摘要
目的 探讨胎儿生长受限(FGR)的多普勒超声血流参数变化,并分析其诊断价值及临床意义.方法 选取2022 年1 月—2023 年6 月确诊的71 例FGR孕妇作为病例组,另匹配同期 71 例小于胎龄儿孕妇作为对照组.统计2 组胎儿脐动脉(UA)、大脑中动脉(MCA)、静脉导管(DV)和孕妇子宫动脉(UtA)的血流参数[收缩期峰值流速/舒张末期血流速度(S/D)、搏动指数(PI)、心室收缩期 S峰流速/心房收缩期谷 a波流速(S/a)及脑-胎盘比(CPR)].采用多因素Logistic回归分析FGR发病影响因素,分别构建含与不含多普勒超声血流参数复合模型.受试者工作特征曲线分析多普勒超声血流参数对FGR的诊断效能.决策曲线和临床影响曲线评价多普勒超声血流参数复合模型临床获益及优劣.结果 病例组UA-S/D、UA-PI、MCA-PI、UtA-PI、DV-S/a、CPR与对照组比较差异有统计学意义(P<0.01).孕妇年龄、孕期合并症、不良妊娠史、新生儿出生体质量、新生儿胎盘及脐带异常、UA-S/D、UA-PI、MCA-PI、UtA-PI、DV-S/a、CPR为FGR发病影响因素(P<0.05,P<0.01).多普勒超声血流参数联合诊断FGR的曲线下面积高于UA-S/D、UA-PI、MCA-PI、UtA-PI、DV-S/a、CPR单独诊断(P<0.05);多普勒超声血流参数复合模型诊断FGR有正向净获益;阈概率值在0.6～1.0 范围内,含多普勒超声血流参数复合模型诊断FGR与实际情况具有较高符合率.结论 产前多普勒超声检测FGR胎儿血流参数异常,其中UA-S/D、UA-PI、MCA-PI、UtA-PI、DV-S/a、CPR联合检测对FGR具有一定诊断价值,且具有良好临床获益度,可为临床早期筛查及干预提供依据.
Abstract
Objective To investigate the changes of blood flow parameters in fetal growth restriction(FGR)with Doppler ultrasound,and to analyze its diagnostic value and clinical significance.Methods A total of 71 pregnant women diag-nosed with FGR from January 2022 to June 2023 were selected as the case group,and 71 pregnant women with small gestational age were selected as the control group during the same period.The blood flow parameters[peak systolic flow velocity/end-dias-tolic flow velocity(S/D),pulse index(PI),peak ventricular systolic flow velocity/atrial systolic valley A-wave flow velocity(S/a)and cerebroplacental ratio(CPR)]of fetal umbilical artery(UA),middle cerebral artery(MCA),ductus venosus(DV)and maternal uterine artery(UtA)in the two groups were analyzed.Multivariate Logistic regression analysis was used to screen the influencing factors of FGR,and the complex models with and without Doppler ultrasound blood flow parameters were constructed respectively.The diagnostic efficacy of Doppler ultrasound blood flow parameters for FGR was analyzed by receiver operating characteristic(ROC)curve.Decision curve and clinical impact curve were used to evaluate the clinical benefits and advantages of the composite model of Doppler ultrasound blood flow parameters.Results There were significant differences in UA-S/D,UA-PI,MCA-PI,UtA-PI,DV-S/a and CPR between case group and control group(P<0.01).Maternal age,com-plications during pregnancy,adverse pregnancy history,birth weight of the newborn,abnormal placenta and umbilical cord of the newborn,UA-S/D,UA-PI,MCA-PI,UtA-PI,DV-S/a and CPR were the influencing factors for the incidence of FGR(P<0.05,P<0.01).The area under the ROC curve of combined detection of Doppler ultrasound blood flow parameters in the diag-nosis of FGR was higher than that of UA-S/D,UA-PI,MCA-PI,UtA-PI,DV-S/a and CPR alone(P<0.05).There was posi-tive net benefit in the diagnosis of FGR by composite model of Doppler ultrasound blood flow parameters.The threshold probabil-ity value was in the range of 0.6-1.0,and the composite model of Doppler ultrasound blood flow parameters had a high coinci-dence rate in the diagnosis of FGR.Conclusion Prenatal Doppler ultrasound was used to detect abnormal fetal blood flow pa-rameters of FGR.The combined detection of UA-S/D,UA-PI,MCA-PI,UtA-PI,DV-S/a and CPR has certain diagnostic value for FGR,and has good clinical benefit,which can provide evidence for early clinical screening and intervention.
基金项目
2021年度黑龙江省卫生健康委科研课题项目(20210909020287)
维普
万方数据