孕产妇脐动脉血流参数与新生儿胎龄的关系研究-现代医学

孕产妇脐动脉血流参数与新生儿胎龄的关系研究

单位：复旦大学附属妇产科医院超声科, 上海 200011

分类号：R714

出版年·卷·期（页码）：2026·54·第六期（881-888）

摘要：

目的：分析孕产妇脐动脉血流参数与新生儿胎龄(GA)的关系。方法：本研究采用回顾性研究方法。选取2023年7月至2023年12月期间在我院分娩的孕妇作为研究对象。收集孕产妇一般信息、超声检查指标和脐动脉血流参数[脐动脉搏动指数(PI)、阻力指数(RI)、收缩期/舒张末期流速比值(S/D)]等临床资料，同时记录新生儿GA和性别。采用多元线性回归模型分析脐动脉血流参数与胎龄的关系。进一步按妊娠期高血压(HDP)状态分层，并检验HDP与RI的交互作用。采用受试者工作特征(ROC)曲线分析孕产妇脐动脉血流参数对新生儿早产的预测效能。结果：与非HDP组相比，HDP组孕产妇分娩年龄更高、新生儿GA更短、孕前BMI和产前BMI更高、胎盘厚度更厚、PI更高、剖宫产的比例更高、胎盘成熟度Ⅲ级的比例更高(均P<0.05)。相关性分析显示，PI、RI、S/D均与新生儿GA呈负相关。多元线性回归提示，产前BMI与新生儿GA呈正相关(P<0.05)，脐动脉RI与新生儿GA呈负相关(β=-5.322, P＜0.001)。分层分析发现，仅在HDP组中RI与新生儿GA呈负相关(β=-3.921, P=0.001)，且HDP与RI对新生儿GA的影响存在显著的交互作用(P_交互=0.039)。ROC曲线分析显示，脐动脉血流参数中，RI预测早产的效能最优(AUC=0.754)，其最佳截断值为0.575。结论：HDP伴随脐动脉血流动力学改变，其中RI与新生儿GA负相关在HDP背景下显著增强。动态监测脐动脉RI变化，有助于识别HDP患者中胎盘功能失代偿高风险个体，对预测早产和改善妊娠结局具有重要临床意义。

Objective: To analyze the association between maternal umbilical artery blood flow parameters and neonatal gestational age(GA). Methods: This was a retrospective study. Pregnant women who delivered in our hospital from July 2023 to December 2023 were enrolled. Clinical data including maternal general information, ultrasound indices, umbilical artery blood flow parameters [pulsatility index(PI), resistance index(RI), systolic/diastolic ratio(S/D)]were collected, and neonatal GA and gender of newborns were recorded simultaneously. Multiple linear regression was used to examine the relationship between umbilical artery blood flow parameters and GA. Subgroup analysis stratified by hypertensive disorders of pregnancy(HDP) status was performed, and the interaction between HDP and RI was tested. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive performance of umbilical artery parameters for preterm birth.Results: Compared with the non-HDP group, the HDP group had higher maternal age at delivery, shorter neonatal GA, higher pre-pregnancy body mass index(BMI) and pre-delivery BMI, thicker placenta, higher PI, and higher proportions of cesarean section and placental maturity grade Ⅲ(all P<0.05). Correlation analysis showed that PI, RI, and S/D were negatively correlated with GA. Multiple linear regression indicated that pre-delivery BMI was positively associated with GA(P<0.05), whereas RI was negatively associated with GA(β=-5.322, P<0.001). Subgroup analysis revealed that RI was negatively associated with GA only in the HDP group(β=-3.921, P=0.001), and a significant interaction between HDP and RI on GA was observed(P for interaction=0.039). ROC curve analysis demonstrated that among umbilical artery parameters, RI had the best predictive performance for preterm birth, with an area under the curve(AUC) of 0.754 and an optimal cut-off value of 0.575. Conclusion:HDP is accompanied by altered umbilical artery hemodynamics. The negative association between RI and GA is significantly strengthened in the presence of HDP. Dynamic monitoring of umbilical artery RI changes can help identify HDP patients at high risk for placental decompensation, which has important clinical significance for predicting preterm birth and improving pregnancy outcomes.

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