| 摘要: |
| 摘 要 目的 探讨孕中、晚期超声生物学指标的Z-评分对评估胎儿生长发育的应用价值。方法 选取我院单胎孕妇中，筛查出巨大儿（A组）103例，胎儿生长受限（B组）48例，合并妊娠期糖尿病而血糖控制满意、出生体质量正常儿（C组）169例分别作为观察组，正常妊娠、胎儿体质量正常的196例为正常对照组。回顾分析中孕期（20+1～24周）、晚孕早期（28+1～33周）、晚孕晚期（34+1周～分娩）三个阶段的生长参数，包括胎儿双顶径（BPD）及头围（HC）、腹围（AC）、股骨长（FL）、头腹围比值（HC/AC）、腹围的Z-评分（AC的Z-评分）、头腹围比值的Z-评分（HC/AC的Z-评分），比较不同阶段两组间各生长参数的差异、GDM的巨大儿与非GDM的巨大儿间的差异。结果 在中孕期、晚孕早期、晚孕晚期三个阶段，A组腹围的Z-评分值明显大于正常对照组、B组腹围的Z-评分明显小于正常对照组（P＜0.05），且随孕龄的增加， A组、B组腹围的Z-评分值与正常对照组的偏离度进行性加大。C组在中孕期、晚孕早期腹围的Z-评分值与正常对照组无明显差别，仅在晚孕晚期其腹围的Z-评分值略高于正常对照组（P=0.045）。GDM的巨大儿组与非GDM的巨大儿组在体型上存在差异，表现为晚孕后期，GDM的巨大胎儿组头腹围比的Z-评分值小于非GDM的巨大儿组（P＜0.05）。传统超声生物学指标中，在中孕期（20+1～24周）只有A组的AC与正常对照组有差异、B组与正常组无明显差异。晚孕早期、晚孕晚期两阶段A组、B组BPD、HC、AC、FL、HC/AC均与正常对照组有差异（P＜0.05），但无法直观判断各指标与正常对照组的偏离程度。结论：超声生物学指标的Z-评分有助于更准确定量评估胎儿宫内生长发育状况，在诊断胎儿宫内生长发育异常以及动态观察随访中有一定临床应用价值，值得推广。 |
| 关键词: 超声 胎儿生长发育 生物学测量 Z-评分 |
| DOI： |
| 投稿时间：2017-07-31修订日期：2017-10-11 |
| 基金项目: |
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| Application of fetal biometric parameters Z-scores in the assessment of fetal growth |
| yuhongyu,zhuyongsheng |
| () |
| Abstract: |
| Objective To explore the significance of fetal ultrasonic biological Z-scores for assessing fetal
growth in the mid and late pregnancy. Methods This was a retrospective study.Women who delivered in Shenzhen Hospital
affiliated to Southern medical university between January 2016 and April 2017 were enrolled.Several groups were screened
out and selected as observation groups among them there were 103 mothers of macrosomic fetuses (macrosomia group,including 25 mothers with GDM and 78 mothers with normal pregnancy),48 mothers of fetal growth retardation(FGR group),and 169
mothers of normal birth weight infants(these mothers with GDM controled their blood sugar well,and were selected for
GDM-normal weight group).Other 196 mothers of normal birth weight infants had normal pregnany,and were selected as
control group.The fetal abdominal circumference(AC),head circumference(HC),biparietal diameter(BPD) and femoral length
(FL) were measured at 20+1-24, 28+1-33 weeks and 34+1weeks to delivery under prenatal ultrasound.The ratio of HC to AC
(HC/AC) and AC Z-score were calculated.The BPD,HC,AC,FL,HC/AC ratio and AC Z-scores between observation groups and
control group were compared.The HC/AC ratio Z-scores between macrosomic fetuses of mothers with GDM(GDM- macrosomia group)
and macrosomic fetuses of mothers with normal pregnancy(normal- macrosomia group) were compared.T test was used for statistical analysis between groups. Results At 20+1-24, 28+1-33 weeks and 34+1weeks to delivery,the AC Z-scores of macrosomia group were higher than that of the control group,and the AC Z-scores of FGR group were lower than that of the control group (both P<0.05).The AC Z-scores of macrosomia group showed a progressive increase,and the AC Z-scores of FGR group declined progressively. The AC Z-scores had no obvious difference in the GDM-normal weight group and the control group at 20+1-24 and 28+1-33 weeks.The difference between this two groups was statistically significant at 34+1weeks to delivery, AC Z-scores of GDM-normal weight group were slightly higher than that of the control group(P=0.045).At 34+1weeks to delivery,the HC/AC ratio Z-scores of GDM- macrosomia group were higher than that of normal- macrosomia group(P<0.05).
As to traditional ultrasonic biological parameters,only the AC of macrosomia group was different from that of the con-
Troll group at 20+1-24 weeks(P<0.05),and the AC of FGR group was not. At 28+1-33 weeks and 34+1weeks to delivery,the BPD,
HC,AC,FL,HC/AC of macrosomia group and FGR group were different from those of the control group(P<0.05).But the degree
of data values deviating from the means can not be shown visually with traditional ultrasonic biological parameters.
Conclusions The fetal ultrasonic biological Z-scores can provide quantitative evidence in fetal growth,and evaluate
fetal developmental outcomes more accurately and effectively. |
| Key words: Ultrasound Fetal growth Biometric parameters Z-scores |
