| 摘要: |
| 目的：探讨彩色多普勒超声定量参数预测胎儿生长受限(FGR)的应用价值,并构建定量列线图模型以指导临床应用。方法：前瞻性选择2019年03月至2022年03月于我院分娩的单胎孕妇共140例为研究对象,孕妇年龄21~44岁,分娩孕周28~40周。根据胎儿出生体重小于对应孕周第10百分位将其分为FGR组40例和无FGR组100例。采用彩色多普勒超声定量检测胎儿脐动脉 (UA)、大脑中动脉(MCA)和静脉导管(DV)的血流参数。结果：FGR组孕妇妊娠期并发症和剖宫产比无FGR组增多,分娩孕周减小,UA搏动指数(UA-PI)、阻力指数(UA-RI)、收缩期最大血流速度/舒张末期血流速度(UA-S/D)增加,UA舒张期缺失或者倒置增多,而MCA-PI、MCA-RI、MCA-S/D、DV-心房收缩谷流速(DV-a)和心室收缩峰流速(DV-S)降低,差异均有统计学意义(P＜0.05)。多因素Logistic回归分析显示,孕妇妊娠期并发症(OR=5.659,95%CI=4.235~6.675,P＜0.001)、分娩孕周＜37周(OR=5.001,95%CI=3.657~6.123,P＜0.001)、UA-PI≥第95百分位(OR=3.527,95%CI=2.532~5.021,P=0.001)、UA舒张期缺失或者倒置(OR=3.321,95%CI=2.127~4.528,P=0.006)和MCA-PI＜第5百分位(OR=2.857,95%CI=1.965~3.635,P=0.011)是影响FGR发生的独立危险因素。R软件建立定量列线图模型,总分220分。受试者工作曲线(ROC)显示,列线图预测FGR的曲线下面积(AUC)为0.876。结论：彩色多普勒超声是筛查和诊断FGR的首选方法,孕妇妊娠期并发症、分娩孕周＜37周、UA-PI≥第95百分位、UA舒张期缺失或者倒置和MCA-PI＜第5百分位是影响FGR发生的独立危险因素。通过建立定量列线图模型能够指导临床早期识别FGR高危患儿并辅助诊断,有重要的应用价值。 |
| 关键词: 胎儿生长受限 彩色多普勒超声 列线图 大脑中动脉 静脉导管 |
| DOI： |
| 投稿时间：2022-06-20修订日期：2022-07-14 |
| 基金项目:2018年国家自然科学(81870240);2020年江宁区第四批科技发展计划惠民计划项目(2020SHSY0099) |
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| A nomogram model for predicting fetal growth restriction with quantitative parameters by color Doppler ultrasound |
| LI Ling,ZHANG Wenqin,ZHANG Panpan |
| (Department of Ultrasound Diagnosis,Jiangning Hospital Affiliated to Nanjing Medical University;Jiangsu,China;Department of Obstetrics,Jiangning Hospital Affiliated to Nanjing Medical University;Jiangsu,China;School of Basic Medicine,Nanjing Medical University;Jiangsu,China) |
| Abstract: |
| Objective: To explore the value of quantitative parameters through color Doppler ultrasound for predicting fetal growth restriction (FGR), and construct a quantitative nomogram model to guide clinical application. Methods: A total of 140 singleton pregnant women delivering in our hospital from March 2019 to March 2022 were prospectively selected as the research objects,the pregnant women were 21~ 44 years old and delivery weeks were 28 ~ 40 weeks. According to the fetal birth weight less than the 10th percentile of the corresponding gestational week, they were divided into FGR group(n=40)and non-FGR group(n=100). The blood flow parameters of fetal umbilical artery (UA), middle cerebral artery (MCA) and ductus venous (DV) were measured quantitatively by color Doppler ultrasound. Results: The pregnant complications and cesarean section in FGR group were higher than those in non-FGR group, delivery weeks was less, UA pulsatility index (UA-PI), resistance index (UA-RI), maximum systolic blood flow velocity/end diastolic blood flow velocity (UA-S/D) were higher, UA diastolic loss or inversion was more, while MCA-PI,MCA-RI,MCA-S/D, DV atrial systolic valley velocity (DV-a) and ventricular peak systolic velocity (DV-S) were less, too(P < 0.05). Multivariate Logistic regression showed that pregnant complications(OR = 5.659,95% CI = 4.235 ~ 6.675, P < 0.001), delivery weeks < 37 weeks (OR= 5.001,95% CI = 3.657 ~ 6.123, P < 0.001), UA-PI≥95th percentile (OR= 3.527,95% CI = 2.532 ~ 5.021, P = 0.001),UA diastolic loss or inversion (OR= 3.321,95% CI = 2.127 ~ 4.528, P = 0.006) and MCA-PI< 5th percentile (OR= 2.857,95% CI = 1.965 ~ 3.635, P = 0.011) were the independent risk factors to FGR. R software was used to establish the quantitative nomogram model and total score was 220. Receiver operating curve (ROC) showed that the area under the curve (AUC) of nomogram for predicting FGR was 0.876. Conclusion: Color Doppler ultrasound is the first choice for screening and diagnosis FGR,pregnant complications, delivery weeks < 37 weeks, UA-PI≥ 95th percentile, UA diastolic loss or inversion and MCA-PI < 5th percentile are independent risk factors for FGR. The establishment of quantitative nomogram model could guide early clinical identification of high-risk FGR and assist diagnosis, which has important application value. |
| Key words: Fetal growth restriction Color Doppler ultrasound Nomograph Middle cerebral artery Ductus venous |
