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| 妊娠期糖尿病患者血清FE3、ADP及胎儿AOI血流参数预测胎儿窘迫的效能分析 |
| 陈立秀,何静 |
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| (重庆市红十字会医院;重庆市第十三人民医院) |
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| 摘要: |
| 目的 探讨妊娠期糖尿病(GDM)血清游离雌三醇(FE3)、脂联素(ADP)及胎儿主动脉峡部(AOI)参数预测并发胎儿窘迫(FD)的效能。方法 回顾2019年1月至2020年10月150例GDM患者临床资料,依据是否发生FD分为FD组(37例)与非FD组(113例),另选取同期正常妊娠者75例,设为对照组。比较三组患者血清FE3、ADP及AOI参数(IFI、ISI)的差异,应用Pearson相关性分析FE3、ADP、IFI、ISI的关系,建立受试者工作特征(ROC)曲线,探究FE3、ADP、IFI、ISI及四项联合预测GDM并发FD的价值。结果 FD组FE3、ADP、IFI均明显低于非FD组与对照组,ISI明显高于非FD组与对照组,差异均具有统计学意义(均P<0.05)；非FD组FE3、ADP、IFI均明显低于对照组,ISI明显高于对照组,差异均具有统计学意义(均P<0.05)。Pearson结果显示,血清FE3与ADP(r=0.571,P<0.001)、IFI(r=0.648,P<0.001)呈显著正相关关系,与ISI呈显著负相关关系(r=-0.629,P<0.001)。ADP与IFI呈显著正相关关系(r=0.625,P<0.001),与ISI呈显著负相关关系(r=-0.539,P<0.001)。IFI与ISI呈显著负相关关系(r=-0.648,P<0.001)。ROC曲线分析显示,FE3、ADP、IFI、ISI及四项联合预测GDM并发FD的曲线下面积AUC分别为0.681、0.793、0.727、0.669、0.863。成对法Z检验结果显示,ADP的AUC均明显高于FE3、ISI(均P<0.05),四项联合的AUC均明显高于FE3、IFI、ISI(均P<0.05)。当取cut-off值时,FE3、ADP、IFI、ISI及四项联合的敏感度分别为90.3%、56.6%、90.2%、90.3%、85.8%；特异度分别为43.2%、91.9%、51.4%、37.8%、86.5%。结论 GDM并发FD患者血清FE3、ADP及胎儿IFI明显降低,胎儿ISI升高,监测FE3、ADP及胎儿IFI、ISI水平变化或可预测GDM并发FD。【关键词】妊娠期糖尿病；胎儿窘迫；游离雌三醇；脂联素；胎儿主动脉峡部参数 |
| 关键词: |
| DOI： |
| 投稿时间：2022-05-20修订日期：2023-01-10 |
| 基金项目: |
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| Analysis of the efficacy of serum FE3, ADP and fetal AOI blood flow parameters in predicting fetal distress in patients with gestational diabetes |
| Chen Lixiu,He Jing |
| () |
| Abstract: |
| Objective To explore the efficacy of serum free estriol (FE3), adiponectin (ADP) and fetal aortic isthmus (AOI) parameters in predicting complications of fetal distress (FD) in gestational diabetes (GDM). Methods The clinical data of 150 patients with GDM from January 2019 to October 2020 were reviewed. According to whether FD occurred, they were divided into FD group (37 cases) and non-FD group (113 cases). In addition, 75 cases of normal pregnancy in the same period were selected as Control group. Compare the differences in serum FE3, ADP and AOI parameters (IFI, ISI) of the three groups of patients, apply Pearson correlation to analyze the relationship between FE3, ADP, IFI, ISI, establish receiver operating characteristics (ROC) curves, and explore FE3, ADP, IFI, ISI and the four joint forecasts of the value of GDM concurrent FD. Results FE3, ADP, IFI of the FD group were significantly lower than those of the non-FD group and the control group, and ISI was significantly higher than that of the non-FD group and the control group. The differences were statistically significant (all P<0.05); the non-FD group FE3, ADP, IFI was significantly lower than the control group, ISI was significantly higher than the control group, the difference was statistically significant (all P<0.05). Pearson results showed that serum FE3 was significantly positively correlated with ADP (r=0.571, P<0.001), IFI (r=0.648, P<0.001), and significantly negatively correlated with ISI (r=-0.629, P<0.001) ). ADP was significantly positively correlated with IFI (r=0.625, P<0.001), and significantly negatively correlated with ISI (r=-0.539, P<0.001). There was a significant negative correlation between IFI and ISI (r=-0.648, P<0.001). ROC curve analysis shows that the area under the curve AUC of FE3, ADP, IFI, ISI and the four joint predictions of GDM concurrent FD are 0.681, 0.793, 0.727, 0.669, 0.863, respectively. The pairwise Z test results showed that the AUC of ADP was significantly higher than FE3, ISI (all P<0.05), and the four combined AUC were significantly higher than FE3, IFI, ISI (all P<0.05). When the cut-off value is taken, the sensitivities of FE3, ADP, IFI, ISI, and the combination of the four are 90.3%, 56.6%, 90.2%, 90.3%, and 85.8%, respectively; the specificity is 43.2%, 91.9%, and 51.4, respectively %, 37.8%, 86.5%. Conclusion Serum FE3, ADP, and fetal IFI in patients with GDM complicated by FD are significantly reduced, and fetal ISI is increased. Monitoring the changes in FE3, ADP, and fetal IFI and ISI levels may predict GDM complicated by FD. |
| Key words: gestational diabetes fetal distress free estriol adiponectin fetal aortic isthmus parameters |
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