摘要
目的 探讨母体免疫性疾病与胎儿生长受限(FGR)的关系,以期为临床早期对FGR进行干预提供依据,减少因FGR导致母婴不良结局。方法 前瞻性选取2021年1月至2023年7月在郑州市妇幼保健院住院分娩的254例单胎小于胎龄儿(SGA)作为研究对象,根据是否为FGR分为FGR组(82例)、SGA组(172例),收集所有病例临床资料,包括孕妇年龄、家族遗传病史、流产史、产妇吸烟、孕次、产次、羊水过少、胎盘异常、妊娠高血压、低蛋白血症、孕期感染、抗磷脂抗体阳性(任意1项阳性)、免疫球蛋白3项[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)]、补体C3、C4、血清甲状腺激素[三碘甲状腺原氨酸(T_(3))、游离甲状腺素(T_(4))、促甲状腺素(TSH)]、产前超声诊断参数(胎儿体重、腹围),分析SGA为FGR的相关影响因素,并分析logistic回归模型对FGR的预测价值。结果 两组胎盘异常、妊娠高血压、低蛋白血症、抗磷脂抗体阳性、血清IgA、IgG、IgM、补体C3、C4、T_(3)、T_(4)、TSH、胎儿体重及腹围比较,差异有统计学意义(P<0.05);多因素logistic回归方程分析结果显示,胎盘异常、低蛋白血症、抗磷脂抗体阳性、血清免疫球蛋白三项、T_(3)、TSH水平升高为SGA FGR的独立危险因素,血清补体C3、C4、T_(4)水平升高为SGA FGR的保护因素(P<0.05);采用logistic回归模型统计分析数据,得到SGA胎儿发生FGR的预测概率P,根据预测值和真实值绘制受试者工作特征曲线,曲线下面积为0.917(95%CI:0.876~0.962),当log(P)>2.85时,预测敏感度为80.59%,特异度为93.16%。结论 母体免疫性疾病与FGR密切相关,临床可通过早期筛查母体免疫性疾病、胎盘异常、低蛋白血症、抗磷脂抗体、免疫球蛋白三项、补体C3、C4、甲状腺素水平评估FGR发生风险,可用于与SGA鉴别,以针对性制定干预方案。
Objective To explore the relationship between maternal immune diseases and fetal growth restriction(FGR),with a view to providing evidence for early clinical intervention in FGR and reducing adverse outcomes for both mothers and infants caused by FGR.Methods A prospective study was conducted to select 254 singleton small for gestational age infants(SGA)admitted to Women&Infants Hospital of Zhengzhou from January 2021 to July 2023 as the research subjects.They were divided into the FGR group(82 cases)and the SGA group(172 cases)according to whether they had FGR.Clinical data were collected for all cases,including maternal age,family genetic history,miscarriage history,maternal smoking,parity,parity,oligohydramnios,placental abnormalities,gestational hypertension,hypoproteinemia,pregnancy-related infections,positive anti-phospholipid antibodies(any one positive),immunoglobulin three items[immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)],complement C3,C4,serum thyroid hormones[triiodothyronine(T_(3)),thyroxine(T_(4)),thyroid stimulating hormone(TSH)],prenatal ultrasound diagnostic parameters(fetal weight,abdominal circumference),and analyzed the relevant factors affecting SGA infants as FGR.The logistic regression model was used to analyze the predictive value of FGR.Results There were statistically significant differences in the two groups in terms of placental abnormalities,gestational hypertension,hypoproteinemia,positive antiphospholipid antibodies,serum IgA,IgG,IgM,complement C3,C4,T_(3),T_(4),TSH,fetal weight,and abdominal circumference(P<0.05).Multivariate logistic regression analysis showed that placental abnormalities,hypoproteinemia,positive antiphospholipid antibodies,elevated levels of serum immunoglobulin,T_(3) and TSH were independent risk factors for FGR in SGA.Elevated levels of serum complement C3,C4 and T_(4) were protective factors for FGR in SGA(P<0.05).Logistic regression model was used for data analysis,the predictive probability P of FGR in SGA was obtained.According to the predicted value and true value,a receiver operating characteristic curve was drawn,with an area under the curve of 0.917(95%CI:0.876-0.962).When log(P)>2.85,the predictive sensitivity was 80.59%and the specificity was 93.16%.Conclusion Maternal immune diseases are closely related to FGR.Clinicians can assess the risk of FGR through early screening for maternal immune diseases,placental abnormalities,hypoproteinemia,antiphospholipid antibodies,immunoglobulin levels,complement C3,C4,and thyroid hormone levels.This can be used to differentiate between SGA and develop targeted intervention plans.
作者
吕会娟
杨俊娟
周斌
李保平
L Huijuan;YANG Junjuan;ZHOU Bin;LI Baoping(Department of Obstetrics,Women&Infants Hospital of Zhengzhou,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2024年第20期3696-3700,共5页
Henan Medical Research
基金
河南省医学科技攻关计划联合共建项目(LHGJ20210784)。
关键词
胎儿生长受限
小于胎龄儿
母体免疫性疾病
影响因素
fetal growth restriction
small for gestational age
maternal immune diseases
influence factor
