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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (01) : 23 -30. doi: 10.3877/cma.j.issn.1672-6448.2022.01.005

妇产科超声影像学

产前部分上臂容积测量与新生儿出生体质量的相关性
张卿1, 吴桂花1,†(), 朱国燕1   
  1. 1. 215128　江苏苏州，苏州市吴中人民医院超声科
  • 收稿日期:2020-04-22 出版日期:2022-01-01
  • 通信作者: 吴桂花

Correlation between prenatal fractional upper arm volume and neonatal birth weight

Qing Zhang1, Guihua Wu1,†(), Guoyan Zhu1   

  1. 1. Department of Ultrasonography, Suzhou Wuzhong People's Hospital, Suzhou 125128, China
  • Received:2020-04-22 Published:2022-01-01
  • Corresponding author: Guihua Wu
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张卿, 吴桂花, 朱国燕. 产前部分上臂容积测量与新生儿出生体质量的相关性[J/OL]. 中华医学超声杂志（电子版）, 2022, 19(01): 23-30.

Qing Zhang, Guihua Wu, Guoyan Zhu. Correlation between prenatal fractional upper arm volume and neonatal birth weight[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(01): 23-30.

目的

探讨三维超声5D Limb技术测量正常孕晚期临产前7 d内胎儿部分上臂容积（AVol）在新生儿估算出生体质量（EFW）中的应用价值。

方法

选取2018年7月至2019年6月期间在苏州市吴中人民医院超声科进行产检的临产前7 d内的115例胎儿作为研究对象，运用二维、三维超声技术为孕妇产检，并记录相关测量值，主要包括双顶径、股骨长度、头围、腹围、AVol。采用单因素和多因素线性回归分析各参数与新生儿BW之间的相关性，并建立回归方程产生新的BW估算公式。以新生儿BW为金标准，Hadlock经典公式为对照，运用χ2检验比较Hadlock经典公式与新公式的估算符合率（绝对误差和相对误差）的差异。再将胎儿按照BW分为低BW组、正常BW组和巨大儿组，运用配对t检验比较2种公式估算3组胎儿BW的相对误差（系统误差±随机误差）的差异。

结果

单因素相关分析显示，BW与双顶径、头围、腹围、股骨长度、AVol均具有相关性（r=0.477、0.515、0.506、0.404、0.827，P均＜0.001）；多因素回归分析显示，腹围、AVol为新生儿BW估算的独立影响因素（P=0.007、＜0.001）；基于双顶径、头围、腹围、股骨长度、AVol构建回归方程EFW（AVol）=-2470.985+56.547×双顶径+33.225×头围+50.142×腹围+169.806×股骨+47.203×AVol。EFW（AVol）公式估算BW的绝对误差符合率和相对误差符合率均高于Hadlock经典公式（65.2% vs 48.7%；84.3% vs 64.3%），差异具有统计学意义（P=0.011、＜0.001）。EFW（AVol）公式和Hadlock经典公式估算低BW组、正常BW组和巨大儿组胎儿BW的相对误差分别为（19.5%±7.2% vs 44.8%±29.6%）、（5.5%±4.3% vs 7.8%±5.5%）、（5.3%±3.4% vs 8.5%±4.5%），2种公式对正常BW组胎儿BW估算的相对误差比较，差异具有统计学意义（P＜0.001）。

结论

AVol与BW相关性显著，可作为新参数应用于估算新生儿BW的临床实践中。

关键词: 超声检查, 部分上臂容积, 新生儿, 出生体质量
Objective

To explore the application value of fetal fractional upper arm volume (AVol) measured by three-dimensional ultrasound 5D Limb technique within 7 days before delivery in the normal third trimester of pregnancy in neonatal birth weight (BW) estimation.

Methods

From July 2018 to June 2019, 115 fetuses within 7 days before delivery at the Ultrasound Department of Wuzhong People's Hospital in Suzhou City were selected as the research subjects. Two-dimensional and three-dimensional ultrasound technology was used for maternity examination. The measured values mainly included double parietal diameter (BPD), femoral length (FL), head circumference (HC), abdominal circumference (AC), and AVol. The correlations between each parameter and newborn BW were analyzed and a multi-factor linear regression equation was established to generate a new weight estimation formula. With BW as the gold standard and Hadlock classic formula as a control, the Chi-square test was used to analyze the absolute error and relative error coincidence rate of the new formula. Then, the fetuses were divided into a low BW group, a normal BW group, and a macrosomia group according to BW. Paired t-test was used to estimate the systematic and random errors of BW of different groups of fetuses.

