【摘要】 目的探讨孕中期超声与甲状腺激素联合检查对诊断非匀称型胎儿宫内生长受限（IUGR）的价值。方法选取2016年6月至2019年6月在南京医科大学第二附属医院建立围产期保健卡的自然受孕单胎孕中期母胎6010例,其中胎儿为非匀称型IUGR者97例为观察组,同孕期胎儿生长均衡的孕母30例为对照组。分别采用Mann-Whitney U检验和独立样本t检验对比评价孕（18±1）周、（22±1）周,观察组与对照组母体血清促甲状腺激素（TSH）和游离甲状腺素（FT₄）水平的差异。采用受试者操作特征（ROC）曲线分析孕（18±1）周和（22±1）周母体TSH和FT₄预测胎儿生长迟缓的价值。结果观察组母体（18±1）周和（22±1）周时FT₄水平低于对照组[（10.74±2.87）pmol/L vs（14.83±1.91）pmol/L;（11.96±2.87）pmol/L vs（15.28±2.14）pmol/L],差异均具有统计学意义（t=-6.978、-6.793,P均<0.001）;观察组母体（22±1）周时TSH水平高于对照组[2.52（1.74～3.21）mlU/ml vs 1.96（1.54～2.76）mlU/ml],差异有统计学意义（Z=-2.191,P=0.028）;（18±1）周时2组母体TSH水平比较,差异无统计学意义（P> 0.05）。孕（18±1）周、（22±1）周时母体FT₄预测胎儿生长迟缓的敏感度均大于95%,分别为96.7%和100%,显著高于TSH（32.4%和55.2%）;但母体TSH预测胎儿生长迟缓的特异度（90.0%和73.3%）却高于FT₄（75.7%和56.2%）。结论孕中期超声与甲状腺激素联合检查对非匀称型IUGR具有一定的预测价值。更多还原

【Abstract】 Objective To evaluate the diagnostic value of mid-pregnancy ultrasound combined with thyroid hormone examination for asymmetrical fetal intrauterine growth restriction（IUGR）. Methods A total of 6010 naturally conceived single fetuses in the second trimester of gestation were selected at the Second Affiliated Hospital of Nanjing Medical University from June 2016 to June 2019, among which 97 cases of fetuses with asymmetrical IUGR were included in an observation group. Thirty cases of fetuses during normal pregnancy were included in a control group. Mann-Whitney U test and independent sample t test were used to compare the difference of maternal serum thyroid stimulating hormone（TSH） and free thyroxine（FT₄） between the observation group and the control group at（18±1） weeks and（22±1） weeks of pregnancy. The receiver operating characteristic（ROC） curve was used to analyze the value of maternal TSH and FT₄ in predicting fetal growth retardation at（18±1） weeks and（22±1） weeks of gestation. Results The FT₄ levels of the observation group were significantly lower than those of the control group at（18±1） weeks and（22±1） weeks [（10.74±2.87） pmol/L vs（14.83±1.91） pmol/L, t=-6.978, P < 0.001;（11.96±2.87） pmol/L vs（15.28±2.14） pmol/L, t=-6.793, P < 0.001], but TSH was significantly higher in the observation group than in the control group at（22±1） weeks [2.52（1.74～3.21） mIU/ml vs 1.96（1.54～2.76） mIU/ml, Z=-2.191, P=0.028]. There was no significant difference in maternal TSH between the two groups at 18±1 weeks（P > 0.05）. At（18±1） weeks and（22±1） weeks, the sensitivities of maternal FT₄ in predicting fetal growth retardation were 96.7% and 100%, respectively, which were significantly higher than those of TSH（32.4% and 55.2%）. However, maternal TSH predicted fetal growth retardation more specifically than FT₄（90.0% vs 75.7%, 73.3% vs 56.2%）. Conclusion Ultrasound combined with thyroid hormone detection has appreciated predictive value for asymmetrical IUGR in the second trimester of pregnancy.更多还原