超声血流参数变化联合D-二聚体、25-羟基维生素D水平与胎儿生长指标及出生结局的关系

The relationship between changes in ultrasound blood flow parameters combined with D-dimer, 25-hydroxyvitamin D levels and fetal growth indicators and birth outcomes

摘要

目的 探究超声血流参数变化联合血清D-二聚体、25-羟基维生素D[25-(OH)D]水平与胎儿生长指标及出生结局的关系。方法 选取2021年11月至2023年2月在我院进行规律性产检并分娩的164例孕妇为研究对象,根据胎儿出生结局将其分为出生结局良好组(n=110)和不良组(n=54).收集孕中、晚期胎儿生长指标:双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)及脐动脉血流参数:动脉搏动指数(PI)、血流阻力指数(RI)及收缩峰末期最大血流速度/舒张末期峰值流速(S/D);使用酶联免疫吸附试验(ELISA)测定血清D-二聚体、25-(OH)D水平;使用受试者工作特征(ROC)曲线分析血流参数联合血清D-二聚体、25-(OH)D对胎儿出生结局的预测价值。结果 孕晚期血流参数PI、RI、S/D及血清25-(OH)D水平均显著低于孕中期(t值分别为5.883、9.723、6.506和5.631,P<0.001).孕晚期血清D-二聚体水平及BPD、HC、AC、FL胎儿生长指标均显著高于孕中期(t值分别为4.479、74.673、27.840、35.009和36.904,P<0.05).结局良好组孕晚期孕妇血流参数PI、RI、S/D及血清D-二聚体水平均低于结局不良组(t值分别为4.305、6.575、4.833和5.133,P<0.001),25-(OH)D水平高于结局不良组(t值为8.345,P<0.001).ROC曲线结果显示,孕晚期血流参数PI、RI、S/D联合血清D-二聚体、25-(OH)D预测胎儿出生结局的灵敏度为90.7%,特异度为84.3%,曲线下面积(AUC)为0.962,95%CI为0.934~0.991,高于PI、RI、S/D、D-二聚体、25-(OH)D单独检测(P<0.05)。结论 不同妊娠阶段血流参数PI、RI、S/D及血清D-二聚体、25-(OH)D和胎儿生长指标有显著性差异.血流参数PI、RI、S/D联合血清D-二聚体、25-(OH)D对胎儿出生结局有良好的预测价值.

Abstract

Objective To explore the relationship between changes in ultrasound blood flow parameters combined with serum D-dimer and 25-hydroxyvitamin D [25-(OH)D] levels with fetal growth indicators and birth outcomes. Methods A total of 164 pregnant women who underwent regular prenatal examinations and gave birth at our hospital from November 2021 to February 2023 were selected as the study subjects. According to the fetal birth outcomes, pregnant women were divided into two groups: the good birth outcome group (n=110) and the poor birth outcome group (n=54). Fetal growth indicators during the second and third trimesters were collected, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femoral length (FL), and umbilical artery blood flow parameters: pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D). Serum D-dimer and 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of blood flow parameters combined with serum D-dimer and 25-(OH)D levels for fetal birth outcomes. Results In the late pregnancy stage, the blood flow parameters PI, RI, S/D and serum 25-(OH)D levels were significantly lower than those in the mid-pregnancy stage (t=5.883, 9.723, 6.506, and 5.631, respectively, all P<0.001). Serum D-dimer level and fetal growth indicators such as BPD, HC, AC, FL were significantly higher in late pregnancy compared to mid-pregnancy (t=4.479, 74.673, 27.840, 35.009, and 36.904, respectively, all P<0.05). In the favorable outcome group, blood flow parameters PI, RI, S/D, and serum D-dimer levels were lower than those in the adverse outcome group in late pregnancy (t=4.305, 6.575, 4.833, and 5.133, respectively, all P<0.001), while 25-(OH)D levels were higher than in the adverse outcome group (t=8.345, P<0.001). The ROC curve results showed that the combined detection of blood flow parameters PI, RI, S/D, and serum D-dimer and 25-(OH)D in late pregnancy predicted fetal birth outcomes with a sensitivity of 90.7%, specificity of 84.3%, and an area under the curve (AUC) of 0.962 (95% CI: 0.934-0.991), which was higher than the individual detection of PI, RI, S/D, D-dimer, or 25-(OH)D (P<0.05). Conclusion There are significant differences in blood flow parameters PI, RI, S/D, serum D-dimer, 25-(OH)D and fetal growth indicators in different pregnancy stages. The combination of blood flow parameters PI, RI, S/D with serum D-dimer and 25-(OH)D has good predictive value for fetal birth outcomes.

