超聲血流參數(shù)變化聯(lián)合D-二聚體、25-羥基維生素D水平與胎兒生長指標及出生結局的關系

［摘"要］目的"探究超聲血流參數(shù)變化聯(lián)合血清D-二聚體、25-羥基維生素D［25-（OH）D］水平與胎兒生長指標及出生結局的關系。方法"選取2021年11月至2023年2月在我院進行規(guī)律性產檢并分娩的164例孕婦為研究對象，根據(jù)胎兒出生結局將其分為出生結局良好組（n=110）和不良組（n=54）。收集孕中、晚期胎兒生長指標：雙頂徑（BPD）、頭圍（HC）、腹圍（AC）、股骨長（FL）及臍動脈血流參數(shù)：動脈搏動指數(shù)（PI）、血流阻力指數(shù)（RI）及收縮峰末期最大血流速度/舒張末期峰值流速（S/D）；使用酶聯(lián)免疫吸附試驗（ELISA）測定血清D-二聚體、25-（OH）D水平；使用受試者工作特征（ROC）曲線分析血流參數(shù)聯(lián)合血清D-二聚體、25-（OH）D對胎兒出生結局的預測價值。結果"孕晚期血流參數(shù)PI、RI、S/D及血清25-（OH）D水平均顯著低于孕中期（t值分別為5.883、9.723、6.506和5.631，P＜0.001）。孕晚期血清D-二聚體水平及BPD、HC、AC、FL胎兒生長指標均顯著高于孕中期（t值分別為4.479、74.673、27.840、35.009和36.904，P＜0.05）。結局良好組孕晚期孕婦血流參數(shù)PI、RI、S/D及血清D-二聚體水平均低于結局不良組（t值分別為4.305、6.575、4.833和5.133，P＜0.001），25-（OH）D水平高于結局不良組（t值為8.345，P＜0.001）。ROC曲線結果顯示，孕晚期血流參數(shù)PI、RI、S/D聯(lián)合血清D-二聚體、25-（OH）D預測胎兒出生結局的靈敏度為90.7%，特異度為84.3%，曲線下面積（AUC）為0.962，95%CI為0.934～0.991，高于PI、RI、S/D、D-二聚體、25-（OH）D單獨檢測（P＜0.05）。結論"不同妊娠階段血流參數(shù)PI、RI、S/D及血清D-二聚體、25-（OH）D和胎兒生長指標有顯著性差異。血流參數(shù)PI、RI、S/D聯(lián)合血清D-二聚體、25-（OH）D對胎兒出生結局有良好的預測價值。

［關鍵詞］血流參數(shù)；D-二聚體；25-羥基維生素D；生長指標；出生結局

Doi：10.3969/j.issn.1673-5293.2024.10.04

［中圖分類號］R714""""［文獻標識碼］A

［文章編號］1673-5293（2024）10-0021-06

The relationship between changes in ultrasound blood flow parameters combined with

D-dimer，25-hydroxy vitamin D levels and fetal growth indicators and birth outcomes

SUN Ling1，F(xiàn)AN Hongxia2，SUN Xiaomei1，ZHU Xiaoling1

（1.Department of Ultrasound Ⅱ，Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine，Hebei

Cangzhou 061001，China;2.Department of Obstetrics and Gynecology，Botou Hospital，Hebei Cangzhou 062150，China）

［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，F(xiàn)L 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，Plt;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 （Plt;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.

［Key words］ blood flow parameters;D-dimer;25-hydroxy vitamin D;growth indicator;birth outcome

胎兒宮內生長發(fā)育過程受多種因素的影響，宮內營養(yǎng)不均衡將對胎兒發(fā)育帶來不良影響，這些影響可能持續(xù)到嬰幼兒期、青春期，有些甚至將誘發(fā)成年期疾病［1］。……