摘要
目的探讨脐动脉血流收缩期末最大血流速度/舒张期末最大血流速度(S/D)、血清趋化因子C-X3-C配体1(CX3CL1)、血清缺氧诱导因子-1α(HIF-1α)对胎儿窘迫(FD)的诊断价值。方法选取2020年5月至2022年5月在青岛市妇女儿童医院妇产科分娩且出现FD的128例孕妇为研究对象(FD组),根据新生儿Apgar评分将FD孕妇分为轻度窘迫组74例和重度窘迫组54例,另取同期在本院定期产检并分娩的健康且未出现FD的孕妇78例为正常组;超声检测FD孕妇脐动脉血流S/D值;ELISA法检测FD孕妇血清CX3CL1、HIF-1α水平;Pearson法分析FD孕妇血清CX3CL1、HIF-1α水平与脐动脉血流S/D值的相关性;受试者工作特征(ROC)曲线分析血清CX3CL1、HIF-1α水平及脐动脉血流S/D值对胎儿重度窘迫的诊断价值。结果FD组孕妇脐动脉血流阻力指数(RI)、搏动指数(PI)、S/D值、血清CX3CL1及HIF-1α水平均显著高于正常组(P<0.05),重度窘迫组孕妇RI值、PI值、S/D值、血清CX3CL1及HIF-1α水平均高于轻度窘迫组(P<0.05)。FD组血清CX3CL1、HIF-1α与脐动脉血流S/D值均呈正相关(r=0.531、0.489,P<0.05)。脐动脉血流S/D值、血清CX3CL1、HIF-1α以及3项联合诊断胎儿重度窘迫的AUC分别为0.870、0.802、0.731、0.941,联合诊断的灵敏度为87.04%,特异度为90.54%,3项联合优于脐动脉血流S/D值、血清CX3CL1、HIF-1α各自单独诊断(Z3项联合-S/D=2.775、Z3项联合-CX3CL1=3.998、Z3项联合-HIF-1α=4.925,P均<0.05)。结论FD孕妇脐动脉血流S/D值、血清CX3CL1、HIF-1α水平均上升,且血清CX3CL1、HIF-1α水平与脐动脉血流S/D值均呈正相关,3项联合对诊断胎儿重度窘迫有更高的价值。
Objective To investigate the diagnostic value of the maximum systolic/diastolic blood flow velocity(S/D)ratio of the um⁃bilical artery,serum chemokine C-X3-C ligand 1(CX3CL1),and serum hypoxia inducible factor-1α(HIF-1α)for fetal distress(FD).Meth⁃ods A total of 128 pregnant women who delivered in our hospital from May 2020 to May 2022 and experienced FD were collected as the study subjects(FD group);according to the neonatal Apgar score,the FD group was separated into a mild distress group of 74 cases and a severe dis⁃tress group of 54 cases,and 78 healthy pregnant women who underwent regular prenatal examinations and delivered in our hospital during the same period and did not experience FD were regarded as the normal group;Ultrasound was applied to detect the S/D ratio of umbilical artery blood flow;ELISA was applied to detect serum levels of CX3CL1 and HIF-1α;Pearson method was applied to analyze the correlation between the serum CX3CL1,HIF-1αlevels of FD pregnant women and the S/D ratio of umbilical artery blood flow;ROC curve was applied to analyze the diagnostic value of serum CX3CL1,HIF-1αlevels and umbilical artery blood flow S/D ratio for severe fetal distress.Results The umbili⁃cal artery blood flow resistance index(RI),pulsatility index(PI),S/D value,serum CX3CL1 and HIF-1αlevels in FD group were obviously higher than those in the normal group(P<0.05);the RI value,PI value,S/D value,serum CX3CL1 and HIF-1αlevels of pregnant women in the severe distress group were obviously higher than those in the mild distress group(P<0.05);in FD group,serum CX3CL1 and HIF-1αwere posi⁃tively correlated with the S/D ratio of umbilical artery blood flow(r=0.531,0.489,P<0.05).The AUC of umbilical artery blood flow S/D ratio,se⁃rum CX3CL1,HIF-1αand three items of combined diagnosis of severe fetal distress was 0.870,0.802,0.731 and 0.941,respectively.The sen⁃sitivity of combined diagnosis was 87.04%,and the specificity was 90.54%,the combination of the three were better than the S/D ratio of umbili
作者
许旭
王书萍
江楠
XU Xu;WANG Shuping;JIANG Nan(Department of Gynaecology and Obstetrics,Qingdao Women and Children's Hospital,Qingdao 266000,China;Department of Obstetrics,Xintai Hospital of Traditional Chinese Medicine,Xintai 271200,China)
出处
《安徽医学》
2024年第4期458-462,共5页
Anhui Medical Journal
