早中孕期超声指标对单绒毛膜双羊膜囊双胎发生选择性宫内生长受限的预测价值  

The Value of Ultrasound Indicators in Predicting Selective Intrauterine Growth Restriction in Monochorionic Diamniotic Twins During Early and Middle Pregnancy

作　　者：刘明敏[1] 刘俊[1] 杨淳玮 高钧霖 Liu Mingmin;Liu Jun;Yang Chunwei;Gao Junlin(Department of Ultrasound,Wuxi Maternity and Child Health Care Hospital,Wuxi,Jiangsu 210000,China)

机构地区：[1]无锡市妇幼保健院超声科,江苏省无锡市210000

出　　处：《中国超声医学杂志》2024年第7期787-791,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 探讨早中孕期超声指标对单绒毛膜双羊膜囊(MCDA)双胎选择性宫内生长受限(sIUGR)的预测价值。方法 回顾性分析346例MCDA双胎孕妇的病例资料。测量颈部透明层厚度(NT)及头臀长(CRL),计算NT、CRL差异,采用受试者工作特征(ROC)曲线评估其预测MCDA双胎孕妇sIUGR的价值。利用Logistic回归分析寻找独立预测因素并构建预测模型。结果 (1)训练集sIUGR组脐带不一致的发生率、NT差异及CRL差异大于对照组,差异具有统计学意义(P<0.05)。(2)NT差异预测sIUGR的ROC曲线下面积为0.624,最佳截断值为32.46%;CRL差异预测sIUGR的ROC曲线下面积为0.789,最佳截断值为4.65%;两者预测sIUGR的ROC曲线比较,差异具有统计学意义(P<0.05)。(3)多因素Logistic回归分析CRL差异及脐带插入不一致是独立预测因素。(4)预测模型预测sIUGR的ROC曲线下面积为0.938,灵敏度为91.3%,特异度为81.2%;对模型进行内部验证,灵敏度为90.90%,特异度为70.90%。结论 CRL差异和胎盘脐带插入不一致是MCDA双胎sIUGR的独立预测因素,基于此建立的预测模型有助于预测sIUGR。Objective To explore the value of ultrasound parameters at the first and second-trimester in predicting monochorionic diamniotic(MCDA) twins affected by selective intrauterine growth restriction(sIUGR).Methods The clinical data of 346 MCDA twin pregnant women were retrospectively analyzed.Measuring the nuchal translucency(NT) and crown-rump length(CRL),calculating the differences in NT and CRL,and the value in predicting sIUGR in MCDA twins was evaluated by receiver operating characteristic(ROC) curve.Logistic analysis was used to detect independent predictors and construct a prediction model.Results(1)In the training set,the incidence of umbilical cord inconsistency,NT difference and CRL difference in the sIUGR group were significantly higher than those in the control group(P<0.05).(2)The area under the ROC curve of NT difference for predicting sIUGR was 0.624,and the best cut-off value was 32.46%.The area under the ROC curve of CRL difference predicting sIUGR was 0.789,and the best cut-off value was 4.65%.There was a statistically significant difference in the ROC curve between the two groups(P<0.05).(3)Multivariate Logistic regression analysis showed that differences in CRL and inconsistent umbilical cord insertion were independent predictors.(4)The area under the ROC curve of the prediction model for sIUGR was 0.938,the sensitivity was 91.3%,and the specificity was 81.2%.Internal validation of the model showed a sensitivity of 90.90% and a specificity of 70.90%.Conclusions Differences in CRL and discordant placenta and umbilical cord insertion are independent predictors of sIUGR in MCDA twins,and the prediction model based on these factors is helpful for prediction.

关 键 词：单绒毛膜双羊膜囊 选择性宫内生长受限 超声 双胎 

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]