广西医学

目的构建正常胎儿脐静脉血流量（Quv）Z评分模型，并探讨该模型对小于胎龄儿（SGA）围生期不良结局的预测价值。方法（1）纳入862例18~40周正常胎儿建立模型。以腹部超声测量的腹内段Quv作为因变量，孕周为自变量，采用回归分析获得Quv均数及标准差的最佳拟合方程后，根据公式［Z评分=（实际Quv测值-拟合Quv均值）/拟合Quv标准差］建立正常胎儿Quv Z评分模型。（2）另纳入53例正常胎儿（正常组）和109例SGA，并根据围生期有无不良结局将SGA分为不良结局组（n=50）、无不良结局组（n=59）。利用所建立的模型获得3组的胎儿Quv Z评分。通过绘制受试者工作特征曲线分析正常胎儿Quv Z评分预测SGA围生期不良结局的效能。结果（1）正常胎儿的Quv与孕周呈正相关（P<0.05），Quv的均数及标准差相对孕周的最佳拟合方程均为线性方程。根据公式获得正常胎儿Quv Z评分模型：Z评分=（Quv+346.069-20.754×孕周）/（-51.320+4.075×孕周）。正常组胎儿Quv 的Z评分呈正态分布，且不随孕周而改变。（2）不良结局组、无不良结局组、正常组的胎儿Quv Z评分依次增加（P<0.05）。（3）正常胎儿Quv Z评分预测SGA围生期不良结局的曲线下面积为0.843，基于最佳截断值-2.06的预测敏感度、特异度、阳性预测值、阴性预测值分别为74.0%、86.4%、82.2%、76.4%。结论所建立的正常胎儿Quv Z评分模型可消除孕周的影响，具有较好的临床适用性。正常胎儿Quv Z评分是预测SGA围生期不良结局较敏感的指标。

Objective To establish the Z⁃score model of umbilical venous blood flow (Quv) in normal fetuses, and to explore the predictive value of this model on perinatal adverse outcome in small for gestational age fetuses (SGA).Methods (1) A total of 862 normal fetuses from 18 to 40 weeks were enrolled to establish the model.The intra⁃abdominal Quv measured by abdominal ultrasound was taken as the dependent variable, gestational age was taken as the independent variable, and the regression analysis was used to obtain the best fitting equation of mean and standard deviation of Quv, after then the Quv Z⁃score model of normal fetuses was established according to the equation (Z score=［actual Quv measured value⁃fitting Quv mean value］/fitting Quv standard deviation). (2) In addition, 53 normal fetuses (the normal group) and 109 SGA were enrolled, and SGA was assigned to adverse outcome group (n=50) or non⁃adverse outcome group (n=59) according to the presence of perinatal adverse outcome. The established model was used to obtain Quv Z score of fetuses in the 3 groups. The receiver operating characteristic curve was drawn to analyze the efficiency of normal fetuses' Quv Z score for predicting SGA perinatal adverse outcome. Results (1) Quv positively correlated with gestational age in normal fetuses (P<0.05), and the best fitting equations of mean and standard deviation of Quv relative to gestational age were all linear equations. The Quv Z⁃score model of normal fetuses was obtained according to the equations as follows: Z score=(Quv+346.069-20.754×gestational age)/(-51.320+4.075×gestational age). Quv Z score of fetuses in the normal group presented as normal distribution, and did not change with the gestational age. (2) Fetuses' Quv Z scores were successively increased in the adverse outcome, non⁃adverse outcome, and normal groups (P<0.05). (3) Area under the curve of normal fetuses' Quv Z score for predicting SGA perinatal adverse outcome was 0.843, and the sensitivity, specificity, positive predictive value, and negative predictive value were 74.0%, 86.4%, 82.2%, and 76.4% based on the optimal cut⁃off value of -2.06, respectively. Conclusion The established normal fetuses' Quv Z⁃score model can eliminate effects of gestational age, exerting favorable clinical applicability. Normal fetuses' Quv Z score is relatively sensitive indicator for predicting SGA perinatal adverse outcome.

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