目的 探讨产前三维超声测量胸腺参数在胎儿生长受限(fetal growth restriction,FGR)评估中的应用价值.方法 选取2021年3月至2022年3月西北妇女儿童医院收治的75例孕晚期FGR孕妇作为研究组,另采用随机数字表法选取同期、同年龄段、同院收治的75例孕晚期胎儿发育正常孕妇作为对照组,均行产前三维超声检查测量胎儿的胸腺体积、横径、前后径、胸腺-胸廓比(thymic-thoracic ratio,T-T)值.比较两组孕妇的一般资料、FGR相关血清学标志物[胎盘生长因子(placental growth factor,PLGF)、妊娠相关血浆蛋白A(pregnancy-associated plasma protein-A,PAPP-A)、β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)]、胎儿腹围Z-评分值、子宫动脉血流参数[搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、收缩末期峰值流速与舒张末期峰值流速比值(end-systolic peak flow velocity to end-diastolic peak flow velocity ratio,S/D)]、胎儿三维超声胸腺参数,分析胎儿三维超声胸腺参数与其他FGR相关指标的关系.随访至妊娠结束,分析胎儿三维超声胸腺参数与新生儿5 min Apgar评分的关系及评估胎儿FGR的价值.统计学方法采用t检验、x2检验、Spearman相关性分析和受试者操作特征(receiver operating characteristic,ROC)曲线.结果 研究组与对照组孕妇的年龄、孕周、经产情况等比较,差异均无统计学意义(P值均>0.05).研究组与对照组孕妇产前身体质量指数(body mass index,BMI)[(21.4±1.9)与(23.2±2.2)kg/m2]、血清PLGF[(0.63±0.19)与(1.04±0.30)MOM]、PAPP-A[(0.78±0.23)与(1.57±0.42)MOM]、β-hCG水平[(0.69±0.21)与(1.35±0.36)MOM]、胎儿腹围Z-评分值[(-1.75±0.53)与(-0.16±0.05)分]比较,研究组均低于对照组;妊娠期糖尿病(gestational diabetes mellitus,GDM)发生率[26.7%(20/75)与6.7%(5/75)]、妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)发生率[34.7%(26/75)与10.7%(8/75)]、子宫动脉PI(1.39±0.37与0.95±0.30)、RI(0.71±0.21与0.54±0.16)、S/D(3.08±0.85与2.49±0.71)比较,研究组均高于对照组,差异均有统计学意义(P值均<0.05).研究组与对照组胎儿的胸腺体积[(8.25±0.76)与(8.84±0.83)ml],横径[(3.11±0.25)与(3.40±0.28)cm],前后径[(1.33±0.15)与(1.45±0.20)cm,T-T值(0.32±0.06与0.38±0.08)比较,研究组均低于对照组(P值均<0.001).Spearman相关性分析结果显示,研究组胎儿的胸腺体积、横径、前后径、T-T值与血清PLGF、PAPP-A、β-HCG水平、胎儿腹围Z-评分值呈正相关,与子宫动脉PI、RI、S/D呈负相关(P值均<0.05).研究组5 min Apgar评分<7分与7～10分新生儿的胎儿时期胸腺体积[(7.92±0.59)与(8.45±0.65)ml],横径[(2.95±0.22)与(3.21±0.26)cm],前后径[(1.24±0.13)与(1.38±0.15)cm],T-T值(0.29±0.03与0.34±0.05)比较,<7分组均低于7～10分组(P值均<0.001).研究组胎儿的胸腺体积、横径、前后径、T-T值与新生儿5 min Apgar评分呈正相关(r=0.348、0.416、0.379、0.450,P值均<0.05);胎儿胸腺体积、横径、前后径、T-T值联合评估胎儿FGR的曲线下面积(area under the curve,AUC)最大,为0.918(95%CI:0.863～0.957,P<0.001).结论 产前三维超声胸腺参数与FGR子宫动脉血流、胎儿胎盘发育情况及新生儿5 min Apgar评分关系密切,胎儿胸腺体积、横径、前后径、T-T值联合评估FGR的诊断效能较高.
