胎盘三维彩色能量多普勒血管超声成像在早孕期预测胎儿生长受限中的应用价值

朱玲; 梅丽娜; 邵冰鑫

doi:10.16766/j.cnki.issn.1674-4152.003342

胎盘三维彩色能量多普勒血管超声成像在早孕期预测胎儿生长受限中的应用价值

doi: 10.16766/j.cnki.issn.1674-4152.003342

湖州市妇幼保健院超声科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2022KY1226

湖州市科学技术局项目 2023GY29

详细信息

通讯作者:
朱玲，E-mail：15088354690@163.com

中图分类号: R714.5 R445.1
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- 文章访问数: 146
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- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-06
- 网络出版日期: 2024-03-09

Application value of placenta three-dimensional color power Doppler vascular ultrasound imaging in predicting fetal growth restriction in early pregnancy

Department of Ultrasound, Huzhou Maternal and Child Health Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的采用胎盘三维彩色能量多普勒血管超声成像(3D-CPA)检测早孕期产妇的胎盘三维能量多普勒指数，并分析其预测胎儿生长受限(FGR)的临床价值。方法选取2022年1月—2023年1月于湖州市妇幼保健院行早孕期胎儿结构筛查的300名孕妇为研究对象，分娩后确诊为FGR的胎儿纳入研究组(150例)，确诊为正常的胎儿纳入对照组(150例)。对比2组血流指数(FI)、血管化指数(VI)、血管化-血流指数(VFI)和妊娠结局，将差异有统计学意义的指标纳入多因素logistic回归分析模型，绘制ROC曲线分析相关指标预测FGR的价值。结果研究组早产、剖宫产及胎儿窘迫发生率明显高于对照组，住院时间长于对照组，FI、VI及VFI均低于对照组，差异均有统计学意义(P＜0.05)。多因素logistic回归模型分析显示，FI(OR=0.919)、VI(OR=0.860)、VFI(OR=0.703)均是FGR的影响因素(P＜0.05)。ROC曲线显示，FI、VI及VFI的AUC分别为0.653、0.702及0.802。结论与胎儿正常生长发育相比，存在FGR的胎盘内血流灌注减弱，且导致早产、剖宫产及胎儿窘迫等不良妊娠结局发生率升高；早孕期3D-CPA对FGR有重要的预测价值，可作为FGR诊断的辅助检查手段。
- 三维彩色能量多普勒血管超声成像 /
- 胎儿生长受限 /
- 胎儿体质量 /
- 妊娠结局 /
- 血管化指数 /
- 血流指数
Abstract: Objective The placental three-dimensional color power angiographic (3D-CPA) was used to detect the placental three-dimensional power Doppler index of early pregnant women, and its clinical value in predicting fetal growth restriction (FGR) was analyzed. Methods From January 2022 to January 2023, 300 pregnant women who underwent fetal structure screening in Huzhou Maternal and Child Health Hospital were selected as the research objects. Fetuses diagnosed as FGR after delivery were included in the study group (n=150) and normal fetuses were included in the control group (n=150). The blood flow index (FI), vascularization index (VI), vascularization-flow index (VFI) and pregnancy outcome were compared between the two groups, and a multivariate logistic regression analysis model was constructed with statistically significant indicators, and the ROC curve was drawn to analyze the value of related indicators in predicting FGR. Results The incidence of premature delivery, cesarean section and fetal distress in the study group were significantly higher than those in the control group, while the FI, VI and VFI were lower than those in the control group, with statistical significance (P < 0.05). Multivariate logistic regression model analysis showed that FI (OR=0.919), VI (OR=0.860) and VFI (OR=0.703) were the influencing factors of FGR (P < 0.05). The ROC curve showed that the AUC of FI, VI and VFI were 0.653, 0.702 and 0.802, respectively. Conclusion Compared with normal fetal growth and development, placental blood perfusion with FGR is weakened, and the incidence of adverse pregnancy outcomes such as premature delivery, cesarean section and fetal distress is increased. 3D-CPA in early pregnancy has important predictive value for FGR, and can be used as an auxiliary examination method for FGR diagnosis.
- Three-dimensional color power angiographic /
- Fetal growth restriction /
- Fetal body mass /
- Pregnancy outcome /
- Vascularization index /
- Flow index

HTML全文

图 1 2组孕妇3D-CPA检测图像

注：A为对照组，B为研究组。

Figure 1. 3D-CPA test chart of pregnant women in the two groups

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图 2 FI、VI及VFI预测FGR的ROC曲线

Figure 2. ROC curve of FGR predicted by FI, VI and VFI

下载: 全尺寸图片幻灯片

表 1 2组孕妇一般资料比较

Table 1. Comparison of general information between two groups of pregnant women

组别	例数	年龄(x±s, 岁)	初产妇[例(%)]	孕次(x±s, 次)	孕周(x±s, 周)	BMI(x±s)
对照组	150	31.58±4.60	82(54.67)	1.76±0.41	11.15±0.83	24.13±2.16
研究组	150	31.20±4.54	75(50.00)	1.82±0.46	11.07±0.92	24.25±2.19
统计量		0.720^a	0.655^b	1.193^a	0.791^a	0.478^a
P值		0.472	0.418	0.234	0.430	0.633
注：^a为t值，^b为χ²值。

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表 2 2组孕妇妊娠结局比较

Table 2. Comparison of pregnancy outcomes between two groups of pregnant women

组别	例数	早产[例(%)]	剖宫产[例(%)]	新生儿窒息[例(%)]	胎儿窘迫[例(%)]	住院时间[M(P₂₅, P₇₅), d]
对照组	150	5(3.33)	31(20.67)	2(1.33)	3(2.00)	4(2, 7)
研究组	150	39(26.00)	46(30.67)	4(2.67)	11(7.33)	7(3, 12)
统计量		30.788^a	3.931^a	0.170^a	4.795^a	8.607^b
P值		＜0.001	0.047	0.680	0.029	＜0.001
注：^a为χ²值，^b为Z值。

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表 3 2组孕妇胎盘三维能量多普勒指数比较(x±s)

Table 3. Comparison of three-dimensional power Doppler index of placenta between two groups of pregnant women(x±s)

组别	例数	FI	VI	VFI
对照组	150	32.16±7.69	26.48±6.92	11.35±3.98
研究组	150	26.74±6.82	21.45±6.03	8.03±3.14
t值		6.458	6.712	8.021
P值		＜0.001	＜0.001	＜0.001

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表 4 变量赋值情况

Table 4. Assignment of Variables

变量	赋值方法
是否发生FGR	是=1，否=0
FI	以实际值赋值
VI	以实际值赋值
VFI	以实际值赋值

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表 5 FGR影响因素的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of FGR influencing factors

变量	B	SE	Waldχ²	P值	OR值	95% CI
FI	-0.085	0.025	11.815	0.001	0.919	0.875~0.964
VI	-0.150	0.030	25.162	＜0.001	0.860	0.811~0.912
VFI	-0.352	0.049	51.181	＜0.001	0.703	0.639~0.775

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表 6 FI、VI及VFI对FGR的预测价值分析

Table 6. Accuracy and predictive value of FGR predicted by FI, VI and VFI

项目	AUC	95% CI	灵敏度(%)	特异度(%)
FI	0.653	0.596~0.707	74.00	52.00
VI	0.702	0.646~0.753	65.33	66.67
VFI	0.802	0.752~0.845	70.67	76.67

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