关键词

血流参数 / D-二聚体 / 25-羟基维生素D / 生长指标 / 出生结局

Key words

blood flow parameters / D-dimer / 25-hydroxyvitamin D / growth indicator / birth outcome

参考文献

[1] 宋清芸, 罗红. 浅谈应用超声指标评估胎儿生长发育的重要意义[J]. 中华医学超声杂志(电子版), 2021, 18(8): 733-736.

[2] 师霞君. 彩超检测中晚期妊娠胎儿UA及MCA血流频谱在宫内窘迫预测中的价值[J]. 中外医学研究, 2022, 20(20): 85-88.

[3] Sekielska-Domanowska MI, Myszkowski B, Czuba B, et al. The role of individual blood flow parameters through ductus venosus in the first and second trimesters of pregnancy in predicting the condition of the fetus and newborn[J]. Ginekol Pol, 2022, 93(7): 558-563.

[4] Rodríguez-Peña Y, Ibáñez-Pinilla M. Elevated levels of D-dimer tested by immunoturbidimetry are associated with the extent of severity of pre-eclampsia[J]. Int J Gynaecol Obstet, 2020, 150(2): 241-247.

[5] 李少维, 林惠玲, 叶桂青, 等. 婴幼儿及儿童血清维生素A、维生素E及维生素D水平分析[J]. 中国妇幼健康研究, 2020, 31(9): 1161-1165.

[6] Sharawat IK, Dawman L. Bone mineral density and its correlation with vitamin D status in healthy school-going children of Western India[J]. Arch Osteoporos, 2019, 14(1): 13.

[7] 聂文静, 寇应琳. 血清25-(OH)-D、D-D表达水平与妊娠期高血压疾病的相关性[J]. 医药论坛杂志, 2021, 42(4): 94-96, 100.

[8] 谢幸, 苟文丽. 妇产科学[M].第8版. 北京: 人民卫生出版社, 2013: 228-239.

[9] 中华医学会妇产科学分会产科学组. 胎膜早破的诊断与处理指南(2015)[J]. 中华妇产科杂志, 2015, 50(1): 3-8.

[10] 朱颖, 魏娜, 陈伟伟. 超声生物学指标Z-评分值与孕妇糖脂代谢指标的相关性及其评估胎儿生长发育情况的临床价值[J]. 临床和实验医学杂志, 2021, 20(16): 1745-1749.

[11] Yu D Q, Lv P P, Yan Y S, et al. Intrauterine exposure to hyperglycemia retards the development of brown adipose tissue[J]. FASEB J, 2019, 33(4): 5425-5439.

[12] Walia A, Berger V K, Gonzalez J M, et al. Mode of delivery and neonatal outcomes with early preterm severe preeclampsia: does fetal growth restriction matter? [J]. J Matern Fetal Neonatal Med, 2023, 36(1): 2208251.

[13] Witkowski S, Strzelecka I, Respondek-Liberska M. Fetal heart biventricular diameter/foot length index as a diagnostic marker of fetal macrosomia in the second and third trimester of pregnancy[J]. J Matern Fetal Neonatal Med, 2023, 36(1): 2183751.

[14] Röbl-Mathieu M, Kunstein A, Liese J, et al. Vaccination in pregnancy[J]. Dtsch Arztebl Int, 2021, 118(15): 262-268.

[15] 王国纬, 李逗, 霍晓娜. 影响新生儿出生状况的孕晚期超声指标多因素临床研究[J]. 河北医药, 2022, 44(2): 256-259.

[16] Paniccia R, Prisco D, Bandinelli B, et al. Plasma and serum levels of D-dimer and their correlations with other hemostatic parameters in pregnancy[J]. Thromb Res, 2002, 105(3): 257-262.

[17] Baboolall U, Zha Y, Gong X, et al. Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies: a retrospective observational cohort study[J]. Medicine (Baltimore), 2019, 98(23): e15903.

[18] 张轶娜, 黄树雪. 外周血D-二聚体和尿蛋白/肌酐比值与子痫前期患者发生胎儿窘迫的相关性[J]. 河南医学研究, 2022, 31(1): 116-119.

[19] Karpova N, Dmitrenko O, Arshinova E, et al. Review: influence of 25(OH)D blood concentration and supplementation during pregnancy on preeclampsia development and neonatal outcomes[J]. Int J Mol Sci, 2022, 23(21): 12935.

[20] 潘晓, 陈熙光. 探讨妊娠早期孕妇血清25-羟基维生素D3[25-(OH)D3]水平及其对新生儿结局与发育的影响[J]. 医学食疗与健康, 2020, 18(15): 18, 24.

基金资助

河北省医学科学研究课题计划项目(20232147)