Value of measuring thymic parameters based on prenatal three-dimensional ultrasound in the evaluation of fetal growth restriction
Objective To explore the application value of prenatal three-dimensional ultrasound measurement of thymic parameters in the evaluation of fetal growth restriction (FGR).Method Seventy-five pregnant women with FGR in the third trimester of pregnancy who were admitted to the Northwest Women's and Children's Hospital from March 2021 to March 2022 were selected as the study group.Seventy-five pregnant women with normal fetal development in the third trimester of pregnancy who were admitted to the same hospital during the same period and in the same age group were selected as the control group using a random number table method.All participants underwent prenatal three-dimensional ultrasound examination to measure the thymuic volume,transverse diameter,anterior and posterior diameter,and thymic-thoracic ratio (T-T) value of the fetus.Clinical data,FGR-related serological markers[(placental growth factor (PLGF),pregnancy-associated plasma protein-A (PAPP-A),β-human chorionic gonadotropin (β-hCG)],fetal abdominal circumference Z-score,uterine artery flow parameters[pulsatility index (PI),resistance index (RI),end-systolic peak flow velocity to end-diastolic peak flow velocity ratio (S/D),fetal three-dimensional ultrasound thymic parameters were compared between the two groups,and the relationship between fetal three-dimensional ultrasound thymic parameters and other FGR related indicators were analyzed.The relationship between fetal thymus parameters and 5-min Apgar score of fetus was analyzed and the value of fetal FGR was evaluated.Statistical methods performed by t-test,x2 test,Spearman correlation analysis and receiver operating characteristic (ROC) curve.Result There was no significant difference in age,gestational age and postpartum between the study group and the control group (all P>0.05).Prenatal body mass index (BMI)[(21.4±1.9) vs (23.2±2.2) kg/m2],serum PLGF[(0.63±0.19) vs (1.04±0.30) MOM],PAPP-A[(0.78±0.23) vs (1.57±0.42) MOM,the levels of β-hCG[(0.69±0.21) vs (1.35±0.36) MOM]and Z-score of fetal abdominal circumference[(-1.75±0.53) vs (-0.16±0.05) points]in the study group were lower than those in the control group.Incidence of gestational diabetes mellitus (GDM)[26.7% (20/75) vs 6.7% (5/75)],the incidence of hypertensive disorders of pregnancy (HDP)[(34.7% (26/75) vs 10.7% (8/75)],uterine artery PI (1.39±0.37 vs 0.95±0.30),RI (0.71±0.21 vs 0.54±0.16),S/D (3.08±0.85 vs 2.49±0.71) in the study group were all higher than those in the control group.The differences were statistically significant (all P<0.05).In the study group,the thymic volume[(8.25±0.76) vs (8.84±0.83) ml],transverse diameter[(3.11±0.25) vs (3.40±0.28) cm],anterior and posterior diameter[(1.33±0.15) vs (1.45±0.20) cm,T-T values (0.32±0.06 vs 0.38±0.08) were lower than those in the control group (all P<0.001).Spearman correlation analysis showed that the thymic volume,transverse diameter,anterior and posterior diameter,and T-T value of the fetus in the study group were positively correlated with serum PLGF,PAPP-A,β-HCG levels,and Z-score of fetal abdominal circumference,and negatively correlated with uterine artery PI,RI,and S/D (P<0.05).The 5 min Apgar score of the study group was<7 and 7-10,the fetal thymic volume[(7.92±0.59) vs (8.45±0.65) ml],the transverse diameter[(2.95±0.22) vs (3.21±0.26) cm],the anterior and posterior diameter[(1.24±0.13) vs (1.38±0.15) cm]and T-T value (0.29±0.03 vs 0.34±0.05) in<7 groups were lower than those in 7-10 groups (all P<0.001).The fetal thymic volume,transverse diameter,anterior and posterior diameter and T-T value were positively correlated with 5 min Apgar score (r=0.348,0.416,0.379,0.450,all P<0.05).The maximum area under the curve (AUC) of fetal FGR was 0.918 (95% CI:0.863-0.957,P<0.001) in the combined evaluation of fetal thymic volume,transverse diameter,anterior and posterior diameter and T-T value.Conclusion The thymic parameters of prenatal three-dimensional ultrasound are closely related to the uterine artery blood flow,fetal placental development,and neonatal 5 min Apgar score in FGR.The combined assessment of fetal thymic volume,transverse diameter,anterior and posterior diameter,and T-T value has a high diagnostic efficiency for FGR.
Fetal growth restrictionThymic-thoracic ratioNewbornUltrasound5 min Apgar score
万方数据
维普
