| Objectives To investigate the serum levels of alpha-fetoprotein(AFP),beta-human chorionic gonadotropin(β-h CG),unconjugated estriol(unconjugated estriol)in the second trimester of pregnancy u E3)and other indicators combined with Doppler ultrasound in late pregnancy to detect the predictive ability of peak systolic velocity/end diastolic velocity(S/D)of fetal growth restriction(FGR).Methods A total of 894 cases of maternal and child health care hospital in Anhui Province were collected during the specified period(January 1,2018 to December 31,2018).A total of85 cases of fetal growth restriction diagnosed as pregnancy outcome in our hospital during this period were selected,which were classified as fetal growth restriction group(FGR group).A total of 809 cases with normal pregnancy outcome became the normal control group.Collect cases general clinical data,mid pregnant women in down syndrome screening serological indexes the levels of AFP,beta h CG and u E3[represented by the digit ratio(multiple of the median,Mo M)] and late pregnancy ultrasound doppler index S/D ratio,by t test and map work curves(ROC curve)evaluation subjects each index to predict the feasibility of FGR alone and in combination.Results 1.Statistical analysis of general clinical data: there was no significant difference in maternal age and previous times of pregnancy and birth between FGR group and normal control group(all P > 0.05);The gestational weeks of delivery were(37.10±4.14)in FGR group and(39.55±5.99)in normal control group,and the difference was statistically significant(P < 0.05).The newborn body weight at birth was 2355.15±300.20 in the FGR group and 3265.87±680.50 in the normal control group,and the difference was statistically significant(P < 0.05).2.Serological results of Down’s screening in the second trimester showed that the AFP and β-h CG values in the FGR group were higher than those in the normal control group(2.24±0.10,2.15±0.11,respectively),and 1.38±0.24,1.50±0.19 in the normal control group(t =62.537,47.515,respectively,P < 0.05).The Mo M value of u E3 in the FGR group was significantly lower than that in the normal control group(0.51±0.08 in the FGR group and 0.91±0.12 in the normal control group),and the difference was statistically significant(t=41.442,P < 0.05).3.The S/D value of Doppler ultrasonography in the late trimester showed that the S/D value of the FGR group was significantly higher than that of the normal control group(2.94±1.01 in the FGR group and 2.21±0.28 in the normal control group)compared with that of the two groups,the difference was statistically significant(t=6.637,P <0.05).4.Receiver operating curve showed that each index had predictive significance(P <0.001).AFP,β-h CG,u E3 and S/D values of ROC-AUC were 0.836,0.724,0.786 and0.741,respectively.The combined ROC-AUC of multiple indicators was 0.937,which was significantly higher than that of individual indicators.The sensitivity and specificity of the combined prediction of FGR were 0.775,0.700,0.638,0.625 and 0.838,respectively,and the specificity were 0.665,0.687,0.839,0.833 and 0.872,respectively.The sensitivity and specificity of the combined prediction of FGR were higher than that of the combined prediction of FGR.The 95%CI of each individual index was 0.786-0.886,0.661-0.788,0.719-0.854,0.666-0.815,respectively,and the 95%CI of multi-index combined prediction was 0.899-0.975.PPV of each individual index were50.9%,58.9%,56.3%,61.0%,and NPV were 96.5%,96.8%,95.0%,98.7%,respectively.The PPV of multi-indicator combination was 85.4%,which was significantly higher than each single indicator,and the NPV was 98.2%,which was only slightly lower than the NPV of S/D value alone,and higher than other single indicators.Conclusions Serum AFP,β-h CG and u E3 of Down’s screening in the second trimester of pregnancy can predict FGR,and S / D value of Doppler ultrasound can also predict FGR.The combined prediction of each index is significantly better than that of each index alone,which is more valuable than that of single index. |
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