摘要
目的 分析早孕期三维能量多普勒联合频谱多普勒定量评估胎盘血流灌注预测胎儿生长受限(FGR)的相关性.方法 选取76例于天津中医药大学附属北辰中医医院2021年4月—2022年9月进行早孕期NT检查的孕妇为研究对象,根据胎儿是否存在生长受限分为对照组69例,FGR组7例.以此对比产妇基本资料,两组超声参数:胎盘血管化指数(VI)、胎盘血流指数(FI)、血管化-血流指数(VFI)、子宫动脉阻力指数(UtA-RI)、子宫动脉搏动指数(UtA-PI)、胎儿静脉导管搏动指数(DV-PI),分析发生FGR独立危险因素,超声参数与FGR的相关性,ROC曲线分析不同指标预测FGR的效能.结果 FGR与年龄、BMI指数、孕期贫血、产次无关,无统计学差异(P＞0.05);主要与胎膜早破、羊水过少、脐带异常、胎粪污染、胎盘异常有关,具有统计学差异(P＜0.05).与对照组相比,FGR组VI、VFI、水平较低,UtA-RI、UtA-PI、DV-PI水平有所提升(P＜0.05).以FGR为因变量(0=否,1=是),建立Logistic回归模型,结果显示,VI、VFI、UtA-RI、UtA-PI、DV-PI是导致FGR的独立危险因素(P＜0.05).VI、VFI参数与FGR呈负相关;UtA-RI、UtA-PI、DV-PI 参数与 FGR 呈正相关(P＜0.05).ROC 曲线显示,VI、VFI、UtA-RI、UtA-PI、DV-PI单一及联合预测均有较高效能,而联合检查预测价值最高(P＜0.05).结论 早孕期采用三维能量多普勒联合频谱多普勒预测FGR的效能较高,有助于早期诊断并及时采取干预措施.
Abstract
Objective Analysis of three-dimensional energy Doppler combined with spectral Doppler to quantitative-ly evaluate placental flow perfusion to predict fetal growth restriction(FGR)during early pregnancy.Methods A total of 76 pregnant women with NT examination in early pregnancy from April 2021 to September 2022 were selected as 69 cases in the control group and 7 cases in the FGR group.Compared with maternal basic data,the two groups of ultra-sound parameters:placental vascularization index(VI),placental blood flow index(FI),vascularization-flow index(VFI),uterine artery resistance index(UtA-RI),uterine artery beat index(UtA-PI),fetal venous catheter beat index(DV-PI),analysis of independent risk factors for FGR,correlation between ultrasound parameters and FGR,ROC curve analysis of different indicators to predict the efficacy of FGR.Results FGR was not related to age,BMI,anemia during pregnancy,or number of deliveries,with no statistical difference(P＞0.05);it was mainly related to premature rupture of membranes,low amniotic fluid,umbilical cord abnormality,fecal contamination,and placental abnormality,with a statistical difference(P＜0.05).Compared with the control group,VI,VFI,lower,UtA-RI,UtA-PI,and DV-PI in-creased(P＜0.05).A Logistic regression model was developed with FGR as the dependent variable(0=no,1=yes),which showed that VI,VFI,UtA-RI,UtA-PI,and DV-PI were independent risk factors for FGR(P＜0.05).VI,VFI pa-rameters were negatively correlated with FGR;UtA-RI,UtA-PI,and DV-PI parameters were positively correlated with FGR(P＜0.05).The ROC curve showed that VI,VFI,UtA-RI,UtA-PI,DV-PI all had high efficiency,while the combined ex-amination had the highest predictive value(P＜0.05).Conclusion Using three-dimensional energy Doppler and combining spectrum Doppler can predict FGR more efficiently,which is helpful for early diagnosis and timely intervention measures.
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