四维彩色多普勒超声联合唐氏筛查诊断胎儿生长受限的临床价值

Clinical value of four-dimensional color Doppler ultrasound combined with Down's syndrome screening in the diagnosis of fetal growth restriction

摘要:

目的 探讨四维彩色多普勒超声联合唐氏筛查诊断胎儿生长受限（FGR）的临床价值。方法 选取2020年5月—2021年5月东莞市人民医院诊断为FGR的60例孕妇作为FGR组，另选取同期60例来该院孕检的正常妊娠孕妇作为对照组。对比两组四维彩色多普勒超声胎盘血管指数［血管化指数（VI）、血流指数（FI）及血管化-血流指数（VFI）］、唐氏筛查指标［游离雌三醇（uE₃）、甲胎蛋白（AFP）、游离β-绒毛膜促性腺激素（β-hCG）］，分析胎盘血管指数与唐筛血清相关指标的相关性，并绘制受试者工作特征（ROC）曲线，分析VI、FI、VFI、uE₃、AFP及β-hCG预测FGR的价值。结果 FGR组VI、FI和VFI较对照组低（P <0.05）。FGR组uE₃水平较对照组低，AFP、β-hCG水平较对照组高（P <0.05）。Pearson相关性分析显示，VI、FI及VFI与uE₃呈正相关（r =0.294、0.370和0.324，均P <0.05），VI、FI及VFI与AFP呈负相关（r =-0.317、-0.308 和-0.312，均P <0.05）、VI、FI及VFI与β-hCG呈负相关（r =-0.237、-0.298 和 -0.338，均P <0.05）。ROC曲线显示，VI的AUC、敏感性、特异性分别为0.689（95% CI：0.590，0.788）、0.702（95% CI：0.611，0.832）、0.722（95% CI：0.632，0.852），FI分别为0.682（95% CI：0.581、0.893）、0.693（95% CI：0.595，0.790）、0.714（95% CI：0.621，0.839），VFI分别为0.687（95% CI：0.587、0.786）、0.699（95% CI：0.602，0.796）、0.720（95% CI：0.625，0.846），uE₃分别为0.696（95% CI：0.597、0.795）、0.711（95% CI：0.623，0.835）、0.731（95% CI：0.635，0.867），AFP分别为0.677（95% CI：0.581、0.772）、0.682（95% CI：0.587，0.779）、0.705（95% CI：0.621，0.825），β-hCG分别为0.644（95% CI：0.542、0.746）、0.679（95% CI：0.576，0.752）、0.693（95% CI：0.592，0.792），联合诊断分别为0.767（95% CI：0.678、0.855）、0.826（95% CI：0.753，0.907）、0.869（95% CI：0.796，0.952）。结论 四维彩色多普勒超声胎盘血管指数、唐筛指标与FGR的发生密切相关，两者联合可有效预测FGR的发生。

Abstract:

Objective To explore the clinical value of four-dimensional color Doppler ultrasound combined with Down's syndrome screening in the diagnosis of fetal growth restriction (FGR).Methods Sixty pregnant women diagnosed with the condition of FGR in Dongguan People's Hospital from May 2020 to May 2021 were selected as FGR group, and another 60 healthy pregnant women undergoing pregnancy check-ups in the hospital during the same period were selected as the control group. The placental vascular indices [vascularization index (VI), flow index (FI) and vascularization flow index (VFI)] measured via four-dimensional color Doppler ultrasound and the serum indicators for the Down's syndrome screening [unconjugated estriol (uE3), alpha-fetoprotein (AFP) and human chorionic gonadotropin beta subunit (β-hCG)] were compared between the two groups. The correlations between placental vascular indices and serum indicators for the Down's syndrome screening were analyzed. The receiver operating characteristic (ROC) curves were plotted to determine the predictive values of VI, FI, VFI, uE3, AFP and β-hCG for the occurrence of FGR.Results The VI, FI, and VFI were lower in the FGR group than those in the control group (P < 0.05). The serum level of uE3 was lower, but serum levels of AFP and β-hCG were higher in the FGR group compared with the control group (P < 0.05). Pearson correlation analysis showed that VI, FI and VFI were positively correlated with the serum level of uE3 (r = 0.381, 0.512 and 0.509, all P < 0.05), but were negatively correlated with serum levels of AFP (r = -0.365, -0.458 and -0.331, all P < 0.05) and β-hCG (r = -0.312, -0.415 and -0.302, all P < 0.05). The ROC curve analysis showed that the area under the ROC curve (AUC), sensitivity, and specificity of VI for diagnosing FGR were 0.689 (95% CI: 0.590, 0.788), 0.702 (95% CI: 0.611, 0.832), and 0.722 (95% CI: 0.632, 0.852), those of FI for diagnosing FGR were 0.682 (95% CI: 0.581, 0.893), 0.693 (95% CI: 0.595, 0.790), and 0.714 (95% CI: 0.621, 0.839), those of VFI for diagnosing FGR were 0.687 (95% CI: 0.587, 0.786), 0.699 (95% CI: 0.602, 0.796), and 0.720 (95% CI: 0.625, 0.846), those of uE3 for diagnosing FGR were 0.696 (95% CI: 0.597, 0.795), 0.711 (95% CI: 0.623, 0.835), and 0.731 (95% CI: 0.635, 0.867), those of AFP for diagnosing FGR were 0.677 (95% CI: 0.581, 0.772), 0.682 (95% CI: 0.587, 0.779), and 0.705 (95% CI: 0.621, 0.825), those of β-hCG for diagnosing FGR were 0.644 (95% CI: 0.542, 0.746), 0.679 (95% CI: 0.576, 0.752) and 0.693 (95% CI: 0.592, 0.792), and those of their combination for diagnosing FGR were 0.767 (95% CI: 0.678, 0.855), 0.826 (95% CI: 0.753, 0.907), and 0.869 (95% CI: 0.796, 0.952).Conclusions The placental vascular indices measured via four-dimensional color Doppler ultrasound and serum indicators for the Down's syndrome screening are closely related to the occurrence of FGR, and the combination of them can effectively predict the occurrence of FGR.