.256[医药卫生—妇产科学] R445.1[医药卫生—临床医学]