颈动脉多普勒测量评价迟发性胎儿生长受限:一项横断面研究

Gokce Naz Kucukbas, Yasemin Doğan
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引用次数: 0

摘要

背景/目的:据报道,颈内动脉(ICA)和颈总动脉(CCA)都与缺氧有关,在迟发性胎儿生长受限(FGR)中也观察到缺氧。然而,目前还没有研究这些多普勒测量是否在迟发性FGR病例中有所不同。本研究评估了迟发性FGR胎儿的ICA和CCA多普勒参数,并将这些测量结果与健康胎儿的测量结果进行了比较。方法:这项横断面观察性研究包括75例妊娠32周至37周诊断为晚发型FGR的单胎妊娠,以及75例健康胎儿,根据产科史和胎龄在2022年6月至2023年5月之间进行1:1配对。迟发性FGR的定义采用2016年德尔菲共识。排除标准为先天性异常、任何其他疾病的存在、母亲体重指数超过35 kg/m2、腹部疤痕妨碍超声显示、使用影响血管功能的药物(如产前类固醇、拟感神经药物和吲哚美辛)、药物使用、孕期吸烟、并发先兆子痫和多胎妊娠。在患者入院后,记录了他们的人口统计学特征,随后进行了超声检查和多普勒测量。脐动脉(UA)的多普勒测速包括收缩期与舒张期比(S/D)、脉搏指数(PI)和峰值收缩期速度(PSV)的测量。大脑中动脉(MCA)、ICA和CCA的颈动脉多普勒测速包括PI、阻力指数(RI)和PSV的测量。我们通过受试者工作特征(ROC)分析评估多普勒测量对迟发性FGR的诊断性能。结果:迟发性FGR组平均UA-SD高于对照组(2.7[0.6]比2.5 [0.5],P=0.006),平均UA-PI(0.8[0.2]比0.9 [0.2],P=0.011)和平均PSV(35.6[8.2]比41.1 [7.1],P<0.001)低于对照组。在迟发性FGR组,颈动脉多普勒测量比UA多普勒测量更明显。此外,与其他多普勒测量相比,ICA多普勒测量在预测晚发性FGR方面表现出更好的诊断性能(曲线下面积[AUC]=0.777, P< ICA- pi为0.001;AUC=0.751, P< ICA-RI为0.001;AUC=0.749, P< ICA-PSV为0.001)。结论:在迟发性FGR胎儿中,UA多普勒测量显示与健康胎儿相比差异很小,但颈动脉多普勒测量的差异,特别是在ICA中,更为明显。因此,在处理疑似迟发性FGR的胎儿时,可能需要更详细的多普勒检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of carotid artery Doppler measurements in late-onset fetal growth restriction: a cross-sectional study
Background/Aim: It has been reported that both the internal carotid artery (ICA) and the common carotid artery (CCA) are associated with hypoxia, also observed in late-onset fetal growth restriction (FGR). However, it has not yet been investigated whether these Doppler measurements differ in cases of late-onset FGR. This study evaluated the ICA and the CCA Doppler parameters in late-onset FGR fetuses and compared these measurements with those of healthy fetuses. Methods: This cross-sectional observational study comprised 75 singleton pregnancies diagnosed with late-onset FGR between the 32nd and 37th weeks of gestation, alongside 75 healthy fetuses paired 1:1 based on obstetric history and gestational age between June 2022 and May 2023. The Delphi consensus of 2016 was used for the definition of late-onset FGR. The exclusion criteria were congenital anomalies, presence of any additional disease, maternal body mass index over 35 kg/m2, abdominal scars hindering ultrasound visualization, use of medications such as antenatal steroids, sympathomimetics, and indomethacin that affect vascular function, drug use, smoking during pregnancy, concurrent preeclampsia, and multiple pregnancies. Upon the patients' admission to the hospital, their demographic characteristics were documented, and ultrasonographic examinations and Doppler measurements were subsequently performed. The Doppler velocimetry of the umbilical artery (UA) encompassed measurements of the systolic to diastolic ratio (S/D), pulsatility index (PI), and peak systolic velocity (PSV). The carotid artery Doppler velocimetry of the middle cerebral artery (MCA), ICA, and CCA encompassed measurements of the PI, resistance index (RI), and PSV. We assessed the diagnostic performance of Doppler measurements for late-onset FGR through receiver operating characteristic (ROC) analysis. Results: In the late-onset FGR group, the mean UA-SD was higher (2.7 [0.6] vs. 2.5 [0.5], P=0.006), and the mean UA-PI (0.8 [0.2] vs. 0.9 [0.2], P=0.011) and mean PSV (35.6 [8.2] vs. 41.1 [7.1], P<0.001) were lower compared to the control group. In the late-onset FGR group, carotid Doppler measurements were more pronounced than UA Doppler measurements. Moreover, ICA Doppler measurements exhibited superior diagnostic performance in predicting late-onset FGR compared to other Doppler measurements (Area under the curve [AUC]=0.777, P<0.001 for ICA-PI; AUC=0.751, P<0.001 for ICA-RI; AUC=0.749, P<0.001 for ICA-PSV). Conclusion: In fetuses with late-onset FGR, UA Doppler measurements showed minimal differences compared to healthy fetuses, but differences in carotid Doppler measurements, especially in the ICA, were more pronounced. Therefore, in the management of fetuses suspected of having late-onset FGR, a more detailed Doppler examination might be required.
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