Relationship between mid‐trimester ultrasound fetal liver length measurements and gestational diabetes mellitus 妊娠中期三个月超声测量的胎儿肝脏长度与妊娠期糖尿病之间的关系

Background The aim of the present study was to investigate the relationship between mid-trimester ultrasound fetal liver length (FLL) and gestational diabetes mellitus (GDM) in a high-risk population. Methods A prospective study was performed in 331 women with singleton pregnancies who were at high risk of GDM and were undergoing a mid-trimester ultrasound examination. The ultrasound scan at 23 weeks gestation was followed by a 100-g oral glucose tolerance test (OGTT) at 24 weeks gestation. Correlations between FLL and OGTT results at different time points were tested. Receiver operating characteristic (ROC) analysis of FLL as a potential prognostic factor for GDM was also performed. Results In GDM patients, there was a significant positive correlation (P < 0.01) between FLL and OGTT glycemia immediately before and 60, 120, and 180 min after glucose intake. Mean FLL in GDM was significantly higher than in healthy subjects (41.04 vs 31.09 mm, respectively; P < 0.001). When tested as a potential prognostic factor for GDM, fetal liver measurements showed excellent diagnostic performance. The ROC analysis established a cut-off value of FLL of 39 mm for the prediction GDM, with sensitivity of 71.76%, specificity 97.56%, positive predictive value 91.0%, and negative predictive value 90.9%. The usefulness of FLL measurements was supported by a high area under the ROC curve (90.5%). Conclusion In conclusion, there is a strong correlation between FLL and OGTT results, with FLL possibly serving as a valid marker for the prediction of GDM in high-risk populations. 摘要 背景： 本研究的目的是在高危人群中调查妊娠中期三个月超声测量的胎儿肝脏长度（fetal liver length，FLL）与妊娠期糖尿病（gestational diabetes mellitus，GDM）之间的关系。 方法： 这是一项前瞻性的研究，纳入了331名具有高危GDM风险的单胎妊娠妇女，在妊娠中期三个月时进行超声检查。在妊娠第23周时进行超声扫描，接着在妊娠第24周进行口服100 g葡萄糖耐量试验（OGTT）。检验不同时间点的OGTT结果与FLL之间的相互关系。还分析了作为GDM的潜在预测因子的FLL的受试者工作特性（Receiver operating characteristic，ROC）。 结果： 在GDM患者中，FLL与OGTT之前的即刻血糖以及服用葡萄糖60、120、180分钟之后的血糖之间具有显著性的正相关关系（P < 0.01）。GDM患者的平均FLL显著高于健康受试者（分别为41.04与31.09 mm；P < 0.001）。在检测GDM潜在预测因子时发现胎儿的肝脏测量结果具有极好的诊断价值。进行ROC分析后确定了预测GDM的FLL临界值为39 mm，敏感性为71.76%，特异性为97.56%，阳性预测值为91%，阴性预测值为90.9%。ROC曲线下面积高达90.5%进一步说明了FLL测量的有效性。 结论： 总而言之，在高危的人群中，FLL与OGTT结果之间存在很强的相关性，FLL可以作为一个有效预测GDM的指标。