| 摘要: |
| 目的 探讨妊娠期糖代谢异常孕妇及胎儿血流动力学参数对妊娠不良结局的预测价值，并分析妊娠不良结局的影响因素。方法 选取晚孕期妊娠期糖代谢异常孕妇109例，按照妊娠结局分为妊娠预后不良组75例和妊娠预后良好组34例。应用彩色多普勒超声分别测量两组胎儿大脑中动脉（MCA）、脐动脉（UA）及孕妇子宫动脉（Ut-A）的血流动力学参数，包括：脐动脉收缩期峰值流速（PSV）、收缩末期血流速度（EDV）、收缩期峰值流速/收缩末期血流速度（S/D） 、阻力指数（RI）及搏动指数（PI）。绘制各血流动力学参数预测妊娠糖代谢异常预后受试者工作特征（ROC）曲线，确定最佳指标及其界值。采用Logistic回归分析妊娠结局相关影响因素。结果 妊娠预后不良组的MCA-PI、MCA-RI、RI比值（MCA/UA）均低于妊娠预后良好组，Ut-A-PI高于妊娠预后良好组，差异均有统计学意义（均P＜0.05）。ROC曲线分析结果表示，当MCA-PI＜1.56，其预测预测妊娠不良结局的敏感性、特异性分别为91.18%、80.00%。Logistic回归分析表示妊娠不良结局的危险因素有：高龄[OR=1.30，95%可信区间（1.107~1.525），P＜0.05]、体质量指数≥24.0 kg/m2[OR=49.549，95%可信区间（1.464~1286.062），P＜0.05]及糖尿病家族史[OR=43.393，95%可信区间（1.464~1286.062），P＜0.05]。保护因素有：有孕期运动[OR=0.068，95%可信区间（0.009~0.522），P＜0.05]、MCA-PI≥1.56[OR=0.113，95%可信区间（0.023~0.558），P＜0.05]、MCA-RI≥0.63[OR=0.072，95%可信区间（0.009~0.581），P＜0.05]及RI比值（MCA/UA）≥0.84[OR=0.034，95%可信区间（0.004~0.332），P＜0.05]。结论 彩色多普勒超声测得MCA-PI＜1.56可作为预测妊娠期糖代谢异常妊娠不良结局的界值。孕妇年龄越大、体质量指数≥24.0 kg/m2及糖尿病家族史为妊娠期糖代谢异常妊娠不良结局的危险因素；有孕期运动、MCA-PI≥1.56、MCA-RI≥0.63及RI比值（MCA/UA）≥0.84为妊娠期糖代谢异常妊娠不良结局的保护因素。 |
| 关键词: 超声检查，多普勒，彩色 妊娠期糖代谢异常 血流动力学参数 妊娠不良结局 ROC曲线 影响因素 |
| DOI： |
| 投稿时间：2017-12-05修订日期：2018-07-04 |
| 基金项目: |
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| Analysis of ROC curve and influencing factors of adverse pregnancy outcomes of gestational impaired glucose metabolism by color DopplerWAN Jie11,MA Lin11,SUN Yuwei11,WANG Yihua11,ZHANG Man1,ZHAO wei2 |
| wanjie,malin |
| () |
| Abstract: |
| Objective Objective to investigate the predictive value of hemodynamic parameters in pregnant women and fetuses with abnormal glucose metabolism during pregnancy, and analyze the influencing factors of adverse pregnancy outcomes.Methods 109 pregnant women with abnormal glucose metabolism during gestational period were selected and divided into 75 cases of poor prognosis group and 34 cases of good prognosis group according to pregnancy outcome. The hemodynamic parameters of the middle cerebral artery (MCA), the umbilical artery (UA) and the uterine artery (Ut-A)of the pregnant women were measured by color Doppler ultrasound. It includes: peak systolic peak velocity of umbilical artery (PSV), end systolic flow velocity (EDV), peak systolic flow velocity / end systolic flow velocity (S/D), resistance index (RI), and pulsatile index (PI). Each hemodynamic parameter was drawn to predict the prognosis characteristics of pregnant women with abnormal glucose metabolism (ROC) curve, and the best index and its boundary value were determined. Logistic regression analysis was used to analyze the related factors of pregnancy outcome.Results The ratio of MCA-PI, MCA-RI and RI (MCA/UA) in poor pregnancy group (MCA/UA) was lower than that of pregnancy with good prognosis, Ut-A-PI was higher than that of good pregnancy group, the difference was statistically significant (P＜0.05). ROC curve analysis showed that when MCA-PI < 1.56 predicted the adverse outcome of pregnancy, the sensitivity and specificity were 91.18% and 80% respectively. Logistic regression analysis showed that there were risk factors for adverse outcome of pregnancy: Advanced age（OR=1.30，95%CI 1.107~1.525，P＜0.05）、Body mass index≥24.0kg/m2（OR=49.549，95%CI 1.464~1286.062，P＜0.05）and Family history of diabetes（OR=43.393，95%CI 1.464~1286.062，P＜0.05）.Protective factors：Pregnancy movemen（OR=0.068，95%CI 0.009~0.522，P＜0.05）、MCA-PI≥1.56（OR=0.113，95%CI 0.023~0.558，P＜0.05）、MCA-RI≥0.63（OR=0.072，95%CI 0.009~0.581，P＜0.05），the ratio RI （MCA/UA ）≥0.84（OR=0.034，95%CI0.004~0.332，P＜0.05）.Conclusion Color Doppler ultrasound measurement of MCA-PI<1.56 can be used to predict the adverse outcome of gestational abnormal glucose metabolism.Maternal age, body mass index greater than 24 kg/m2 and family history of diabetes risk factors for abnormal pregnancy outcome during pregnancy.Pregnancy movemen、MCA-PI > 1.56, MCA-RI > 0.63 and RI ratio (MCA/UA) above 0.84 were protective factors of abnormal pregnancy outcome during gestational period. |
| Key words: ultrasound examination doppler colour gestational impaired glucose metabolism hemodynamic parameters adverse pregnancy outcome ROC curve influence factor |
