目的: 探讨孕11~13+6周超声多普勒检测子宫动脉及联合母血清妊娠相关蛋白A(pregnancy-associated plasma protein A,PAPP-A)在临床预测胎儿生长受限(fetal growth restriction,FGR)中的可行性。方法: 选择在我院行产前检查的2 000例单胎妊娠孕妇,于孕11~13+6周行母血清PAPP-A及子宫动脉超声多普勒检测,并随访其妊娠过程及母胎结局。结果: 入组的2 000例孕妇中,13例28周前终止妊娠或胎死宫内,76例发生FGR ,正常妊娠1 485例,其他异常妊娠426例。FGR组孕妇的子宫动脉血流搏动指数(uterine artery pulsatility index,UtA-PI)(1.87±0.40比1.7±0.37)、子宫动脉阻力指数(uterine artery resistance index,UtA-RI)(0.80±0.08比0.70±0.07)及出现血流舒张早期切迹的比例高于正常组(63.2%比39.3%),而PAPP-A浓度低于正常组。联合UtA-PI及PAPP-A检查预测FGR的灵敏度为81.6%,以上二者再联合血流舒张早期切迹则可将灵敏度提高至82.9%,但2种方法间的差异尚无统计学意义(P>0.05)。结论: 孕 11~13+6周时联合UtA-PI、血流舒张早期切迹及PAPP-A水平是预测FGR的有效方法,但定性指标子宫动脉血流舒张早期切迹的临床有效性不如定量指标。
Objective: To evaluate the predictive level for fetal growth restriction (FGR) at 11-13+6 weeks of gestation by uterine artery Doppler or/and level of PAPP-A. Methods: A prospective study was performed on 2 000 singleton pregnancies attending routine care at 11-13+6 weeks of gestation. Uterine artery Doppler ultrasound was performed and maternal serum pregnancy associated plasma protein A( PAPP-A) level was assayed. The maternal and neonatal outcome were followed up. Results: ① Among the 2 000 cases,13 pregnancies were terminated for fetal abnormalities or intrauterine fetal death before 28 weeks, 76 cases developed FGR, 426 cases were proved having other adverse pregnancy outcomes, and the remaining 1 485 cases had normal outcomes. ② Compared with normal group, the mean uterine artery pulsatility index(PI)and uterine resistance index(RI)and the presence of early diastolic notch in blood flow were higher and PAPP-A level was lower in FGR group.③ In screening FGR, the combination of uterine artery PI and PAPP-A had a sensitivity of 81.6%, and the combination of uterine artery PI, PAPP-A and the presence of early diastolic notch increased the sensitivity to 82.9%, yet the difference did not reach statistical significance. Conclusions: Uterine artery PI together with PAPP-A and presence of early diastolic notch at 11-13+6 weeks could provide sensitive prediction of the development of FGR. However, the effectiveness of presence of early diastolic notch is not as good as that of uterine artery PI or maternal serum PAPP-A level in screening FGR.
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