Objective:This study aimed to investigate factors influencing fetal growth restriction (FGR) occurrence and assess the clinical significance of fetal cardiac parameters in FGR prediction. Methods:Pregnant women with clinically suspected FGR (n=179) and uncomplicated pregnancies (n=53) were included. All had undergone routine obstetric ultrasonography and fetal echocardiography. Umbilical artery flow (UAF) and fetal cardiac parameters (left atrial transverse diameter (LAd), right atrial transverse diameter (RAd), left ventricular transverse diameter (LVd), right ventricular transverse diameter (RVd), foramen ovale width, atrial septum diameter, interventricular septal thickness, left ventricular posterior wall thickness, right ventricular free wall thickness, aortic diameter, pulmonary artery diameter, mitral E velocity, mitral A velocity, tricuspid E velocity, tricuspid A velocity, aortic valve peak flow velocity, and pulmonary valve peak flow velocity) were detected. Follow up was conducted until birth, various fetal clinical parameters were collected: maternal body mass index (BMI), hypertensive disorders complicating pregnancy (HDCP), abnormal umbilical artery flow, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, emergency cesarean delivery, maternal height, maternal age, gestational diabetes mellitus (GDM), hypothyroidism, assisted reproductive technology (ART), parity, and neonatal gender. Participants were categorized into confirmed FGR (n=119) and control (n=113) groups based on neonatal birth weight. Results:Significant differences were observed between groups in maternal BMI, HDCP, abnormal UAF, placental or umbilical cord anomalies, low amniotic fluid volume, preterm birth, and emergency cesarean delivery. FGR was positively related to abnormal UAF, placental or umbilical cord anomalies, preterm birth and emergency cesarean delivery and negatively to maternal BMI (r=-0.276). Compared to the control group, the FGR group exhibited significantly larger RAd, RVd, RA/LA, and RV/LV. Conclusion:Fetal growth-restricted fetuses have enlarged right heart structures. Fetal cardiac examinations are valuable for early FGR diagnosis, potentially improving neonatal body weight and reducing adverse pregnancy outcomes.

目的:探讨自动心肌运动定量(aCMQ)技术评估射血分数保留型频发室性早搏患者左室收缩功能的价值.方法:选取34例射血分数保留型(LVEF>50％)频发室性早搏患者作为室早组.同期选取性别匹配的27例健康者作为对照组.运用常规超声心动图获取2组左房内径(LAD)、左室舒张未内径(LVIDd)、左室收缩末内径(LVIDs)、左室射血分数(LVEF)、二尖瓣舒张早期和心房收缩期峰值流速比值(E/A)、二尖瓣舒张早期峰值流速与组织多普勒二尖瓣环(侧壁及室间隔)舒张早期速度平均值的比值(E/E'a).运用aCMQ技术获得2组两腔心纵向应变(AP2LS)、三腔心纵向应变(AP3LS)、四腔心纵向应变(AP4LS)及整体纵向应变(LVGLS),左室短轴基底段环向应变(SAXBCS)、左室短轴中间段环向应变(SAXMCS)、左室短轴心尖段环向应变(SAXACS)及整体环向应变(LVGCS),并进行比较分析.结果:室早组与对照组年龄、体表面积差异无统计学意义(均P>0.05);室早组与对照组LVIDd、LVIDs差异均有统计学意义(均P<0.05);室早组与对照组LAD、LVEF、E/A、E/E'a差异无统计学意义(均P>0.05).室早组AP2LS、LVGLS、SAXMCS绝对值较对照组减低,差异有统计学意义(均P<0.05).AP2LS及LVGLS对频发室早患者左室收缩功能受损有较好的预测价值.结论:aCMQ技术能发现频发室早患者早期隐匿性的心功能改变,可作为一种评估左室收缩功能相对准确的方法.

