摘要
目的探讨四维彩色多普勒超声联合唐氏筛查诊断胎儿生长受限(FGR)的临床价值。方法选取2020年5月—2021年5月东莞市人民医院诊断为FGR的60例孕妇作为FGR组,另选取同期60例来该院孕检的正常妊娠孕妇作为对照组。对比两组四维彩色多普勒超声胎盘血管指数[血管化指数(VI)、血流指数(FI)及血管化-血流指数(VFI)]、唐氏筛查指标[游离雌三醇(uE_(3))、甲胎蛋白(AFP)、游离β-绒毛膜促性腺激素(β-hCG)],分析胎盘血管指数与唐筛血清相关指标的相关性,并绘制受试者工作特征(ROC)曲线,分析VI、FI、VFI、uE_(3)、AFP及β-hCG预测FGR的价值。结果FGR组VI、FI和VFI较对照组低(P<0.05)。FGR组uE_(3)水平较对照组低,AFP、β-hCG水平较对照组高(P<0.05)。Pearson相关性分析显示,VI、FI及VFI与uE_(3)呈正相关(r=0.294、0.370和0.324,均P<0.05),VI、FI及VFI与AFP呈负相关(r=-0.317、-0.308和-0.312,均P<0.05)、VI、FI及VFI与β-hCG呈负相关(r=-0.237、-0.298和-0.338,均P<0.05)。ROC曲线显示,VI的AUC、敏感性、特异性分别为0.689(95%CI:0.590,0.788)、0.702(95%CI:0.611,0.832)、0.722(95%CI:0.632,0.852),FI分别为0.682(95%CI:0.581、0.893)、0.693(95%CI:0.595,0.790)、0.714(95%CI:0.621,0.839),VFI分别为0.687(95%CI:0.587、0.786)、0.699(95%CI:0.602,0.796)、0.720(95%CI:0.625,0.846),uE_(3)分别为0.696(95%CI:0.597、0.795)、0.711(95%CI:0.623,0.835)、0.731(95%CI:0.635,0.867),AFP分别为0.677(95%CI:0.581、0.772)、0.682(95%CI:0.587,0.779)、0.705(95%CI:0.621,0.825),β-hCG分别为0.644(95%CI:0.542、0.746)、0.679(95%CI:0.576,0.752)、0.693(95%CI:0.592,0.792),联合诊断分别为0.767(95%CI:0.678、0.855)、0.826(95%CI:0.753,0.907)、0.869(95%CI:0.796,0.952)。结论四维彩色多普勒超声胎盘血管指数、唐筛指标与FGR的发生密切相关,两者联合可有效预测FGR的发生。
Objective To explore the clinical value of four-dimensional color Doppler ultrasound combined with Down's syndrome screening in the diagnosis of fetal growth restriction(FGR).Methods Sixty pregnant women diagnosed with the condition of FGR in Dongguan People's Hospital from May 2020 to May 2021 were selected as FGR group,and another 60 healthy pregnant women undergoing pregnancy check-ups in the hospital during the same period were selected as the control group.The placental vascular indices[vascularization index(VI),flow index(FI)and vascularization flow index(VFI)]measured via four-dimensional color Doppler ultrasound and the serum indicators for the Down's syndrome screening[unconjugated estriol(uE_(3)),alpha-fetoprotein(AFP)and human chorionic gonadotropin beta subunit(β-hCG)]were compared between the two groups.The correlations between placental vascular indices and serum indicators for the Down's syndrome screening were analyzed.The receiver operating characteristic(ROC)curves were plotted to determine the predictive values of VI,FI,VFI,uE_(3),AFP andβ-hCG for the occurrence of FGR.Results The VI,FI,and VFI were lower in the FGR group than those in the control group(P<0.05).The serum level of uE_(3)was lower,but serum levels of AFP andβ-hCG were higher in the FGR group compared with the control group(P<0.05).Pearson correlation analysis showed that VI,FI and VFI were positively correlated with the serum level of uE_(3)(r=0.381,0.512 and 0.509,all P<0.05),but were negatively correlated with serum levels of AFP(r=-0.365,-0.458 and-0.331,all P<0.05)andβ-hCG(r=-0.312,-0.415 and-0.302,all P<0.05).The ROC curve analysis showed that the area under the ROC curve(AUC),sensitivity,and specificity of VI for diagnosing FGR were 0.689(95%CI:0.590,0.788),0.702(95%CI:0.611,0.832),and 0.722(95%CI:0.632,0.852),those of FI for diagnosing FGR were 0.682(95%CI:0.581,0.893),0.693(95%CI:0.595,0.790),and 0.714(95%CI:0.621,0.839),those of VFI for diagnosing FGR were 0.687(95%CI:0.587,0.786),0.699(95%CI:0.602,0.796),and 0.720(95%CI:0.625,0.846),those of uE_(3)for diagnosing FGR were 0.696(95%CI:0.597,0.795),0.711(95%CI:0.623,0.835),and 0.731(95%CI:0.635,0.867),those of AFP for diagnosing FGR were 0.677(95%CI:0.581,0.772),0.682(95%CI:0.587,0.779),and 0.705(95%CI:0.621,0.825),those ofβ-hCG for diagnosing FGR were 0.644(95%CI:0.542,0.746),0.679(95%CI:0.576,0.752)and 0.693(95%CI:0.592,0.792),and those of their combination for diagnosing FGR were 0.767(95%CI:0.678,0.855),0.826(95%CI:0.753,0.907),and 0.869(95%CI:0.796,0.952).Conclusions The placental vascular indices measured via four dimensional color Doppler ultrasound and serum indicators for the Down's syndrome screening are closely related to the occurrence of FGR,and the combination of them can effectively predict the occurrence of FGR.
作者
陈凤云
李仲均
黄素然
黄丽燕
李瑞满
Feng-yun Chen;Zhong-jun Li;Su-ran Huang;Li-yan Huang;Rui-man Li(Department of Obstetrics and Gynecology,Dongguan People's Hospital(Dongguan Hospital Affiliated to Southern Medical University),Dongguan,Guangdong 523000,China;Department of Ultrasound,Dongguan People's Hospital(Dongguan Hospital Affiliated to Southern Medical University),Dongguan,Guangdong 523000,China;Department of Obstetrics and Gynecology,The First Affiliated Hospital of Jinan University,Guangzhou,Guangdong 510520,China)
出处
《中国现代医学杂志》
CAS
北大核心
2022年第22期44-48,共5页
China Journal of Modern Medicine
基金
广东省2022年度省基础与应用基础研究基金自然科学基金项目(No:2022A1515010359)。
关键词
胎儿生长受限
四维彩色多普勒超声
唐氏筛查
胎盘血管指数
人绒毛膜促性腺激素
甲胎蛋白
fetal growth restriction
four-dimensional color Doppler ultrasound
Down’s syndrome screening
placental vascular indices
human chorionic gonadotropin
alpha-fetoprotein
作者简介
通信作者:李仲均,E-mail:zhongjunlh@163.com。
