子宫动脉血流联合脑胎盘率预测胎儿生长受限的价值研究  

Value of uterine arterial blood flow combined with cerebral placental rate in predicting fetal growth restriction

作　　者：聂丽菊 姚青兰 涂澜涛 陈华艳 周欣[2] 余腊梅[1] NIE Liju;YAO Qinglan;TU Lantao;CHEN Huayan;ZHOU Xin;YU Lamei(Department of Obstetrics,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,Jiangxi,China;Department of Ultrasound Diagnosis,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,Jiangxi,China)

机构地区：[1]江西省妇幼保健院产科,江西南昌330006 [2]江西省妇幼保健院超声诊断科,江西南昌3300061

出　　处：《中国现代医生》2024年第9期33-36,共4页China Modern Doctor

基　　金：江西省卫生健康委科技计划项目(202211093)。

摘　　要：目的分析子宫动脉血流与脑胎盘率(cerebral placental rate,CPR)对胎儿生长受限(fetal growth restriction,FGR)诊断的应用价值。方法选取2021年1月至2022年6月于江西省妇幼保健院建卡并住院分娩的临床诊断为晚发型FGR的114例孕妇纳入研究组,122名胎儿宫内发育正常的孕妇为对照组。超声测定两组孕妇的子宫动脉(uterine artery,UtA)、脐动脉(umbilical artery,UA)与大脑中动脉(middle cerebral artery,MCA)的血流参数,计算两组孕妇的CPR,比较两组孕妇的血流差异与妊娠结局,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析UtA及CPR单独及联合应用在FGR临床诊断中的应用价值。结果研究组孕妇UtA的阻力指数(resistance index,RI)高于对照组,胎儿UA的血流参数较对照组偏高,MCA的血流参数较对照组低,CPR值较对照组低,差异均有统计学意义(P<0.05);研究组新生儿出生体质量与1min Apgar评分较对照组低(P<0.001);研究组的急诊剖宫产手术率、早产及因各种并发症导致的新生儿转入新生儿重症监护病房(neonatal intensive care unit,NICU)的发生率高于对照组(P<0.05)。ROC曲线显示在预测FGR方面,UtA-RI的曲线下面积(area under the curve,AUC)为0.82(95%CI:0.77~0.88),CPR的预测效率AUC为0.75(95%CI:0.69~0.81)。UtA-RI和CPR参数组合在预测FGR方面具有较高的效率,AUC为0.92(95%CI:0.89~0.95)。结论CPR联合UtA-RI监测对临床早期发现FGR、指导干预、改善不良围生儿结局具有临床应用价值。Objective To analyze the application value of uterine artery flow and cerebral placental rate(CPR)in diagnosing fetal growth restriction(FGR).Methods A total of 114 pregnant women with clinically diagnosed late-onset FGR who were hospitalized in Jiangxi Maternal and Child Health Hospital from January 2021 to June 2022 were assigned to study group,and 122 pregnant women with normal intrauterine development were assigned to control group.The blood flow parameters of uterine artery(UtA),umbilical artery(UA)and middle cerebral artery(MCA)in two groups were determined by ultrasound,and CPR in two groups was calculated.The blood flow difference and pregnancy outcome of two groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the application value of UtA and CPR alone and combined in the clinical diagnosis of FGR.Results The UtA resistance index(RI)of pregnant women in study group was higher than that of control group,the fetal UA blood flow parameter was higher than that of control group,the MCA blood flow parameter and the CPR value were both lower than those of control group,the differences were statistically significant(P<0.05).The birth weight and 1min Apgar score of study group were lower than those of control group(P<0.001).In addition,the incidence of emergency cesarean section operation,premature delivery and neonates transferred to neonatal intensive care unit(NICU)due to various complications in study group were significantly higher than those in control group(P<0.05).ROC curve showed that in predicting FGR,the area under the curve(AUC)of UtA-RI was 0.82(95%CI:0.77-0.88).The predictive efficiency of CPR was 0.75(95%CI:0.69-0.81).The combination of UtA-RI and CPR parameters had the highest efficiency in predicting FGR,with an AUC of 0.92(95%CI:0.89-0.95).Conclusion CPR combined with UtA-RI monitoring has clinical application value for early detection of FGR,guiding intervention,and improving adverse perinatal outcomes.

关 键 词：子宫动脉血流 脑胎盘率 胎儿宫内生长受限 预测 诊断 

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]