目的 应用声触诊组织量化(VTQ)技术研究糖尿病患者腓肠肌及比目鱼肌的剪切波速度变化.方法 应用VTQ技术选取2017年10月至2018年3月在温州医科大学附属第二医院确诊的35例糖尿病患者及22例健康人的小腿后侧肌群进行检测,分别于踝关节自然位、最大背屈位及最大跖屈位下在纵切获得双侧小腿腓肠肌内侧头、腓肠肌外侧头、比目鱼肌的剪切波速度.比较糖尿病组小腿后侧不同肌肉在踝关节同一体位下剪切波速度的差异,比较糖尿病组与正常对照组间同一体位下对应小腿肌肉的剪切波速度,同时分析小腿后侧不同肌肉在不同体位下获得剪切波速度的重测信度.结果 在踝关节自然位置、最大背屈位,最大跖屈位下,糖尿病组的左右侧小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波速度对应比较,差异无统计学意义(P>0.05).糖尿病组患者踝关节在同一体位下,腓肠肌内侧头与腓肠肌外侧头剪切波速度比较,差异无统计学意义(P>0.01),腓肠肌内侧头与比目鱼肌的剪切波速度在3种体位下,差异均有统计学意义(H=35.348、52.364、30.348、45.697、51.621、39.318,P均<0.001),而腓肠肌外侧头与比目鱼肌的剪切波速度仅在最大背屈位时,差异有统计学意义(H=46.636、47.288,P均<0.001).分别于踝关节自然位置、最大背屈位、最大跖屈位下正常对照组与糖尿病组的小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波数据比较,差异均有统计学意义(t=2.768、4.110、2.202、10.852、2.246、2.682、2.493、2.541、2.355、2.139,Z=-3.203、2.829、-2.698、-2.912、-3.185、-3.177、-5.439、-2.796,P均<0.05).腓肠肌内外侧头及比目鱼肌在3种体位下剪切波速度的重复测量组内相关系数值均大于0.75,重测信度较好.结论 糖尿病可能会导致小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌肌肉的剪切波速度降低,并且糖尿病患者小腿腓肠肌内侧头、腓肠肌外侧头及比目鱼肌的剪切波速度与踝关节体位相关,不同肌肉肌肉的剪切波速度也有差异.

Fetal hydronephrosis (HY) is a frequent congenital condition, which may be detected by prenatal ultrasound. Society for Fetal Urology (SFU) and anterior-posterior diameter (APD) grading are two major grading systems based on ultrasonography. The present study aimed to assess the predictive value of the SFU and APD grades in patients with fetal HY. A total of 162 patients with 234 kidneys affected by HY were included in the present study. The SFU and APD grades were determined from the ultrasound images at 38 gestational weeks, and a 12-month follow-up was performed after birth. The associations of the SFU and APD grades with the outcome of fetal HY, including HY regression, and post-partum surgery were examined. In the present study, 16 patients with 17 kidneys were diagnosed with pathological HY, and stenosis at the ureteropelvic junction was demonstrated to be a leading cause of pathological HY. Among the 234 kidneys affected by HY, 161 kidneys were scored as SFU grade I, 57 as SFU grade II, 7 as SFU grade III and 9 kidneys as SFU grade IV. According to the APD grading system, 112 kidneys were determined as having low, 104 as having moderate and 18 as having severe HY. The SFU and APD grades were demonstrated to be independently associated with the occurrence of pathological HY by logistic regression analysis with a high diagnostic accuracy to distinguish pathological and physiological HY cases as evidenced by the results of ROC analysis. In addition, univariate and multivariate logistic regression analysis indicated that patients with spontaneous HY regression usually had low SFU and APD grades. Furthermore, the rate of surgery was increased in the group of patients with high SFU or APD grades, and these two systems were identified as independent predictors for the requirement of surgery by Kaplan-Meier analysis. Patients with pathological HY had high SFU and APD grades, and these two grading systems may be used as reliable predictors for the outcome of fetal HY, including HY regression, and post-partum surgery.