Ultrasound combined with thyroid hormone detection for diagnosis of intrauterine growth restriction in asymmetrical fetuses in the second trimester of pregnancy

doi:10.3877/cma.j.issn.1672-6448.2020.11.007

Abstract

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.

Key words: Ultrasound, Thyroid hormone, Intrauterine growth restriction

Kangtai Lyu, Haijing Zhao, Hongbin Deng, Qing Lu, Juan Wang, Haiping Wu, Jinjun Hou, Yuming Luo. Ultrasound combined with thyroid hormone detection for diagnosis of intrauterine growth restriction in asymmetrical fetuses in the second trimester of pregnancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(11): 1090-1094.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2020.11.007

https://chaosheng.cma-cmc.com.cn/EN/Y2020/V17/I11/1090

Figures/Tables 3

References 19

1	陈海燕. 不同孕周产前超声筛查胎儿畸形的临床价值 [J]. 中国医药指南, 2014, 29(4): 324-324.
2	张晓新，许翠平，任秀珍, 等. 中晚孕期产前超声筛查胎儿畸形的临床价值 [J/CD]. 中华临床医师杂志(电子版), 2010, 4(5): 558-562.
3	肖作源，唐新意，陈裕明, 等. 小于胎龄儿临床分型及其与围生期因素相关性探讨 [J]. 中国实用儿科杂志, 2003, 18(7): 408-410.
4	Wier FA, Farley CL. Clinical controversies in screening women for thyroid disorders during pregnancy [J]. J Midwifery Womens Health, 2006, 51(3): 152-158.
5	黄林环，方群，谢红宁, 等. 胎儿短长骨的产前诊断及临床分析 [J]. 中华医学杂志, 2007, 87(45): 3178-3182.
6	朱毓纯，孙瑜，杨慧霞, 等. 胎儿股骨短的临床意义和处理 [J]. 中华围产医学杂志, 2015, 18(4): 313-314.
7	严英榴，杨秀雄. 产前超声诊断学 [M]. 2版. 北京: 人民卫生出版社, 2012: 415-424.
8	Ashoor G, Maiz N, Rotas M, et al. Maternal thyroid function at 11 to 13 weeks of gestation and subsequent fetal death [J]. Thyroid, 2010, 20(9): 989-993.
9	唐慧霞，李胜利. 超声估测胎儿体重的研究进展 [J/CD]. 中华医学超声杂志(电子版), 2014, 11(5): 369-374.
10	李海朋，庞远，董亚男, 等. 彩超检测胎儿骨骼发育迟缓与孕妇甲状腺激素水平的研究[J]. 中国煤炭工业医学杂志, 2017, 20(2): 173-175.
11	代晶. 产前超声诊断胎儿股骨短小的研究进展 [J/CD]. 中华妇幼临床医学杂志(电子版), 2014, 10(3): 105-108.
12	Morreale de Escobar G, Obregón MJ, Escobar del Rey F. Is neuropsychological development related to maternal hypothyroidism or to maternal hypothyroxinemia? [J]. J Clin Endocrinol Metab, 2000, 85(11): 3975-3987.
13	Morreale de Escobar G, Obregon MJ, Escobar del Rey F. Role of thyroid hormone during early brain development [J]. Eur J Endocrinol, 2004, 151 Suppl 3: U25-U37.
14	孙丽洲，姜子燕. 妊娠合并慢性淋巴细胞性甲状腺炎 [J]. 中国实用妇科与产科杂志 , 2007, 23(12): 915-917.
15	姜云生，王崇丹. 妊娠期甲状腺功能减退症的诊治进展 [J]. 齐齐哈尔医学院学报 , 2011(23): 3880-3882.
16	Gil-Garay R, Miralles-Flores C, Obregón MJ, et al. Maternal hypothyroidism and fetal chondro-osseous development in rats [J]. Biol Neonate, 1991, 60(6): 385-394.
17	Lanham SA, Fowden AL, Roberts C, et al. Effects of hypothyroidism on the structure and mechanical properties of bone in the ovine fetus [J]. J Endocrinol, 2011, 210(2): 189-198.
18	马品江，孙燕，郭进军. 吐鲁番盆地碘缺乏病区孕妇碘营养与胎儿生长发育关系的研究[J]. 实用预防医学 , 2009, 16(5): 1448-1451.
19	Farquharson C. Social networking between cells of the foetal skeleton: the importance of thyroid hormones [J]. J Endocrinol, 2011, 210(2): 135-136.

