胎儿心脏参数对胎儿宫内生长受限的预测价值  

Predictive value of fetal cardiac parameters for fetal growth restriction

作　　者：肖莉莉[1] 吴道珠[1] 陈晓乐 李秀云[1] 寇红菊[1] Xiao Lili;Wu Daozhu;Chen Xiaole;Li Xiuyun;Kou Hongju(Department of Ultrasound,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou Key Laboratory of Structural and Functional Imaging,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院超声科、温州市结构与功能影像重点实验室,浙江温州325027

出　　处：《中华医学超声杂志（电子版）》2024年第1期24-31,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：温州市科技计划项目(Y20220448)。

摘　　要：目的初步探讨胎儿心脏参数对胎儿生长受限(FGR)的预测价值。方法选取2018年1月至2022年4月妊娠晚期在温州医科大学附属第二医院进行胎儿超声心动图检查的临床可疑FGR的孕妇50例(观察组),选取同时间段胎儿心脏检查孕周、年龄匹配的正常孕妇56例(对照组)。可疑FGR孕妇根据出生后新生儿体质量分为2个亚组:FGR确认组和FGR改善组。收集胎儿的生长情况及脐动脉血流、大脑中动脉血流、主动脉峡部血流情况;获得胎儿的心脏参数,包括右心房横径、左心房横径、左心室横径、右心室横径、肺动脉内径、主动脉内径、主动脉峡部内径、动脉导管弓内径、右心房横径/左心房横径、右心室横径/左心室横径、左心室球形指数、右心室球形指数、左心室球形指数/右心室球形指数、主动脉内径/肺动脉内径、主动脉峡部内径/动脉导管弓内径;并获取孕妇基本临床资料、分娩情况和妊娠结局。采用方差分析或Kruskal-Wallis秩检验比较FGR确认组、FGR改善组和对照组三组间上述参数的差异,进一步组间两两比较采用LSD-t检验或Bonferroni法校正;各参数与FGR确认组、FGR改善组分组的相关性分析采用Spearman相关分析,采用受试者工作特征(ROC)曲线评估各参数诊断FGR的效能。结果FGR确认组与FGR改善组相比,右心房横径/左心房横径值较高[1.27(1.10,1.44)vs 1.09(1.00,1.20)],差异具有统计学意义(Z=2.581,P=0.030),主动脉峡部内径、主动脉峡部内径/动脉导管弓内径、左心室球形指数/右心室球形指数值较低[2.80(2.50,3.25)mm vs 3.50(3.03,3.78)mm;0.73±0.18 vs 0.96±0.19;0.72±0.11 vs 0.80±0.11],差异具有统计学意义(Z=-3.673,P=0.001;t=-5.043,P<0.001;t=-2.255,P=0.026)。FGR确认组与对照组相比,主动脉峡部内径[2.80(2.50,3.25)mm vs 3.30(3.00,3.80)mm]、主动脉峡部内径/动脉导管弓内径(0.73±0.18 vs 1.00±0.12)、左心室球形指数/右心室球形指数(0.7Objective To preliminarily investigate the predictive value of fetal cardiac parameters for fetal growth restriction(FGR).Methods A total of 50 pregnant women who underwent fetal echocardiography during the late gestational period and were clinically suspected of having FGR(observation group)at the Second Affiliated Hospital of Wenzhou Medical University from January 2018 to April 2022 were enrolled in the study,and 56 normal pregnant women who underwent fetal heart examination during the same time period were selected as controls.Pregnant women with suspected FGR were divided into two subgroups based on postnatal neonatal body weight:FGR-confirmed group and FGR-improved group.Fetal growth and umbilical artery,middle cerebral artery,and aortic isthmus blood flow were recorded.Fetal cardiac parameters were obtained,including right atrial transverse diameter,left atrial transverse diameter,left ventriclular transverse diameter,right ventriclular transverse diameter,pulmonary artery diameter,aorta diameter,aorta isthmus diameter,ductus arteriosus arch diameter,right atrial transverse diameter/left atrial transverse diameter ratio,right ventricular transverse diameter/left ventricular transverse diameter ratio,left ventricular spherical index,right ventricular spherical index,left ventricular spherical index/right ventricular spherical index ratio,aortic diameter/pulmonary artery diameter ratio,and aorta isthmus diameter/ductus arteriosus arch diameter ratio.The basic information of the pregnant women as well as the information on the delivery and outcome of the pregnancy was also recorded.Analysis of variance or the Kruskal-Wallis rank test was used to compare the above parameters among the FGR-confirmed group,FGR-improved group,and control group.Further pairwise comparisons between groups were performed by the LSD-t test or Bonferroni method.Spearman correlation analysis was used to assess the correlation between each parameter and FGR-confirmed group and FGR-improved group.Receiver operating characteristic(ROC)cur

关 键 词：胎儿宫内生长受限 胎儿超声心动图 主动脉峡部 球形指数 

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]