Value of coronary artery dilatation in prognosis fetal growth restriction
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摘要:
目的探讨冠状动脉扩张在胎儿生长受限(FGR)中的预后评估价值。 方法收集2019年1月~2020年12月我院超声诊断并出生后证实FGR胎儿73例，超声观察冠状动脉(CA)扩张、脐动脉、大脑中动脉(MCA)、静脉导管的血流频谱特征。根据胎儿妊娠结局分为预后良好组和预后不良组，比较胎儿的一般情况及胎儿不同血流异常情况，以超声变量特征建立Logistic回归模型，并绘制受试者工作特征曲线，评价Logistic回归模型对胎儿不良预后的预测价值。 结果FGR胎儿预后不良组27例，预后良好组46例，在脐动脉异常、静脉导管异常、CA扩张组比较差异有统计学意义(P < 0.05)，MCA异常组未见明显统计学意义(P>0.05)。Logistic回归分析显示CA扩张、脐动脉异常、静脉导管异常组OR值分别为9.715、4.956、11.291，为胎儿不良预后的独立的危险因素。以CA扩张、脐动脉异常、静脉导管异常3组变量建立的Logistic回归模型预测FGR胎儿不良预后(回归值>0.356)的曲线下面积为0.874，敏感度为81.48%，特异性为91.30%。 结论冠状动脉扩张是FGR预后不良的独立的危险因素。以CA扩张、脐动脉异常、静脉导管异常3个血流异常变量建立的Logistic回归模型能够有效预测FGR不良预后。 Abstract:ObjectiveTo explore the value of coronary artery dilatation in prognosis of fetal growth restriction (FGR). MethodsSeventy-three fetuses with fetal growth restriction (FGR) confirmed by ultrasound in our center from January 2019 to December 2020 were collected. The blood flow spectrum characteristics included coronary artery (CA) dilatation, umbilical artery (UA), middle cerebral artery (MCA) and venous duct (DV) were observed by prenatal ultrasound. The fetuses were divided into two parts: poor prognosis group and good prognosis group according to fetal pregnancy outcome. After comparing the baseline data and blood flow parameters, a logistic regression model based on the characteristics of ultrasonic variableas was established. Receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of logistic regression model for fetal poor prognosis. ResultsThere were 46 cases in good prognosis group and 27 cases in poor prognosis group. The blood flow parameters including abnormal UA, abnormal DV, CA dilatation had significant differences (P < 0.05), whereas abnormal MCA did not (P>0.05) Logistic regression analysis show that CA dilatation, abnormal UA, and abnormal DV were independent risk factors for fetal poor prognosis(OR values=9.715, 4.956, 11.291, respectively). The Logistic regression model based on CA dilation, abnormal UA and abnormal DV predicted that the area under the curve, the sensitivity and specificity of poor prognosis of FGR were 0.874, 81.8% and 91.30%, respectively. ConclusionCoronary artery dilatation was an independent risk factor for poor prognosis in FGR fetuses. Logistic regression model based on three abnormal blood flow variables, including CA dilation, abnormal UA and abnormal DV could effectively predict the poor prognosis of FGR. -
Key words:
- coronary artery /
- umbilical artery /
- venous duct /
- fetal growth restriction
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图 1 左室流出道切面彩色多普勒显示右冠状动脉扩张
Figure 1. This view of the left ventricular outflow tract shows color Doppler imaging of the right coronary artery dilatation.
图 3 UA异常、DV异常、CA扩张预测FGR胎儿不良预后的ROC
Figure 3. ROC of abnormal UA, abnormal DV, and dilated CApredicting adverse prognosis in FGR.
表 1 FGR胎儿不良结局单因素分析
Table 1. Univariate analysis of fetal adverse outcomes in FGR[n(%)]
因素 预后良好组(n=46) 预后不良组(n=27) χ2 P 年龄(岁) 28.50(21~40) 30.00(20~44) 508.50 0.197 首诊孕周(周) 35.50(25.1~39.0) 30.6(23.4~39.2) 325.00 0.001 出生或胎儿死亡孕周(周) 36.60(28.20~39.60) 31.50(24.10~40.10) 315.00 0.001 出生体质量(g) 1950(880~2480) 1050(214~2460) 264.00 0.001 Apgar 1 min 9(8~10) 0(0~9) 88.50 0.001 Apgar 5 min 10(8~10) 0(0~9) 58.00 0.001 Apgar 10 min 10(9~10) 0(0~10) 91.00 0.001 MCA异常 27(0.59) 17(0.63) 0.13 0.719 UA异常 14(0.30) 20(0.74) 13.02 0.001 DV异常 2(0.04) 12(0.44) 17.65 0.001 CA扩张 11(0.24) 22(0.82) 22.76 0.001 MCA: 大脑中动脉; UA: 脐动脉; DV: 静脉导管; CA: 冠状动脉 
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表 2 FGR胎儿不良结局影响因素的多因素Logistic回归分析结果
Table 2. Multivariate Logistic regression analysis of factors affecting fetal adverse outcomes in FGR
项目 B S.E. Wald值 OR值(95%CI) P UA异常 1.513 0.68 4.956 4.539(1.198~17.193) 0.026 DV异常 2.424 0.942 6.621 11.291(1.782~71.543) 0.01 CA扩张 2.274 0.691 10.827 9.715(2.508~37.636) 0.001 常数项 -3.017 0.702 18.492 - 0.001
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