| 摘要: |
| 目的：探讨胎儿肾上腺动脉彩色多普勒血流参数与分娩发动时间的相关性。
方法：研究对象为在孕39周行肾上腺动脉彩色多普勒测量且随访至分娩结局的200例初产妇。孕41周后发动分娩或仍未发动分娩而行人工干预的孕妇作为分娩发动延迟组; 41周前自然发动分娩的孕妇作为对照组。比较两组胎儿肾上腺动脉搏动指数（pulsatility index， PI）、阻力指数（resistance index，RI）和收缩/舒张比值（systole/diastole，S/D），并建立受试者工作特征（receiver operating characteristic, ROC）曲线评价肾上腺动脉参数用于预测分娩发动延迟的诊断效能。
结果：177例初产妇成功测量胎儿肾上腺动脉血流参数，成功率为88.5%（177/200），其中分娩发动延迟组53例，对照组124例。分娩发动延迟组肾上腺动脉PI平均（1.89±1.1）、RI平均（0.81±0.19）；对照组肾上腺动脉PI平均（1.47±0.38）、平均（0.72±0.09），二组差异均有统计学意义（P＜0.05）。肾上腺动脉PI预测分娩发动延迟的ROC曲线下面积为0.665（95%CI：0.511-0.820，P=0.039），RI的ROC曲线下面积为0.679（95%CI：0.533-0.825，P=0.022）。PI和RI预测分娩发动延迟的最佳临界值分别为1.65和0.78，其敏感性、特异性、PPV、NPV及正确性分别为71.1%、70.6%、86.5%、48.0%、71.0%和61.5%、77.8%、66.7%、73.7%、71.0%。
结论：胎儿肾上腺动脉彩色多普勒血流参数与分娩发动时间有一定相关性，分娩发动延迟的胎儿肾上腺动脉PI、RI高于正常时间发动分娩胎儿，肾上腺动脉血流参数有可能作为预测分娩发动延迟的指标。 |
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| DOI： |
| 投稿时间：2018-10-20修订日期：2018-11-07 |
| 基金项目:江苏省卫计委妇幼健康科研项目(F201567)；无锡市卫计委科教强卫工程青年人才(QNRC069) |
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| Ultrasound doppler velocimetry in fetal adrenal artery for predicting initiation of parturition in pregnant women |
| Lu Hai-lan,ding yan |
| () |
| Abstract: |
| Objective To evaluate the correlation between fetal adrenal artery Doppler velocimetry parameters and onset time of labor. Methods The objects were those who underwent Doppler velocimetry ultrasound during 39 weeks of pregnancy with followed-up labor outcomes. The objects without spontaneous delivery and need artificial intervention till after 41 weeks were considered as prolonged pregnancy. The objects without spontaneous delivery before 41 weeks were considered as control. The pulsatility index (PI), resistance index (RI) and systole/diastole (S/D) of fetal adrenal between two groups were compared. ROC curve was established to evaluate the efficiency of adrenal artery Doppler velocimetry parameters to predict prolonged pregnancy. Results The adrenal artery Doppler velocimetry parameters were successfully measured in 177 pregnant women, the success rate was 88.5% (177/200). Among them there were 53 pregnant women in the prolonged pregnancy group and 124 pregnant women in the control group. The mean PI and RI of the fetal adrenal artery in prolonged pregnancy group were 1.89±1.1 and 0.81±0.19, respectively. The mean PI and RI of the fetal adrenal artery in control group were 1.47±0.38 and 0.72±0.09, respectively. There were statistically significant difference of PI and RI between the prolonged pregnancy and control group (P＜0.05). The area under the curve (ACU) of the PI in prolonged pregnancy group was 0.665 (95%CI: 0.511-0.820, P=0.039) and the RI was 0.679 (95%CI: 0.533-0.825, P=0.022). The best cutoff values of PI and RI for predicting prolonged pregnancy were 1.65 and 0.78, respectively. The sensitivity, specificity, PPV, NPV and accuracy of PI and RI were 71.1%、70.6%、86.5%、48.0%、71.0% and 61.5%、77.8%、66.7%、73.7%、71.0%, respectively. Conclusion Fetal adrenal artery Doppler velocimetry is associated with onset time of labor. The PI and RI in prolonged pregnancy women are higher than that of control group, the fetal adrenal artery Doppler velocimetry can be used to predict the prolonged pregnancy. |
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