孕周	TSH高并FT₄低	仅TSH高	仅FT₄低
（18±1）周	4	4	22
（22±1）周	2	4	51

孕周	TSH高并FT₄低	仅TSH高	仅FT₄低
（18±1）周	4	4	22
（22±1）周	2	4	51

组别	例数	（18±1）周		（22±1）周
组别	例数	TSH[mlU/ml，M（Q_R）]	FT₄（pmol/L，±s）	TSH[mlU/ml，M（Q_R）]	FT₄（pmol/L，±s）
观察组	97	2.11（1.40~3.91）	10.74±2.87	2.52（1.74~3.21）	11.96±2.87
对照组	30	2.12（1.46~2.65）	14.83±1.91	1.96（1.54~2.76）	15.28±2.14
统计值		Z=-0.618	t=-6.978	Z=-2.191	t=-6.793
P值		0.537	<0.001	0.028	<0.001

组别	例数	（18±1）周		（22±1）周
组别	例数	TSH[mlU/ml，M（Q_R）]	FT₄（pmol/L，±s）	TSH[mlU/ml，M（Q_R）]	FT₄（pmol/L，±s）
观察组	97	2.11（1.40~3.91）	10.74±2.87	2.52（1.74~3.21）	11.96±2.87
对照组	30	2.12（1.46~2.65）	14.83±1.91	1.96（1.54~2.76）	15.28±2.14
统计值		Z=-0.618	t=-6.978	Z=-2.191	t=-6.793
P值		0.537	<0.001	0.028	<0.001

[1]	Qi Lyu, Pinjing Hui, Yafang Ding, Yanhong Yan. Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1040-1045.
[2]	Lei Ding, Wen Luo, Xiao Yang, Lina Pang, Peidi Zhang, Haijing Liu, Jiani Yuan, Jin Liu. Application of high-frame-rate contrast-enhanced ultrasound in evaluation of imaging features of C-TIRADS 4-5 thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 887-894.
[3]	Qian Zhang, Jiahui Chen, Xuemeng Gao, Aoxue Zhao, Ying Huang. Value of radiomics features based on high-frame-rate contrast-enhanced ultrasound in differential diagnosis of benign and malignant thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 895-903.
[4]	Lianhua Zhu, Xiang Fei, Peng Han, Bo Jiang, Nan Li, Yukun Luo. Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 904-910.
[5]	Miao Li, Lianhua Zhu, Peng Han, Bo Jiang, Xiang Fei. Evaluation of relationsip between vascular morphology and risk factors for hepatocellular carcinoma by high-frame-rate contrast-enhanced ultrasound [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 911-915.
[6]	Weiping Zhang, Jingling Wang, Zhixing Liu, Li Chen, Fangqun Chen. Characteristics of time-intensity curve of high-frame-rate contrast-enhanced ultrasound in clear cell renal cell carcinoma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 916-922.
[7]	Jianmin Ding, Zhengyi Qin, Xiang Zhang, Yan Zhou, Hongyu Zhou, Yandong Wang, Xiang Jing. Contrast-enhanced ultrasound versus gadoxetic acid-enhanced magnetic resonance imaging for LI-RADS classification of focal liver lesions ≤3 cm in patients at high risk of hepatocellular carcinoma: a prospective study [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 930-938.
[8]	Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[9]	Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia. Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 787-794.
[10]	Yanbo Ma, Yang Hua, Guimei Liu, Xiufeng Meng, Liping Cui. Risk factors for carotid atherosclerotic lesions in middle adults [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 822-826.
[11]	Hua Shao, Ziyue Na, Hui Jing, Bo Li, Qiucheng Wang, Wen Cheng. Value of preoperative percutaneous contrast-enhanced ultrasound in diagnosis of axillary sentinel lymph node metastasis and burden in breast cancer [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 849-853.
[12]	Xu Zhang, Jianping Xu, Dongming Su, Caifen Wang, Dali Wang, Wenzhi Zhang. Contrast-enhanced ultrasound features of male breast masses [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 854-859.
[13]	Xining Wu, Peipei Zhang, Zhenhong Qi, Jing Zhang, Ruina Zhao, Hua Meng, Jianchu Li. Quality of ultrasonic diagnosis of retroperitoneal schwannomas and its influencing factors [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 701-704.
[14]	bing Feng, Qiuguo Zou, Zhenbo Liang, Yanming Lu, Yi Zeng, Shumiao Wu. Clinical study of ultrasonic signs and molecular biological indicators of senile non-specific invasive breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 48-51.
[15]	Wenyi Zhao, Bingzi Zou, Guanhui Cai, Yongzhi Liu, Hong Wen. Application of ultrasound strain elastography combined with MRI-DWI guided targeted puncture in diagnosis of prostate lesions [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 988-994.

Please choose a citation manager

Content to export