基于多项超声参数联合评估妊娠期糖尿病孕妇胎儿生长受限的诊断效能

Diagnostic efficacy of combined multi-parameter ultrasound for detecting fetal growth restriction in pregnancies complicated with gestational diabetes mellitus

摘要

目的：探讨基于多项超声参数［脐动脉收缩期与舒张期流速比（S/D）比值与胎儿超声生长参数（双顶径、腹围、股骨长）Z-评分等］单独及联合应用对妊娠期糖尿病（GDM）孕妇胎儿生长受限（FGR）的诊断效能。方法：选取2024年7月至2025年5月在福建医科大学附属龙岩第一医院妇产科登记孕检及直至住院分娩的120例GDM孕妇为研究对象，根据新生儿体质量及孕期超声动态随访结果，将胎儿出生体质量低于同孕周第10百分位数者纳入FGR组（32例），其余纳入非FGR组（88例）。记录所有孕妇的空腹血糖、羊水指数、年龄、孕周、孕前BMI、新生儿阿氏（Apgar）评分等临床常规资料，以及脐动脉S/D比值及超声生长参数，比较这些指标的差异，同时计算出不同指标诊断FGR的灵敏度。结果：FGR组胎儿脐动脉S/D比值显著高于非FGR组（P<0.05）；FGR组胎儿超声生长参数Z-评分均显著低于非FGR组（P<0.05）；根据ROC曲线分析结果显示，单一指标中，脐动脉S/D比值诊断GDM孕妇FGR的AUC为0.852，灵敏度为81.25%，特异度为79.55%；超声生长参数Z-评分联合诊断的AUC为0.896，灵敏度为87.50%，特异度为84.09%；脐动脉S/D比值联合超声生长参数Z-评分诊断的AUC为0.926，灵敏度为90.63%，特异度为88.64%。结论：联合应用脐动脉S/D比值与超声生长参数Z-评分可显著提升对GDM孕妇FGR的诊断效能，该综合评估方案融合血流动力学与生长形态学信息，为早期、客观识别FGR提供更优的超声依据。

Abstract

Objective To evaluate the diagnostic performance of single and combined ultrasonic parameters, including umbilical artery systolic/diastolic velocity ratio (S/D ratio) and Z-scores of fetal ultrasonic growth parameters (biparietal diameter, abdominal circumference, femur length), for the detection of fetal growth restriction (FGR) in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 120 pregnant women with GDM who registered for prenatal check-ups and admitted for delivery at the Department of Obstetrics and Gynecology, Longyan First Hospital Affiliated to Fujian Medical University between July 2024 and May 2025 were enrolled as study subjects. According to neonatal birth weight and serial prenatal ultrasound follow-up results, those with a fetal birth weight below the 10th percentile for the corresponding gestational age were included in the FGR group (n=32), and the remaining were included in the non-FGR group (n=88). The fasting blood glucose, amniotic fluid index, age, gestational weeks, pre-pregnancy BMI, neonatal Apgar score, and other clinical routine data were recorded. Meanwhile, the umbilical artery S/D ratio and ultrasonic growth parameters were collected. Differences in these indicators were compared, and the diagnostic sensitivity of different indicators for FGR was calculated. Results Compared with the non-FGR group, the FGR group demonstrated a higher umbilical artery S/D ratio and lower Z-scores of ultrasonic growth parameters (all P<0.05). ROC curve analysis showed that the umbilical artery S/D ratio alone had an AUC of 0.852, with a sensitivity of 81.25% and a specificity of 79.55% for diagnosing FGR among pregnant women with GDM. The combination of the Z-scores of ultrasonic growth parameters obtained an AUC of 0.896, sensitivity of 87.50%, and specificity of 84.09%. The umbilical artery S/D ratio combined with Z-scores of ultrasonic growth parameters achieved an AUC, sensitivity, and specificity of 0.926, 90.63%, and 88.64%, respectively. Conclusion The combination of the umbilical-artery S/D ratio and Z-scores of ultrasonic growth parameters significantly improves the diagnostic performance for FGR in pregnancies complicated with GDM. By integrating hemodynamic and morphometric information, this assessment scheme provides a superior objective sonographic basis for the early identification of FGR.

关键词

妊娠期糖尿病 / 孕妇 / 胎儿生长受限 / 脐动脉 / 彩色多普勒血流显像 / 超声生长参数

Key words

gestational diabetes mellitus / pregnant woman / fetal growth restriction / umbilical artery / color Doppler flow imaging / ultrasonic growth parameter

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基金资助

福建省自然科学基金(2022J011508)