赵永峰, 甘国财, 王雪, 赵旭, 马淑梅, 李彩琴, 张成. 彩色多普勒超声参数对高原地区妊娠高血压所致胎儿生长受限的预测价值[J]. 实用临床医药杂志, 2024, 28(20): 112-118. DOI: 10.7619/jcmp.20241944
引用本文: 赵永峰, 甘国财, 王雪, 赵旭, 马淑梅, 李彩琴, 张成. 彩色多普勒超声参数对高原地区妊娠高血压所致胎儿生长受限的预测价值[J]. 实用临床医药杂志, 2024, 28(20): 112-118. DOI: 10.7619/jcmp.20241944
ZHAO Yongfeng, GAN Guocai, WANG Xue, ZHAO Xu, MA Shumei, LI Caiqin, ZHANG Cheng. Predictive value of color Doppler ultrasound parameters for fetal growth restriction induced by gestational hypertension in high-altitude regions[J]. Journal of Clinical Medicine in Practice, 2024, 28(20): 112-118. DOI: 10.7619/jcmp.20241944
Citation: ZHAO Yongfeng, GAN Guocai, WANG Xue, ZHAO Xu, MA Shumei, LI Caiqin, ZHANG Cheng. Predictive value of color Doppler ultrasound parameters for fetal growth restriction induced by gestational hypertension in high-altitude regions[J]. Journal of Clinical Medicine in Practice, 2024, 28(20): 112-118. DOI: 10.7619/jcmp.20241944

彩色多普勒超声参数对高原地区妊娠高血压所致胎儿生长受限的预测价值

Predictive value of color Doppler ultrasound parameters for fetal growth restriction induced by gestational hypertension in high-altitude regions

  • 摘要: 目的 探讨彩色多普勒超声参数对高原地区妊娠高血压所致胎儿生长受限(FGR)的预测价值。方法 选取2020年7月—2022年6月于青海大学附属医院(海拔2 300米,按有无FGR分为A1组19例、A2组51例)、玉树州人民医院(海拔3 700米,按有无FGR分为B1组25例、B2组47例)和北京大学民航临床医学院(平原地区,对照组71例)就诊的妊娠高血压孕妇作为研究对象,各组孕妇均于妊娠28周接受胎儿彩色多普勒超声大脑中动脉(MCA)、脐动脉(UA)血流参数搏动指数(PI)、阻力指数(RI)、收缩期峰值流速与舒张末期流速比值(S/D)、血流最高速度(PSV)及脑-胎盘比(CPR)检测。采用多因素Logistic回归分析探讨妊娠高血压孕妇发生FGR的独立危险因素; 绘制受试者工作特征(ROC)曲线,分析彩色多普勒参数对妊娠高血压孕妇发生FGR的预测价值。结果 A1组、A2组、B1组、B2组孕妇胎儿的UA血流参数PI、RI、S/D、PSV均高于对照组, MCA血流参数PI、RI、S/D、PSV和CPR均低于对照组,差异有统计学意义(P<0.05); 5组中, B1组的UA血流参数PI、RI、S/D、PSV最高, MCA血流参数PI、RI、S/D、PSV和CPR最低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,居住地海拔高、脐带异常均为妊娠高血压孕妇发生FGR的独立危险因素(P<0.05)。ROC曲线分析结果显示,彩色多普勒多参数联合预测海拔2 300米和海拔3 700米高原地区妊娠高血压孕妇发生FGR的曲线下面积分别为0.906和0.917, 预测效能显著高于各参数单独预测(P<0.05)。结论 孕中期彩色多普勒超声UA、MCA血流参数对不同海拔高原地区妊娠高血压所致FGR均具有较好的预测价值,且多参数联合检测的预测效能更高。

     

    Abstract: Objective To investigate the predictive value of color Doppler ultrasound parameters for fetal growth restriction (FGR) induced by hypertensive disorders of pregnancy in high-altitude regions. Methods Pregnant women with gestational hypertension who were treated between July 2020 and June 2022 at the Affiliated Hospital of Qinghai University (with altitude of 2, 300 meters, were divided into group A1 with 19 cases and group A2 with 51 cases according to occurrence of FGR), Yushu People's Hospital (with altitude of 3, 700 meters, were divided into group B1 with 25 cases and group B2 with 47 cases according to occurrence of FGR), and Civil Aviation Clinical Medical College of Peking University (plain region, control group with 71 cases) were enrolled in this study. All pregnant women in each group underwent fetal color Doppler ultrasound examination of the middle cerebral artery (MCA) and umbilical artery (UA) blood flow parameters, including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D), peak systolicvelocity (PSV), and cerebroplacental ratio (CPR) at 28 weeks of gestation were detected. Multivariate Logistic regression analysis was performed to identify independent risk factors for FGR in pregnant women with gestational hypertension. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of color Doppler parametersfor FGR. Results The UA blood flow parameters (PI, RI, S/D, PSV) of the fetuses in groups A1, A2, B1, and B2 were significantly higher than those in the control group, while the MCA blood flow parameters (PI, RI, S/D, PSV) and CPR were significantly lower (P<0.05). Among the five groups, group B1 had the highest UA blood flow parameters (PI, RI, S/D, PSV) and the lowest MCA blood flow parameters (PI, RI, S/D, PSV) and CPR (P<0.05). Multivariate Logistic regression analysis revealed that high altitude of residence and umbilical cord abnormalities were independent risk factors for FGR in pregnant women with gestational hypertension (P<0.05). ROC curve analysis showed that the areas under the curves for the combined prediction of FGR in pregnant women with gestational hypertension at altitudes of 2, 300 meters and 3, 700 meters using color Doppler multi-parameters were 0.906 and 0.917, respectively, indicating a significantly higher predictive performance compared to individual parameter (P<0.05). Conclusion Color Doppler ultrasound parameters of UA and MCA bloodflow during the second trimester of pregnancy demonstrate good predictive value for FGR induced by hypertensive disorders of pregnancy in high-altitude regions at different altitudes, and the predictive performance is even higher when multiple parameters are combined.

     

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