胎儿超声血流参数联合母体血浆次黄嘌呤对胎儿宫内窘迫程度的诊断研究  

Diagnostic study of fetal ultrasound blood flow parameters combined with maternal plasma hypoxanthine in the degree of fetal distress

作　　者：常漪潇 辛红艳 禹凯鸣 CHANG Yixiao;XIN Hongyan;YU Kaiming(Department of Ultrasound Medicine,Jinshui District General Hospital of Zhengzhou City,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市金水区总医院超声医学科,河南郑州450000

出　　处：《中国医学工程》2023年第12期97-101,共5页China Medical Engineering

摘　　要：目的 探讨胎儿超声血流参数联合母体血浆次黄嘌呤对胎儿宫内窘迫程度的诊断价值。方法 选取2020年3月至2022年9月在郑州市金水区总医院即将分娩的488例产妇作为研究对象,孕妇分娩前均行超声检查,并采集血样检测血浆次黄嘌呤水平。根据产妇是否存在胎儿宫内窘迫将其分为胎儿窘迫组(107例)和正常组(381例),依据胎心率、胎心监护及羊水污染程度将胎儿窘迫产妇分为轻度组(43例)、中度组(44例)、重度组(20例)。比较胎儿窘迫组和正常组及不同窘迫程度组超声血流参数[包括血流搏动指数(PI)、阻力指数(RI)、收缩与舒张末期最大血流速度比值(S/D)]及血浆次黄嘌呤水平,绘制受试者工作特征(ROC)曲线分析超声血流参数、母体血浆次黄嘌呤水平单独及联合对胎儿宫内窘迫程度的诊断价值。结果 与正常组比较,胎儿窘迫组PI值、RI值、S/D值及血浆次黄嘌呤水平均升高(P<0.05);轻度组、中度组及重度组PI值、RI值、S/D值及血浆次黄嘌呤水平比较,差异有统计学意义(P<0.05),中度组、重度组均高于轻度组(P<0.05),重度组高于中度组(P<0.05);PI、RI、S/D联合诊断中重度宫内窘迫的曲线下面积(AUC)为0.861 (95%CI:0.781~0.920),高于PI、RI、S/D单独诊断的AUC [0.721 (95%CI:0.626~0.803)、0.736 (95%CI:0.642~0.817)、0.726 (95%CI:0.632~0.808)],其敏感性、特异性为85.94%、81.40%;超声血流参数联合母体血浆次黄嘌呤诊断中重度宫内窘迫的AUC为0.950 (95%CI:0.890~0.983),高于超声血流参数、母体血浆次黄嘌呤单独诊断的AUC [0.861(95%CI:0.781~0.920)、0.848 (95%CI:0.766~0.910)],其敏感性、特异性为96.88%、79.07%。结论 胎儿脐动脉超声血流参数、母体血浆次黄嘌呤水平均对中重度宫内窘迫具有一定的诊断价值,但两者联合诊断价值更高。【Objective】To explore the diagnostic value of fetal ultrasound blood flow parameters combined with maternal plasma hypoxanthine in the degree of fetal distress.【Methods】A total of 488 pregnant women who were about to give birth in Jinshui District General Hospital of Zhengzhou City from March 2020 to September 2022 were selected as the study subjects.All pregnant women were examined by ultrasound before delivery,and blood samples were collected to detect the levels of plasma hypoxanthine.According to the presence or absence of fetal distress,the pregnant women were divided into fetal distress group(107 cases)and normal group(381 cases).According to the fetal heart rate,fetal heart rate monitoring and amniotic fluid contamination,the pregnant women with fetal distress were divided into mild group(43 cases),moderate group(44 cases)and severe group(20 cases).The ultrasonic blood flow parameters[including blood pulsation index(PI),resistance index(RI),maximum systolic and diastolic blood flow velocity(S/D)]and plasma hypoxanthine levels of the fetal distress group and the normal group and the different distress groups were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of ultrasound blood flow parameters,maternal plasma hypoxanthine levels alone and in combination to fetal distress degree.【Results】Compared with the normal group,the PI value,RI value,S/D value and plasma hypoxanthine levels in the fetal distress group increased(P<0.05).There were significant differences in PI value,RI value,S/D value and plasma hypoxanthine levels among mild group,moderate group and severe group(P<0.05).The moderate group and the severe group were significantly higher than those in the mild group(P<0.05),and the severe group was higher than those in the moderate group(P<0.05).The area under the curve(AUC)for the combined diagnosis of moderate to severe intrauterine distress by PI,RI,and S/D was 0.861(95%CI:0.781–0.920),which was higher than the AUC[0.721(95%CI:0.626–0

关 键 词：宫内窘迫 超声血流参数 脐动脉 次黄嘌呤 

分 类 号：R714.5[医药卫生—妇产科学]