三维超声评估胎儿皮下脂肪情况及预测巨大儿低体质量儿的价值
摘要
目的探讨三维超声部分肢体体积在评估胎儿皮下脂肪情况和预测巨大儿、低体质量儿的价值。方法选取2017年10月至2018年4月在中国科学技术大学附属第一医院产检并分娩的孕妇121例,应用二维超声测量胎儿双顶径(BPD)、头围(HC)、股骨长(FL)、腹围(AC)、大腿中段软组织厚度(STT),应用三维超声测量上臂、大腿中段50%体积(AVol、TVol),与出生后新生儿皮褶厚度(SSFT)进行相关性分析。对各超声参数和出生体质量进行多元线性回归分析,建立胎儿体质量预估模型,绘制ROC曲线,计算AVol、TVol诊断巨大儿和低体质量儿的临界值。结果 BPD、HC、FL、AC、STT、AVol、TVol与SSFT均呈线性相关(r分别为0. 446、0. 448、0. 493、0. 587、0. 516、0. 637、0. 766,P <0. 05)。以出生体质量为因变量,以TVol、AVol、AC、HC为自变量建立回归方程Y=-2 689. 231+4. 323×HC+12. 987×AC+8. 866×AVol+6. 891×TVol。AVol、TVol诊断巨大儿的临界值分别为42. 52、93. 76 cm~3,诊断低体质量儿的临界值分别为27. 72、70. 50 cm~3。结论三维超声部分肢体体积较二维超声参数能更好地反映胎儿皮下脂肪状况,可为产前预测巨大儿和低体质量儿提供重要价值。
引文
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[2]LEE W,BALASUBRAMANIAM M,DETER R L,et al.Fetal growth parameters and birth weight:their relationship to neonatal body composition[J].Ultrasound Obstet Gynecol,2009,33(4):441-446.
[3]MOYER-MILEUR L J,SLATER H,THOMSON J A,et al.Newborn adiposity measured by plethysmography is not predicted by late gestation twodimensional ultrasound measures of fetal growth[J].J Nutr,2009,139(9):1772-1778.
[4]STIRNERMANN J,VILLAR J,SALOMON L J,et al.International estimated fetal weight standards of the INTER-GROWTH-21st Project[J].Ultrasound Obstet Gynecol,2017,49(4):478-486.
[5]LEE W,DETER R L,EBERSOLE J D,et al.Birth weight prediction by three-dimensional ultrasonography:fractional limb volume[J].J Ultrasound Med,2001,20(12):1283-1292.
[6]MOORE G S,ALLSHOUSE A A,FISHER B M,et al.Can fetal limb soft tissue measurements in the third trimester predict neonatal adiposity?[J].J Ultrasound Med,2016,35(9):1915-1924.
[7]SIMCOX L E,MYERS J E,COLE T J,et al.Fractional fetal thigh volume in the prediction of normal and abnormal fetal growth during the third trimester of pregnancy[J].Am J Obstet Gynecol,2017,217(4):453.e1-453.e12.
[8]GORAN M I,DRICOLL P,JOHNSON R,et al.Cross-calibration of body-composition techniques against dual-energy X-ray absorptiometry in young chilrden[J].Am J Clin Nutr,1996,63(3):299-305.
[9]LEE W,BALASUBRAMANIAM M,DETER R L,et al.Fractional limb volume-a soft tissue parameter of fetal body composition:validation,technical considerations and normal ranges during pregnancy[J].Ultrasound Obstet Gynecol,2009,33(4):427-440.
[10]O'CONNOR C,O'HIGGINS A,DOOLAN A,et al.Birth weight and neonatal adiposity prediction using fractional limb volume obtained with 3D ultrasound[J].Fetal Diagn Ther,2014,36(1):44-48.