摘要
目的:探究超声联合血清缺氧诱导因子-α(HIF-1α)、β-人绒毛膜促性腺激素(β-HCG)及C反应蛋白(CRP)诊断胎儿宫内窘迫(FIUD)价值.方法:收集本院2019年1月—2020年6月收治的临床最终诊断为FIUD的孕妇87例为FIUD组,健康孕妇60例为对照组,超声诊断仪检查孕妇胎儿大脑中动脉(MCA)与脐动脉的搏动指数(PI)、阻力指数(RI)及脐动脉收缩末期血流峰值(PSV)与舒张末期流速(EDV)比值(S/D),超声检查当天采集孕妇外周静脉血,检测血清HIF-1α、β-HCG、CRP水平,分析超声联合血清HIF-1α、β-HCG、CRP诊断FIUD价值.结果:FIUD组胎儿MCA阻抗指数PI、RI及S/D水平均低于对照组,脐动脉阻抗指数PI、RI及S/D水平均高于对照组(均P<0.05).以临床诊断为“金标准”,超声诊断FIUD的灵敏度(72.4%)、特异度(90.0%)及准确度(79.6%).FIUD组血清HIF-1α、β-HCG、CRP水平均高于对照组(P<0.05).绘制受试者工作曲线,血清HIF-α诊断FIUD效能最高(AUC=0.816),但3者联合应用提高了诊断效能(AUC=0.953).超声联合HIF-α+β-HCG+CRP诊断效能最高(AUC=0.995).结论:胎儿MCA及脐动脉血阻抗指数异常可反映FIUD,但诊断准确性有限,而超声联合血清HIF-1α、β-HCG、CRP可提高FIUD诊断效果,利于临床了解胎儿情况,制定相应措施,改善母婴结局.
Objective: To investigate the value of ultrasound combined with serum hypoxia-inducible factor-1α(HIF-1α),β-human chorionic gonadotropin β(β-HCG), and C-reactive protein(CRP) levels of pregnant women for diagnosing their fetal intrauterine distress(FIUD). Methods: 87 pregnant women with FIUD were collected in observation group and 60 healthy pregnant women were selected in control group from January 2019 to June 2020. The values of ultrasonic parameters, such as the fetal middle cerebral artery(MCA),and the pulse index(PI), the resistance index(RI),and the peak systolic velocity(PSV)/end diastolic velocity(EDV)ratio(S/D) of the fetal umbilical artery were examined by ultrasound. The levels of serum HIF-1α,β-HCG, and CRP of the women on the day of ultrasonic examination were detected. The values of ultrasonic parameters combined with the levels of serum HIF-1α,β-HCG, and CRP for diagnosing FIUD was analyzed. Results: The values of PI, RI, and S/D of fetal MCA in the observation group were significantly lower than those in the control group, and the values of PI, RI, and S/D of fetal umbilical artery in the observation group were significantly higher than those in the control group(all P<0.05). Based on the "gold standard" of clinical diagnosis, the sensitivity, the specificity, and the accuracy of ultrasonic parameters for diagnosing FIUD were 72.4%, 90.0%, and 79.6%, respectively. The levels of serum HIF-1α, β–hCG, and CRP of the women in the observation group were significantly higher than those in the control group(P<0.05). Receiver operating characteristic(ROC) curve showed that the serum HIF-α level for diagnosing FIUD had the highest efficacy(AUC=0.816),and the diagnostic efficacy of the combination of the levels of serum HIF-1α,β-HCG,and CRP for diagnosing FIUD had been improved(AUC=0.953).The diagnostic efficacy of the values of ultrasonic parameters combined with the levels of serum HIF-1α,β-HCG,and CRP for diagnosing FIUD was the highest(AUC=0.995).Conclusion:The abnormal resistance index of fetal MCA and umbilical artery blood by ultrasound can indicate the FIUD occurrence,while the diagnostic accuracy of which is limited.The diagnostic efficacy of the ultrasonic parameters values combined with the levels of serum HIF-1α,β-HCG,and CRP for diagnosing FIUD can effectively improve the diagnostic efficacy,which is beneficial to know the fetal situation and formulate the corresponding measures for improving the maternal and infant outcomes in clinic.
作者
冯梅
陈思骄
杨顺实
FENG Mei;CHEN Sijiao;YANG Shunshi(Wuhan Central Hospital Affiliated to Tongji Medical College,Huazhong University of science and technology,Wuhan,Hubei Province,430024)
出处
《中国计划生育学杂志》
2022年第5期1137-1140,1145,共5页
Chinese Journal of Family Planning
关键词
胎儿宫内窘迫
超声检查
缺氧诱导因子-Α
Β-人绒毛膜促性腺激素
C反应蛋白
诊断价值
Fetal intrauterine distress
Ultrasonic examination
Hypoxia-inducible factor-1α
β-human chorionic gonadotropin
C-reactive protein
Diagnostic value
作者简介
通信作者:杨顺实,yss3977@163.com。
