小脑横径/腹围与头围/腹围在预测不对称性宫内生长受限中的效能比较
Efficacy of Transcerebellar Diameter/Abdominal Circumference Versus Head Circumference/Abdominal Circumference in Predicting Asymmetric Intrauterine Growth Retardation.
作者信息
Nagaraju Rashmi M, Bhat Venkataramana, Gowda Puttanna Vn
机构信息
Senior Resident, Department of Radiodiagnosis, PK Das Institute of Medical Sciences , Palakkad, Kerala, India .
Assistant Professor, Department of Radiodiagnosis, PK Das Institute of Medical Sciences , Palakkad, Kerala, India .
出版信息
J Clin Diagn Res. 2015 Oct;9(10):TC01-5. doi: 10.7860/JCDR/2015/14079.6554. Epub 2015 Oct 1.
BACKGROUND
The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR.
AIM
To compare the accuracy of transcerebellar diameter/abdominal circumference with head circumference/abdominal circumference in predicting asymmetric intrauterine growth retardation after 20 weeks of gestation.
MATERIALS AND METHODS
The prospective study was conducted over a period of one year on 50 clinically suspected IUGR pregnancies who were evaluated with 3.5 MHz frequency ultrasound scanner by a single sonologist. BPD, HC, AC and FL along with TCD were measured for assessing the sonological gestational age. Two morphometric ratios- TCD/AC and HC/AC were calculated. Estimated fetal weight was calculated for all these pregnancies and its percentile was determined.
STATISTICAL METHODS
The TCD/AC and HC/AC ratios were correlated with advancing gestational age to know if these were related to GA. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) for TCD/AC and HC/AC ratios in evaluating IUGR fetuses were calculated.
RESULTS
In the present study, linear relation of TCD and HC in IUGR fetuses with gestation was noted. The sensitivity, specificity, PPV, NPV & DA were 88%, 93.5%, 77.1%, 96.3% & 92.4% respectively for TCD/AC ratio versus 84%, 92%, 72.4%, 95.8% & 90.4% respectively for HC/AC ratio in predicting IUGR.
CONCLUSION
Both ratios were gestational age independent and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric IUGR.
背景
胎儿生长受限（IUGR）的高发病率及其低识别率导致围产期发病率和死亡率不断上升，因此，对IUGR进行预测并及时做出管理决策至关重要。许多研究比较了几种与孕周无关的参数的效能，发现经颅多普勒/腹围（TCD/AC）是不对称性IUGR的更好预测指标。
目的
比较经小脑横径/腹围与头围/腹围在预测妊娠20周后不对称性胎儿生长受限方面的准确性。
材料与方法
前瞻性研究历时一年，对50例临床疑似IUGR的孕妇进行研究，由一名超声科医生使用3.5MHz频率的超声扫描仪进行评估。测量双顶径（BPD）、头围（HC）、腹围（AC）、股骨长度（FL）以及经颅多普勒（TCD），以评估超声孕周。计算两个形态学比值——TCD/AC和HC/AC。计算所有这些孕妇的估计胎儿体重并确定其百分位数。
统计方法
将TCD/AC和HC/AC比值与孕周进展进行相关性分析，以了解它们是否与孕周相关。计算TCD/AC和HC/AC比值在评估IUGR胎儿时的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性（DA）。
结果
在本研究中，观察到IUGR胎儿的TCD和HC与孕周呈线性关系。在预测IUGR方面，TCD/AC比值的敏感性、特异性、PPV、NPV和DA分别为88%、93.5%、77.1%、96.3%和92.4%，而HC/AC比值分别为84%、92%、72.4%、95.8%和90.4%。
结论
两个比值均与孕周无关，可用于检测IUGR，诊断准确性良好。然而，在预测不对称性IUGR方面，TCD/AC比值比HC/AC比值具有更好的诊断有效性和准确性。
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