Results

BW had significant correlations with BPD, HC, AC, FL, and AVol (r=0.477, P＜0.001; r=0.515, P＜0.001; r=0.506, P＜0.001; r=0.404, P＜0.001; r=0.827, P＜0.001). The regression equation generated was EFW(AVol)=-2470.985+56.547×BPD+33.225×HC+50.142×AC+169.806×FL+47.203×AVol. The new formula had significantly higher absolute and relative error compliance rates for BW estimation than the Hadlock classical formula (65.2% vs 48.7%, P=0.011; 84.3% vs 64.3%, P＜0.001). The relative errors of the new formula and the Hadlock classical formula for fetal BW estimation in the low BW group, normal BW group, and macrosomia group were (19.5%±7.2%) vs (44.8%±29.6%), (5.5%±4.3%) vs (7.8%±5.5%), and (5.3%±3.4%) vs (8.5%±4.4%), respectively, with statistically significant differences between the two formulas (P＜0.001).

Conclusion

AVol has a significant correlation with BW, and can be used as a new parameter for estimating neonatal BW in clinical practice.

Key words: Ultrasonography, Fractional upper arm volume, Neonates, Birth weight
图1 正常出生体质量儿上臂三维容积超声扫描图。图a为肱骨长轴切面，以肱骨中心的50%肱骨长度作5个等距横截面；图b为肱骨中心所在的上臂横截面
图2 巨大儿部分上臂容积（AVol）容积图像。分别描记胎儿上臂5个横截面边界，软件自动计算每个横截面面积，最后得出50%肱骨长度的肢体容积为AVol。图a~e是以肱骨中心50%长度作的5个等距横截面图。图f是由5个等距横截面及50%肱骨长度计算所得的AVol图像
图3 正常出生体质量儿部分上臂容积（AVol）容积图像。分别描记胎儿上臂5个横截面边界，软件自动计算每个横截面面积，最后得出50%肱骨长度的肢体容积为AVol。图a~e是以肱骨中心50%长度作的5个等距横截面图。图f是由5个等距横截面及50%肱骨长度计算所得的AVol图像
图4 操作者通过三维超声2次测量同一部分上臂容积的Bland-Altman图
图5 胎儿部分上臂容积与出生体质量关系散点图
表1 产前部分上臂容积估算新生儿出生体质量的多因素线性回归分析
因素 B值 B值的标准误差 t值 P值 B值的95%可信区间
双顶径 56.547 105.239 0.537 0.592 -152.033~265.126
头围 33.225 31.436 1.057 0.293 -29.081~95.530
腹围 50.142 18.397 2.725 0.007 13.678~86.605
股骨长度 169.806 186.133 0.912 0.364 -199.104~538.717
AVol 47.203 4.049 11.657 ＜0.001 39.177~55.228
表2 2种新生儿出生体质量估算公式的估算符合率比较［例（%）］
公式 例数 绝对误差 相对误差
符合 不符合 符合 不符合
Hadlokc经典公式 115 56（48.7） 59（51.3） 74（64.3） 41（35.7）
EFW（AVol）公式 115 75（65.2） 40（34.8） 97（84.3） 18（15.7）
χ2值 6.402 12.060
P值 0.011 0.001
表3 2种公式估算不同BW组胎儿体质量的相对误差比较（
xˉ
±s）
公式 低BW组 正常BW组 巨大儿组
Hadlock经典公式 44.8%±29.6% 7.8%±5.5% 8.5%±4.5%
EFW（AVol）公式 19.5%±7.2% 5.5%±4.3% 5.3%±3.4%
差值及95%可信区间 25.0（-6.3~57.0） 2.3（1.1~3.4） 3.1（2.9~6.4）
t值 2.222 3.897 1.974
P值 0.090 ＜0.001 0.700
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