Journal of Developmental Medicine(Electronic Version)  2024, Vol. 12 Issue (4): 255-262 DOI: 10.3969/j.issn.2095-5340.2024.04.003 |
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| Value of measuring thymic parameters based on prenatal three-dimensional ultrasound inthe evaluation of fetal growth restriction |
| Zhou Xundan, An Peili, Yang Fang, et al
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(Ultrasound Center, Northwest Women's and Children'sHospital, Shaanxi, Xi'an 710061, China)
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Abstract 【Abstract】 Objective To explore the application value of prenatal three-dimensional ultrasound
measurement of thymic parameters in the evaluation of fetal growth restriction (FGR). Method Seventyfivepregnant women with FGR in the third trimester of pregnancy who were admitted to the NorthwestWomen's and Children's Hospital from March 2021 to March 2022 were selected as the study group. Seventyfivepregnant women with normal fetal development in the third trimester of pregnancy who were admitted tothe same hospital during the same period and in the same age group were selected as the control group using arandom number table method. All participants underwent prenatal three-dimensional ultrasound examinationto measure the thymuic volume, transverse diameter, anterior and posterior diameter, and thymic-thoracicratio (T-T) value of the fetus. Clinical data, FGR-related serological markers [(placental growth factor(PLGF), pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-hCG)],fetal abdominal circumference Z-score, uterine artery flow parameters [pulsatility index (PI), resistance index(RI), end-systolic peak flow velocity to end-diastolic peak flow velocity ratio (S/D), fetal three-dimensionalultrasound thymic parameters were compared between the two groups, and the relationship between fetalthree-dimensional ultrasound thymic parameters and other FGR related indicators were analyzed. Therelationship between fetal thymus parameters and 5-min Apgar score of fetus was analyzed and the valueof fetal FGR was evaluated. Statistical methods performed by t-test, χ2 test, Spearman correlation analysisand receiver operating characteristic (ROC) curve. Result There was no significant difference in age,gestational age and postpartum between the study group and the control group (all P>0.05). Prenatal bodymass index (BMI) [(21.4±1.9) vs (23.2±2.2) kg/m2], serum PLGF[(0.63±0.19) vs (1.04±0.30) MOM],PAPP-A[(0.78±0.23) vs (1.57±0.42) MOM, the levels of β-hCG [(0.69±0.21) vs (1.35±0.36) MOM] andZ-score of fetal abdominal circumference [(-1.75±0.53) vs (-0.16±0.05) points] in the study group werelower than those in the control group. Incidence of gestational diabetes mellitus (GDM) [26.7% (20/75) vs6.7% (5/75)], the incidence of hypertensive disorders of pregnancy (HDP) [(34.7% (26/75) vs 10.7% (8/75)],uterine artery PI (1.39±0.37 vs 0.95±0.30), RI (0.71±0.21 vs 0.54±0.16), S/D (3.08±0.85 vs 2.49±0.71)in the study group were all higher than those in the control group. The differences were statistically significant(all P<0.05). In the study group, the thymic volume [(8.25±0.76) vs (8.84±0.83) ml], transverse diameter[(3.11±0.25) vs (3.40±0.28) cm], anterior and posterior diameter [(1.33±0.15) vs (1.45±0.20) cm, T-Tvalues (0.32±0.06 vs 0.38±0.08) were lower than those in the control group (all P<0.001). Spearmancorrelation analysis showed that the thymic volume, transverse diameter, anterior and posterior diameter,and T-T value of the fetus in the study group were positively correlated with serum PLGF, PAPP-A, β-HCGlevels, and Z-score of fetal abdominal circumference, and negatively correlated with uterine artery PI, RI,and S/D (P<0.05). The 5 min Apgar score of the study group was <7 and 7-10, the fetal thymic volume[(7.92±0.59) vs (8.45±0.65) ml], the transverse diameter [(2.95±0.22) vs (3.21±0.26) cm], the anterior andposterior diameter [(1.24±0.13) vs (1.38±0.15) cm] and T-T value (0.29±0.03 vs 0.34±0.05) in <7 groups
were lower than those in 7-10 groups (all P<0.001). The fetal thymic volume, transverse diameter, anterior
and posterior diameter and T-T value were positively correlated with 5 min Apgar score (r=0.348, 0.416, 0.379,0.450, all P<0.05). The maximum area under the curve (AUC) of fetal FGR was 0.918 (95% CI: 0.863-0.957,P<0.001) in the combined evaluation of fetal thymic volume, transverse diameter, anterior and posteriordiameter and T-T value. Conclusion The thymic parameters of prenatal three-dimensional ultrasoundare closely related to the uterine artery blood flow, fetal placental development, and neonatal 5 minApgar score in FGR. The combined assessment of fetal thymic volume, transverse diameter, anterior andposterior diameter, and T-T value has a high diagnostic efficiency for FGR.
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Received: 16 May 2024
Published: 31 July 2024
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