妊娠23~24周三维容积超声预测晚发型胎儿生长受限的应用价值

目的探讨妊娠23~24周三维容积超声部分肢体体积预测晚发型胎儿生长受限(FGR)的应用价值。方法选取在我院行产前检查并于出生后最终确诊为晚发型FGR的产妇74例(病例组),另选同期正常产妇200例为对照组。应用超声测量妊娠23~24周胎儿二维超声参数:双顶径、头围、腹围、股骨长度,记录二维超声参数生成的胎儿体质量(EFW1);应有三维容积超声测量胎儿上臂中段50%的体积(AVol)和大腿中段50%的体积(TVol),EFW1联合AVol或TVol生成EFW2或EFW3。比较两组上述各参数差异;应用受试者工作特征(ROC)曲线分析各个参数预测晚发型FGR的价值。结果两组双顶径、头围、腹围、股骨长度、EFW1、EFW2、EFW3比较差异均无统计学意义;两组AVol和TVol比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,AVol和TVol截断值分别为4.5 ml和9.4 ml,预测晚发型FGR的敏感性、特异性、准确率、曲线下面积分别为63.5%vs.69.4%、89.4%vs.88.1%、81.4%vs.83.2%、0.70 vs.0.74;二者曲线下面积比较差异无统计学意义;二者联合预测晚发型FGR的敏感性、特异性及准确率分别为79.0%、94.8%及90.1%,均较二者单独应用的诊断效能高。结论妊娠23~24周胎儿的AVol和TVol可作为预测晚发型FGR的特征性指标。

Application value of fractional limb volume obtained by three-dimensional volume ultrasound in predicting late-onset fetal growth restriction at 23~24 weeks of gestation

Objective To explore the application value of fractional limb volume obtained by three-dimensional(3 D)ultrasound in predicting late-onset fetal growth restriction(FGR)at 23~24 weeks of gestation.Methods A total of 74 pregnant women diagnosed with late-onset FGR in our hospital were selected as the case group,and 200 normal pregnant women were included as the control group.Measurements were performed at 23~24 weeks of gestation by two-dimensional ultrasound for standard fetal biometry,biparietal diameter,head circumference,abdominal circumference,femur length and ultrasoundestimated fetal weights(EFW1),3 D ultrasound for fractional arm volume on 50%of the humeral diaphysis length(AVol)and fractional thigh volume on 50%of the femoral diaphysis length(TVol),EFW2 or EFW3 were obtained by EFW1 combined with AVol or TVol.The value of the parameters in predicting the late-onset FGR was analyzed by ROC curve.Results There were no significant differences in terms of biparietal diameter,head circumference,abdominal circumference,femur length and EFW1,EFW2,EFW3.There were significant differences in AVol and TVol between the two groups(both P<0.05).ROC curve analysis showed that the area under ROC curve in predicting by AVol and TVol for late-onset FGR were 0.70 and 0.74,respectively,and there was no significant differences between groups.The cut-off values were 4.5 ml and 9.4 ml,respectively.The sensitivity,specificity and accuracy for predicting late-onset FGR of the two groups were 63.5%and 69.4%,89.4%and88.1%,81.4%and 83.2%,respectively.The sensitivity,specificity and accuracy in combined prediction of late-onset FGR were79.0%,94.8%and 90.1%,respectively.Conclusion AVol and TVol can be used as the specific indicators in predicting lateonset FGR at 23~24 weeks of gestation.