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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (3): 210-214.DOI: 10.3969/j.issn.1673-5501.2022.03.007

• 论著 • 上一篇    下一篇

足月胎儿主肺动脉超声收缩期加速时间/射血时间比值与新生儿肺成熟度关系的病例对照研究


尚缜邈1，李建玲1，石太英1，崔利丹2
  

  1. 1 河南省新乡市中心医院超声二科新乡，453000；2 郑州市儿童医院超声科郑州，450000
  • 收稿日期:2021-08-04 修回日期:2022-07-01 出版日期:2022-06-25 发布日期:2022-06-25
  • 通讯作者: 尚缜邈

The relationship between systolic acceleration time or ejection time ratio of full-term fetal main pulmonary artery ultrasound and neonatal lung maturity: A case-control study

SHANG Zhenmiao 1, LI Jianling1, SHI Taiying1, CUI Lidan2   

  1. 1 The Second Department of Ultrasound, Xinxiang Central Hospital, Xinxiang 453000, China; 2 Department of Ultrasound, Zhengzhou Children's Hospital, Zhengzhou 450000, China
  • Received:2021-08-04 Revised:2022-07-01 Online:2022-06-25 Published:2022-06-25
  • Contact: SHANG Zhenmiao, email: liyou741lian@163.com

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摘要： 背景：胎儿肺较其他器官发育得晚，且新生儿肺发育成熟度与妊娠结局密切相关。 目的：探讨足月胎儿主肺动脉超声收缩期加速时间（AT）/射血时间（ET）比值与新生儿肺成熟度的关系及预测价值。 设计：病例对照研究。 方法：以2019年10月至2020年10月在河南省新乡市中心医院行胎儿主肺动脉超声检查的孕妇为研究对象，按照分娩后胎儿羊水或气管抽吸液中板层小体（LB）是否≥50×109·L-1分为肺发育成熟组和肺发育不成熟组，比较两组临床资料、胎儿主肺动脉超声AT/ET比值；多因素Logistic回归分析影响新生儿肺成熟度的因素；Spearman相关性分析AT/ET比值与新生儿肺成熟度的相关性；绘制ROC曲线，分析AT/ET比值对新生儿肺成熟度的预测价值。 主要结局指标：胎儿主肺动脉超声AT/ET比值与新生儿肺成熟度的关系。 结果：102例孕妇及其胎儿主肺动脉超声图像和新生儿LB数据进入本文分析，孕产妇年龄23~36（29.4±1.0）岁，胎儿主肺动脉超声检查时孕周37＋1~38+6（38.3±0.1）周。肺发育成熟组76例，肺发育不成熟组26例。两组孕妇营养状况、胎儿呼吸样运动评分、收缩期峰值流速（PSV）、胎儿主肺动脉中段AT/ET比较，差异均有统计学意义（P＜0.05）。多因素Logistic回归分析显示，胎儿主肺动脉中段AT/ET是新生儿肺成熟度的影响因素（OR=0.881，95%CI：0.678~0.983）。 Spearman相关性分析显示，胎儿主肺动脉中段AT/ET比值与新生儿肺成熟度呈正相关（r=0.678，P=0.003）。ROC曲线显示，胎儿主肺动脉中段AT/ET预测新生儿肺成熟度最佳截断值为0.22时，敏感度为92.1%（95%CI：84.1%~97.4%），特异度为84.6%（95%CI：70.9%~93.4%），AUC为0.818（95%CI：0.715~0.927），AT/ET比值预测新生儿肺成熟度Kappa值为0.812（P＜0.05）。 结论：足月胎儿主肺动脉超声AT/ET与新生儿肺成熟度密切相关，对新生儿肺成熟度有一定预测价值。

关键词: 足月胎儿, 主肺动脉超声, 收缩期加速时间/射血时间, 新生儿肺成熟度

Abstract: Background：Fetal lung development is later than other organs, and the maturity of lung development is closely related to pregnancy outcome. Objective：To investigate the relationship between the ratio of systolic acceleration time/ejection time (AT/ET) of fullterm fetal main pulmonary artery ultrasound and neonatal lung maturity and its predictive value. Design：Casecontrol study. Methods：Pregnant women who underwent ultrasound examination of fetal main pulmonary arteries in Xinxiang Central Hospital of Henan Province from October 2019 to October 2020 were taken as the research objects. According to fetal amniotic fluid or tracheal aspiration liquid lamellar bodies (LB)≥50×109·L-1 after delivery, they were divided into mature and immature groups. The clinical data and AT/ET ratio of fetal main pulmonary artery were compared between the two groups. Multivariate logistic regression analysis was used to analyze the factors affecting neonatal lung maturity. Spearman correlation analysis to explore the correlation between AT/ET ratio and neonatal lung maturity. ROC curve was drawn to analyze the predictive value of AT/ET ratio on neonatal lung maturity. Main outcome measures：The relationship between AT/ET ratio of fetal main pulmonary artery and neonatal lung maturity. Results：Ultrasound images of 102 pregnant women and their pulmonary aorta and LB data of newborns were analyzed in this paper, aged from 23 to 36 (29.4±1.0) years, with 37+138+6 (38.3±0.1) weeks of ultrasonic examination of main pulmonary artery. There were 76 cases in mature lung group and 26 cases in immature lung group. There were significant differences in nutritional status, fetal respiratory motor score, PSV and AT/ET in the middle of fetal main pulmonary artery between the two groups (P<0.05). Multivariate logistic regression analysis showed that AT/ET in the middle segment of fetal main pulmonary artery was an independent factor affecting neonatal lung maturity (OR=0.881, 95%CI:0.6780.983). Spearman correlation analysis showed that AT/ET ratio in the middle of fetal main pulmonary artery was positively correlated with neonatal lung maturity (r=0.678, P=0.003). ROC curve showed that the best cutoff value of AT/ET in the middle of fetal main pulmonary artery for predicting neonatal lung maturity was 0.22. At this time, the sensitivity was 92.1% (95%CI：84.1%97.4%), the specificity was 84.6% (95%CI:70.9%93.4%), and the AUC was 0.818 (95%CI:71.5%92.7%). The kappa value of lung maturity predicted by AT/ET ratio was 0.812 (P<0.05). Conclusion：AT/ET in the main pulmonary artery of fullterm fetus is closely related to the lung maturity of newborns, and has certain predictive value for the lung maturity of newborns.

Key words: Term fetus, Main pulmonary artery ultrasound, Systolic acceleration time/ejection time, The lung maturity of the newborn