摘要
目的 探讨超声多参数Z-评分联合预测模型评估胎儿生长受限(FGR)的价值.方法 回顾性分析2017年1月～2020年12月我院收治的88例单胎、孕22～29周且婴儿出生后确诊为FGR的孕妇临床资料,并以同期年龄、产次、妊娠期合并症等一般资料基本匹配的108例非FGR孕妇资料作为对照.采用Logistic回归方程建立胎儿体质量测定(EFW)、脐动脉(UA)、大脑中动脉(MCA)、脑-胎盘比(CPR)、腹围(AC)和头-腹围比值(HC/AC)等参数的单参数模型和多参数联合模型,并绘制受试者工作特征曲线(ROC),通过与Hadlock-EFW百分位数(Hadlock-EFWc)比较,以评估不同模型预测FGR的价值.结果 FGR组EFW、EFWc及CPR、AC、HC/AC的Z-评分均明显低于非FGR组,UA-PI、MCA-PI的Z-评分高于非FGR组(P＜0.001).联合模型预测FGR的灵敏度为82.95％、特异度为70.37％、约登指数为0.533、ROC曲线下面积(AUC)为0.897,95％CI为(0.795,0.956),其预测效能优于Hadlock-EFWc及各超声单参数(P＜0.05).结论 超声多参数Z-评分联合模型预测FGR相较Hadlock-EFWc和超声单参数更为准确且诊断价值更高.
Abstract
Objective To investigate the value of the combined prediction model of ultrasound multi-parameter Z-score in assessing fetal growth restriction(FGR).Methods The clinical data of 88 pregnant women with single pregnancy,22-29 weeks of pregnancy,and FGR infants born after deliv-ery in our hospital from January 2017 to December 2020 were retrospectively analyzed.The general in-formation such as age,parity,pregnancy comorbidity was basically matched with that of 108 non-FGR pregnant women.The single parameter model and the multi-parameter combined model of fetal body mass measurement(EFW),umbilical artery(UA),middle cerebral artery(MCA),cerebral-placental ratio(CPR),abdominal circumference(AC)and head-abdominal circumference ratio(HC/AC)were established by using logistic regression equation.The receiver operating characteristic curve(ROC)was plotted,and the value of different models in predicting FGR was evaluated by comparing with Hadlock-EFW percentile(Hadlock-EFWc).Results The Z-scores of EFW,EFWc,CPR,AC and HC/AC in the FGR group were significantly lower than those in the non-FGR group,while the Z-scores of UA-PI and MCA-PI were higher than those in the non-FGR group(P＜0.001).The sensi-tivity,specificity,Youden index and area under the ROC curve(AUC)of the combined model for pre-dicting FGR were 82.95％,70.37％,0.533 and 0.897,respectively,with 95％CI of(0.795,0.956).Its predictive performance was better than that of Hadlock-EFWc and each single ultrasound parameter(P＜0.05).Conclusion The combined model of ultrasound multi-parameter Z-score is more accu-rate and has higher diagnostic value than Hadlock-EFWc and each single ultrasound parameter in pre-dicting FGR.
基金项目
山东省医药卫生科技发展计划(202009021246)
NETL
NSTL
维普
万方数据