改良胎儿生物物理评分联合无应激试验及胎儿血流频谱对胎儿宫内窘迫诊断的临床价值

Clinical value of modified fetal biophysical profile score combined with non-stress test and fetal blood flow spectrum in the diagnosis of intrauterine fetal distress

摘要:

目的 探讨改良胎儿生物物理评分（BPS）、无应激试验（NST）及胎儿血流频谱检测的联合应用对胎儿宫内窘迫诊断的临床价值。方法 选取2020年1月—2023年12月江油市人民医院因自觉“胎动减少”就诊的157例单胎妊娠孕妇作为研究对象。受试者均接受改良BPS、NST及彩色多普勒超声检测胎儿脐动脉（UA）和大脑中动脉（MCA）血流频谱，包括收缩期与舒张期血流速度比值（S/D）、搏动指数（PI）及阻力指数，并计算MCA-PI/UA-PI。以新生儿出生后1 min Apgar评分≤7分为胎儿宫内窘迫的诊断标准，将入组新生儿分为宫内窘迫组（22例）与宫内非窘迫组（135例）。绘制受试者工作特征（ROC）曲线分析各项指标及联合检测的诊断效能。结果 共纳入的157例孕妇中确诊胎儿宫内窘迫22例（14.01%）。在改良BPS各指标中，窘迫组胎动、肌张力及羊水量评分均低于非窘迫组（P <0.05），而两组呼吸样运动评分比较，差异无统计学意义（P >0.05）。窘迫组改良BPS和MCA-PI/UA-PI均低于非窘迫组（P <0.05），而UA-S/D高于非窘迫组（P <0.05）。与非窘迫组比较，宫内窘迫组NST分类较高（P <0.05）。ROC曲线分析结果表明：NST的敏感性为77.3%、特异性为63.0%；改良BPS的敏感性为72.7%、特异性为88.9%；UA-S/D的敏感性为81.8%、特异性为84.4%；MCA-PI/UA-PI的敏感性为86.4%、特异性为90.4%；NST的敏感性为77.3%、特异性为63.0%。改良BPS联合NST的敏感性为90.9%、特异性为75.6%；改良BPS联合MCA-PI/UA-PI的敏感性为86.4%、特异性为87.4%；改良BPS联合UA-S/D的敏感性为81.8%、特异性为88.9%；UA-S/D联合MCA-PI/UA-PI的敏感性为81.8%、特异性为92.6%；单一检测中，MCA-PI/UA-PI表现出良好的敏感性和特异性。联合检测中，改良BPS联合NST在敏感性方面表现突出，而UA-S/D联合MCA-PI/UA-PI则表现出较好的特异性。结论 改良BPS、UA-S/D、MCA-PI/UA-PI及NST对胎儿宫内窘迫均具诊断价值，联合诊断有进一步提升效能的潜力，且各项指标在敏感性和特异性上各有特点，临床可根据侧重避免漏诊或控制误诊的不同需求进行选择。

Abstract:

Objective To explore the clinical value of the combined application of modified fetal biophysical profile score (BPS), non-stress test (NST), and fetal blood flow spectrum detection in the diagnosis of intrauterine fetal distress.Methods A total of 157 singleton pregnant women who visited the hospital due to self-reported "decreased fetal movement" from January 2020 to December 2023 were selected as the research objects. All subjects underwent modified BPS, NST, and color Doppler ultrasound to detect the blood flow spectra of fetal umbilical artery (UA) and middle cerebral artery (MCA), including systolic/diastolic ratio (S/D), pulsatility index (PI), resistance index (RI), and the MCA-PI/UA-PI ratio was calculated. According to the diagnostic criterion of a 1-minute Apgar score ≤ 7, the enrolled neonates were divided into a fetal distress group (22 cases) and a non-fetal distress group (135 cases). The diagnostic efficacy of each index and combined detection was analyzed by receiver operating characteristic (ROC) curve.Results This study included 157 pregnant women, of whom 22 (14.01%) were diagnosed with fetal intrauterine distress. Among the indicators of the modified BPS, the scores for fetal movement, muscle tone, and amniotic fluid volume in the distress group were lower than those in the non-distress group (P < 0.05), whereas there was no statistically significant difference in the score for fetal breathing movements between the two groups (P > 0.05). Compared with the non-distress group, the distress group showed significantly lower values in modified BPS, MCA-PI/ UA-PI (P < 0.05), while demonstrating a significantly higher UA-S/D (P < 0.05). Additionally, the distress group was associated with a significantly higher NST classification (P < 0.05). In comparison to the non-distress group, the distress group showed significantly lower values for modified BPS and MCA-PI/UA-PI, while UA-S/D was significantly higher (P < 0.05). Additionally, the distress group exhibited a higher NST classification compared to the non-distress group (P < 0.05). ROC curve analysis revealed that among the single detection indicators, NST had a sensitivity of 77.3% and specificity of 63.0%; modified BPS had a sensitivity of 72.7% and specificity of 88.9%; UA-S/D had a sensitivity of 81.8% and specificity of 84.4%; and MCA-PI/UA-PI had a sensitivity of 86.4% and specificity of 90.4%. Among the combined detection strategies, modified BPS combined with NST achieved a sensitivity of 90.9% and specificity of 75.6%; modified BPS combined with MCA-PI/UA-PI yielded a sensitivity of 86.4% and specificity of 87.4%; modified BPS combined with UA-S/D showed a sensitivity of 81.8% and specificity of 88.9%; and UA-S/D combined with MCA-PI/UA-PI demonstrated a sensitivity of 81.8% and specificity of 92.6%. Among the single detection indicators, MCA-PI/UA-PI demonstrated favorable sensitivity and specificity. In combined detection, the combination of modified BPS and NST performed notably well in sensitivity, while UA-S/D combined with MCA-PI/UA-PI demonstrated relatively high specificity.Conclusion The modified BPS, UA-S/D, MCA-PI/UA-PI, NST and combined all have diagnostic value for fetal intrauterine distress. Combined diagnosis shows potential to further improve diagnostic performance. Different combinations show different characteristics in sensitivity and specificity, allowing clinicians to choose an appropriate strategy based on the need to either minimize missed diagnoses or control misdiagnoses.