隋金萍

【摘要】 目的：探究胎兒脑-胎盘血流分布以及孕妇血清促血管生成素-2（Ang-2）对单绒毛膜双羊膜囊（MCDA）双胎胎儿生长受限（FGR）的预测价值。方法：选取2012年1月-2020年1月于本院进行剖宫产的30例足月双胎FGR产妇为研究组，另选取同期于本院正常妊娠的30例健康双胎产妇为对照组。对两组临床资料进行回顾性分析。产前分别采集两组产妇静脉血，并对产妇实施超声检测，对比两组产妇静脉血Ang-1、Ang-2、脐动脉波动指数（UA-PI）、大脑中动脉搏动指数（MCA-PI）及脑-胎盘率（CPR）;分析Ang-1和Ang-2及脑-胎盘血流分布指标对MCDA双胎FGR的预测价值。结果：研究组分娩孕周和新生儿体重均低于对照组，双胎体重差大于对照组（P<0.05）。研究组Ang-1水平高于对照组，Ang-2水平低于对照组（P<0.05）。研究组UA-PI低于对照组，MCA-PI和CPR均高于对照组（P<0.05）。Ang-2和CPR诊断MCDA双胎胎儿FGR的诊断价值较高，AUC分别为0.847 6和0.951 6（P<0.05）。结论：CPR以及Ang-2对于MCDA双胎胎儿FGR具有较好的预测价值，有助于在临床实践中监测高危风险FGR胎儿，便于对产妇开展积极的干预治疗，改善胎儿围产结局。

【关键词】 脑-胎盘血流分布 Ang-2 MCDA 双胎 胎儿生长受限

Predictive Value of Fetal Brain-placental Blood Flow Distribution and Maternal Serum Ang-2 on MCDA Twins Fetal Growth Restriction/SUI Jinping. //Medical Innovation of China， 2021， 18（28）： 0-032

[Abstract] Objective： To investigate the predictive value of fetal brain-placental blood flow distribution and maternal serum ang-2 on monochorionic double amniotic （MCDA） twins fetal growth restriction （FGR）. Method： A total of 30 full-term twins FGR pregnant women who underwent cesarean section in our hospital from January 2012 to January 2020 were selected as the study group， and 30 healthy twins pregnant women in our hospital during the same period were selected as the control group. The clinical data of the two groups were retrospectively analyzed. The venous blood of the two groups were collected， and the pregnant women were detected by ultrasound. The venous blood Ang-1， Ang-2， umbilical artery fluctuation index （UA-PI）， middle cerebral artery pulsatility index （MCA-PI） and brain placental rate （CPR） were compared between the two groups; the predictive value of Ang-1， Ang-2 and brain-placental blood flow distribution indexes for MCDA twins FGR were analyzed. Result： The gestational age and neonatal weight in the study group were lower than those in the control group， and the twin weight difference was greater than that in the control group （P<0.05）. The level of Ang-1 in the study group was higher than that in the control group， and the level of Ang-2 was lower than that in the control group （P<0.05）. UA-PI in the study group was lower than that in the control group， while MCA-PI and CPR were higher than those in the control group （P<0.05）. Ang-2 and CPR had higher diagnostic value for FGR in MCDA twins， with AUC of 0.847 6 and 0.951 6 （P<0.05）， respectively. Conclusion： CPR and Ang-2 have good predictive value for FGR in MCDA twins， and help to monitor high-risk FGR in clinical practice fetus， it is convenient to carry out active intervention treatment for the parturient to improve the perinatal outcome of the fetus.

[Key words] Brain-placental blood flow distribution Ang-2 MCDA Twins Fetal growth restriction

First-author’s address： Lyushunkou District Women’s and Children’s Hospital， Dalian 116041， China

doi：10.3969/j.issn.1674-4985.2021.28.007

胎儿生长受限（FGR）又被称为宫内生长受限，是指胎儿大小异常，在宫内未达到其遗传的生长潜能。FGR是当前产科面临的最为复杂的产科问题之一，数据显示FGR是围产儿死亡的第二大原因，约有30%的死产婴儿与FGR相关，同时还有报道指出FGR还与早产和产时窒息密切相关[1-2]。此外对FGR婴儿的长期随访显示，FGR会明显增加围产儿的死亡率和发病率，长期来看FGR胎儿存在一定的远期健康缺损情况，成年后出现神经认知发育损害、心血管和代谢性疾病的风险大幅升高[3]。……