2023 年第 12 期 第 18 卷

超声脐血流参数联合孕妇血清学指标在胎儿生长受限辅助诊断中的价值探讨

The value exploration of ultrasound umbilical blood flow parameters combined with maternal serological indicators in the auxiliary diagnosis of fetal growth restriction

作者：刘阳1田秋阁2刘嘉琳3李佼阳1李真1朱月1

英文作者：Liu Yang1 Tian Qiuge2 Liu Jialin3 Li Jiaoyang1 Li Zhen1 Zhu Yue1

单位：1河北省沧州市中心医院产科，沧州061000；2河北省任丘市人民医院妇产科，任丘062550；3河北省沧州市中心医院神经电生理科，沧州061000

英文单位：1Department of Obstetrics Cangzhou Central Hospital Hebei Province Cangzhou 061000 China; 2Department of Obstetrics and Gynecology Renqiu People′s Hospital Hebei Province Renqiu 062550 China; 3Department of Neuroelectrophysiology Cangzhou Central Hospital Hebei Province Cangzhou 061000 China

关键词：胎儿生长受限；超声脐血流参数；血管内皮生长因子；胎盘生长因子；可溶性Fms样酪氨酸激酶1

英文关键词：Fetalgrowthrestriction;Ultrasoundumbilicalbloodflowparameters;Vascularendothelialgrowthfactor;Placentalgrowthfactor;SolubleFms-liketyrosinekinase1

• 摘要：

• 目的  探讨超声脐血流参数［脐动脉阻力指数、脐动脉搏动指数及脐静脉心室收缩期峰值血流速度与最大心房收缩期回流速度比值（S/a）］联合孕妇血清学指标［血管内皮生长因子（VEGF）、胎盘生长因子（PLGF）、可溶性Fms样酪氨酸激酶1（sFLT-1）］对胎儿生长受限（FGR）的辅助诊断价值。方法  选择2019年1月至2020年12月于河北省沧州市中心医院诊断为FGR的孕妇68例作为FGR组，选择同期正常妊娠单胎孕妇70例作为对照组。超声检查脐动脉阻力指数、脐动脉搏动指数及脐静脉S/a，酶联免疫吸附试验法检测血清VEGF、PLGF、sFLT-1水平并行组间比较，受试者工作特征曲线分析超声脐血流参数及VEGF、PLGF、sFLT-1对FGR的辅助诊断价值，Logistic回归方法分析FGR的影响因素。结果  FGR组脐带血流异常比例显著高于对照组，差异有统计学意义（P＜0.05）。FGR组脐动脉阻力指数、脐动脉搏动指数及脐静脉S/a显著高于对照组，差异均有统计学意义［（0.84±0.15）比（0.60±0.07）、（1.21±0.18）比（0.95±0.15）、（2.7±0.5）比（2.0±0.6）］（t=12.100、9.229、7.645，均P＜0.001）。脐动脉阻力指数、脐动脉搏动指数、脐静脉S/a联合血清VEGF、PLGF和sFLT-1辅助诊断FGR的敏感度为89.71%，特异度为94.29%，曲线下面积为0.979，诊断效能显著高于各指标单独检测（Z=4.512、4.184、4.682、4.808、4.740、3.929，均P＜0.05）。多因素Logistic回归分析结果显示，脐带血流异常、sFLT-1是FGR发生的危险因素，VEGF、PLGF是FGR发生的保护因素（均P＜0.05）。结论  超声脐血流参数脐动脉阻力指数、脐动脉搏动指数、脐静脉S/a及孕妇血清sFLT-1水平升高，血清VEGF、PLGF水平降低与FGR有关，其联合检测对FGR具有较高辅助诊断价值。

• Objective To investigate the value of ultrasound umbilical blood flow parameters［umbilical artery resistance index(RI), umbilical artery pulsation index(PI) and ratio of umbilical vein peak systolic blood flow velocity to maximum atrial systolic reflux velocity(S/a)］ combined with maternal serological indicators ［vascular endothelial growth factor(VEGF), placental growth factor(PLGF) and soluble Fms-like tyrosine kinase 1 (sFLT-1)］ in the auxiliary diagnosis of fetal growth restriction(FGR). Methods From January 2019 to December 2020 in Cangzhou Central Hospital, Hebei Province, 68 pregnant women diagnosed with FGR were regarded as FGR group, and 70 singleton pregnant women with normal pregnancy during the same period were regarded as the control group. Ultrasound was used to examine umbilical artery RI, umbilical artery PI and umbilical vein S/a. Enzyme linked immunosorbent assay method was applied to detect serum VEGF, PLGF, sFLT-1 levels. Receiver operating characteristic curve was used to analyze the diagnostic value of umbilical artery RI, umbilical artery PI, umbilical vein S/a, VEGF, PLGF and sFLT-1 in FGR. Logistic regression was used to analyze the influencing factors of FGR. Results  The abnormal rate of umbilical cord blood flow in FGR group was significantly higher than that in control group(P<0.05). The umbilical artery RI, umbilical artery PI, and umbilical vein S/a in the FGR group were significantly higher than those in the control group［(0.84±0.15) vs (0.60±0.07), (1.21±0.18) vs (0.95±0.15), (2.7±0.5) vs (2.0±0.6)］(t=12.100, 9.229, 7.645, all P<0.001). The sensitivity and specificity of umbilical artery RI, umbilical artery PI and umbilical vein S/a combined with serum VEGF, PLGF and sFLT-1 in the auxiliary diagnosis of FGR were 89.71% and 94.29%, and the area under the curve was 0.979; the diagnostic efficacy was significantly higher than that of RI, PI, umbilical vein S/a and serum VEGF, PLGF and sFLT-1 alone(Z=4.512, 4.184, 4.682, 4.808, 4.740, 3.929, all P<0.05). Multivariate Logistic regression analysis showed that abnormal umbilical cord blood flow and sFLT-1 were risk factors for FGR, and VEGF and PLGF were protective factors for FGR(all P<0.05). Conclusions  Ultrasound umbilical blood flow parameters umbilical artery RI, umbilical artery PI, umbilical vein S/a and pregnant women′s serum sFLT-1 levels increase, while serum VEGF and PLGF levels decrease, which are related to FGR. Their combined detection has high auxiliary diagnostic value for FGR.