目的 探讨脑胎盘率( cerebroplacental ratio,CPR)在胎儿生长受限( fetal growth restriction,FGR))围生结局的预测价值。方法 选取2017-12至2020-02石家庄市第六医院分娩,孕期超声诊断FGR的单胎孕妇118例为研究组,另选取同期非FGR孕妇118例为对照组。通过ROC曲线分析脐动脉(umbilical artery,UA)、大脑中动脉(middle cerebral artery,MCA)、脑胎盘率(cerebral placental rate,CPR)对于FGR的预测价值,并计算曲线下面积(AUC),对比各血流指标诊断FGR的灵敏度、特异度。结果 研究组UA血流指标高于对照组, MCA血流指标低于对照组,CPR＜1.08发生率高于对照组(37.29% vs 1.69%),且差异均有统计学意义(P<0.05);研究组CPR＜1.08预测FGR的灵敏度96%,特异度88%,AUC最大值为0.96,高于UA和MCA各参数。CPR＜1.08组新生儿5 min Apgar评分＜7.0、胎儿窘迫行剖宫产、异常NST、入住NICU、不良围生儿结局发生率均高于对照组,差异均有统计学意义(P<0.05)。结论 CPR可作为FGR不良妊娠结局的重要预测指标。
Abstract
Objective To investigate the ability of the cerebroplacental ratio to help predict the perinatal outcome of fetal growth restriction (FGR). Methods One hundred and eighteen singleton pregnant women who had delivered at Shijiazhuang Sixth Hospital and had been diagnosed with FGR by ultrasonography between December 2017 and February 2020 were selected as the study group, while another 118 non FGR pregnant women during the same period served as the control group. The predictive value of UA、MCA and CPR for FGR was analyzed by the ROC curve. The AUC was calculated. The sensitivity and specificity of each blood flow index in the diagnosis of FGR were compared. CPR＜1.08 was taken as a reference to evaluate the predictive value for the perinatal outcome of FGR. Results The blood flow index of UA in the study group was higher than that of the control group, but that of MCA was lower.There was statistically significant difference between the two groups.The incidence of CPR＜1.08 in the study group was higher than that of the control group. The sensitivity, specificity and maximum of the AUC when CPR was less than 1.08 were 96%, 88%,and 0.96 as far as FGR prediction was concerned. The incidence of adverse perinatal outcomes was higher in pregnant women with CPR＜1.08.In the group of CPR＜1.08,the incidences of five-minute Apgar scores less than 7.0,cesarean section for fetal distress, abnormal NST, admission to NICU and adverse perinatal outcomes were much higher than in the control group. Conclusions CPR is an important index for predicting perinatal outcomes of FGR.
关键词
胎儿生长受限 /
脐动脉 /
大脑中动脉 /
脑胎盘率 /
围生结局
Key words
fetal growth restriction /
umbilical artery /
middle cerebral artery /
cerebral placental rate /
perinatal outcome
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 苗治晶, 怀莹莹,吴 虹,等. 胎儿生长受限预测方法的研究进展[J]. 现代妇产科进展, 2015(4):315-317.
[2] Morales R J, Khalil A, Morlando M, et al. Changes in fetal doppler indices as a marker of failure to reach growth potential at term[J]. Ultrasound Obstet Gynecol. 2014,43(3): 303-310.
[3] 王伽略, 杨 孜. 胎儿生长受限与死胎[J]. 中国实用妇科与产科杂志, 2017,(11):32-36.
[4] Pallotto E K,Kilbride H W. Perinatal outcome and later implications of intrauterine growth restriction[J]. Clinical Ob Gyn, 2006, 49(2):257-269.
[5] 罗晓芳, 漆洪波. 胎儿生长受限的胎盘因素及其临床诊治[J]. 中国实用妇科与产科杂志, 2016,32(4):14-18.
[6] 张 兰, 漆洪波. 英国、美国、加拿大和法国胎儿生长受限指南解读与比较[J]. 中华产科急救电子杂志, 2018, 7(1):35-39.
[7] Mifsud W, Sebire N J. Placental pathology in early-onset and late-onset fetal growth restriction[J]. Fetal Diagn Ther,2014,36(2): 117-28.
[8] 鲍 静. 脑胎盘率诊断胎儿宫内缺氧的研究进展[J]. 医疗装备, 2018, 31(19):203-204.
[9] Vollgraff C A, De Boer M A, Heymans M W, et al. Prognostic accuracy of cerebroplacental ratio and middle cerebral artery doppler for adverse perinatal outcome: systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol,2018. 51(3): 313-322.
[10] Odibo A O, Riddick C, Pare E, et al. Cerebroplacental doppler ratio and adverse perinatal outcomes in intrauterine growth restriction[J]. J Ultrasound Med,2005.24(9):1223-1228.
[11] 黄苑铭,赵贤哲,田湘英,等.胎儿脑-胎盘率对胎儿宫内生长受限临床预后研究[J]中国产前诊断杂志(电子版),2017,9(1): 14-18.
[12] 许桂杰,尚丽新.早发型和晚发型胎儿生长受限相关情况比较[J].武警医学,2017,28(2):120-123.
[13] 张兰珍,勾晨雨,刘晓岚.脑胎盘率对预测胎儿生长受限的作用[J].中华产科急救电子杂志,2019,8(1):45-49.
[14] Prior T,Mullins E,Bennett P,et al. Prediction of intrapartum fetal compromise using the cerebroumbilical ratio:a prospective observational study[J]. Am J Obstet Gynecol,2013, 208(2): e1-6.
[15] Arabin B, Goerges J, Bilardo C M. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses[J]. Am J Obstet Gynecol,2016,214(2): 298-299.
基金
河北省医学科学研究重点课题—青年科技课题(201901572)
PDF(699 KB)
