国际妇产科学杂志

国际妇产科学杂志 ›› 2018, Vol. 45 ›› Issue (6): 696-699.

• 论著 • 上一篇    下一篇

早中孕期联合筛查对胎儿生长受限的风险评估与预测

钟海燕，罗文斌#，王冬菊，肖小敏   

  1. 510630  广州，暨南大学附属第一医院妇产科
  • 收稿日期:2018-05-22 修回日期:2018-08-26 出版日期:2018-12-15 发布日期:2018-12-15
  • 通讯作者: 肖小敏，E-mail：xiaoseminar@163.com E-mail:978828610@qq.com
  • 基金资助:
    广东省中医药局科研课题（34015011）

Risk Assessment and Prediction of Combined Screening for Fetal Growth Restriction in Early and Mid Pregnancy

ZHONG Hai-yan，LUO Wen-bin，WANG Dong-ju，XIAO Xiao-min   

  1. Department of Gynecology and Obstetrics，Jinan University First Affiliated Hospital，Guangzhou 510630，China
  • Received:2018-05-22 Revised:2018-08-26 Published:2018-12-15 Online:2018-12-15
  • Contact: XIAO Xiao-min，E-mail：xiaoseminar@163.com E-mail:978828610@qq.com

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摘要： 目的：通过早中孕期联合筛查建立数学模型，探讨不同模型对胎儿生长受限（FGR）的风险评估与预测价值。方法：选取2010年1月—2015年12月于暨南大学第一附属医院行孕早期联合筛查及孕中期四维彩超并纳入标准的2 621例孕妇，最终确诊为FGR者49例（1.87%）。收集孕妇年龄、孕前体质量指数（BMI），孕早期联合筛查的游离人绒毛膜促性腺激素β亚单位（β-hCG）和妊娠相关蛋白A（PAPP-A），子宫动脉搏动指数（UtA PI）和大脑中动脉压（MAP），颈项透明层（NT），孕中期胎儿双顶径（BPD）、头围（HC）、腹围（AC）和股骨长（FL），并同时将NT、UtA PI、MAP、BPD、HC、AC及FL采用中位数倍数（MoM）表示。以原始所有参数组合为A组，β-hCG、PAPP-A、UtA PI、MAP转化为MoM后与剩余参数组合为B组，β-hCG、PAPP-A、UtA PI、MAP、NT、BPD、HC、AC及FL均转化为MoM后与剩余参数组合为C组，分别将3组数据采用Logistic逐步回归分析方法建立FGR预测模型，并进一步采用受试者工作特征曲线（ROC曲线）分析，比较各模型的敏感度和特异度。结果：ROC曲线结果显示，3组回归模型ROC曲线下的面积（AUC）分别为0.69（95%CI：0.61～0.76）、0.69（95%CI：0.61～0.77）和0.71（95%CI：0.64～0.78），在假阳性率为5%条件下，各组的检出率分别为12.26%、14.29%和16.32%；敏感度分别为10.2%、10.2%和16.3%；特异度分别为97.3%、97.2%和96.8%。结论：在早、中孕期联合筛查时，胎儿生长发育的指标应用MoM值进行评估可提高FGR联合预测检出率。

关键词: 胎儿生长迟缓, 妊娠初期, 妊娠中期, Logistic模型

Abstract: Objective：To establish a mathematical model through early and middle pregnancy, and to explore the value of different models for risk assessment and prediction of fetal growth restriction (FGR). Methods：2 621 cases of pregnant women were selected from January 2010 to December 2015 at the First Affiliated Hospital of Jinan University, which were combinated prenatal ultrasound screening in early and middle stage of pregnancy. Forty-nine cases(1.87%) were finally diagnosed as FGR. The age of pregnant women, pre-pregnancy body mass index (BMI), nuchal translucency (NT), free human beta chorionic gonadotropin (β-hCG), pregnancy related protein A (PAPP-A), pulsation index value of uterine artery (UtA PI) and middle cerebral artery pressure (MAP) were collected at the early stage of pregnancy. In the mid-term screening, biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were screened. At the same time, NT, UtA PI, MAP, BPD, HC, AC and FL were expressed by the median multiplier (MoM). Group A include all original parameters. Group B include them but β-hCG, PAPP-A, UtA PI and MAP were represented by MOM. Group C include them but β-hCG, PAPP-A, UtA PI, MAP, NT, BPD, HC, AC and FL were represented by MOM. The stepwise regression analysis method were used to establish the prediction model of FGR. Reciever operating characteristic curve (ROC) analysis was conducted to compare the sensitivity and specificity of the models. Results：The results of ROC curve calculation showed that area under the curve (AUC) of three groups of regression models were 0.69 (95%CI: 0.61-0.76), 0.69 (95%CI: 0.61-0.77), 0.71 (95%CI: 0.64-0.78), respectively, and under the condition of 5% false positive rate, the detection rates were 12.26%, 14.29%, 16.32%, respectively, and the sensitivity was 10.2%, 10.2%, 16.3%, respectively. The specificity was 97.3%, 97.2% and 96.8%, respectively. Conclusions：MOM value can improve the detection rate of FGR combined prediction in early and mid pregnancy screening.

Key words: Fetal growth retardation, Pregnancy trimester, first, Pregnancy trimester, second, Logistic models