新型超声技术评估血糖控制良好的妊娠期糖尿病胎儿心功能及妊娠结局：前瞻性病例对照研究
该前瞻性病例对照研究纳入122例血糖控制良好的GDM孕妇和256例血糖正常孕妇，采用HOLO-PW技术提取胎儿心功能参数。结果显示GDM组胎儿左右心室MPI、KI、ICT、IRT均升高，且心功能参数与不良围产结局相关；基于LMPI、LKI、RIRT构建的列线图预测不良围产结局的AUC达0.960（95%CI:0.924-0.996），但需外部验证。
要点
- 血糖控制良好的GDM胎儿仍存在心功能改变，表现为左右心室MPI、KI、ICT、IRT升高。
- LMPI预测GDM不良围产结局能力最强，AUC为0.951（95%CI:0.909-0.993）。
- 基于LMPI、LKI、RIRT的列线图预测不良围产结局AUC为0.960（95%CI:0.924-0.996），需外部验证。
关键影像表现/征象
- GDM组胎儿左右心室心肌性能指数（MPI）、K指数（KI）、等容收缩时间（ICT）和等容舒张时间（IRT）均较对照组升高（p<.05）。
- GDM组中生长异常胎儿与适龄胎儿的以下心功能参数存在显著差异（p<.05）。
- GDM组不良围产结局发生率高于对照组，且不良结局与正常围产结局胎儿的心功能参数显著不同（p<.05）。
诊断标准与关键数值
- 左心室心肌性能指数（LMPI）预测GDM不良围产结局的AUC为0.951（95%CI:0.909-0.993）。
- 基于LASSO回归筛选的3个关键预测因子（LMPI、LKI、RIRT）构建的列线图预测不良围产结局的AUC为0.960（95%CI:0.924-0.996）。
临床应用与阅片要点
- HOLO-PW技术可定量评估胎儿心功能，MPI、KI、ICT、IRT等参数在GDM胎儿中升高，阅片时可关注这些指标的变化。
- 对于GDM孕妇，可结合LMPI、LKI、RIRT等参数评估不良围产结局风险，但需注意模型尚未外部验证。
局限性
- 模型需外部验证后方可用于临床。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To investigate the changes in fetal cardiac function in pregnant women with well-controlled gestational diabetes mellitus (GDM) using a novel ultrasound technology named HOLO-PW. Secondly, we aim to evaluate the predictive ability of cardiac function parameters for adverse perinatal outcomes and establish an individualized nomogram.
METHODS: This study included 122 pregnant women with well-controlled GDM and 256 pregnant women with normal blood glucose. Fetal cardiac function parameters were extracted based on the HOLO-PW technology. The differences between the 2 groups were analyzed. Subgroup analysis was performed in the GDM group according to the pregnancy outcome and fetal growth status. The effectiveness of cardiac function parameters in predicting adverse pregnancy outcomes in GDM was evaluated by receiver operating characteristic (ROC) curves. Independent predictors were identified through logistic regression with LASSO variable selection, and a nomogram was developed. The model's performance was evaluated with ROC analysis, calibration curves, and decision curve analysis (DCA).
RESULTS: Compared with the control cohort, the myocardial performance index (MPI), K index (KI), isovolumic contraction time (ICT), and isovolumic relaxation time (IRT) of left and right ventricles were increased in the fetuses of GDM cohort (p < .05). Compared with the appropriate for gestational age (AGA), the fetuses with abnormal growth in the GDM cohort presented significant differences in the cardiac function parameters (p < .05). The incidence of adverse pregnancy outcomes in the GDM cohort was higher than that in the control cohort. The cardiac function parameters of fetuses with adverse and normal perinatal outcomes significantly differed in the GDM cohort (p < .05). We also evaluated the predictive capacity of each heart function parameter for adverse pregnancy outcomes in GDM. The LMPI showed the strongest ability to predict adverse pregnancy outcomes with an AUC of 0.951 (95% CI: 0.909-0.993). A nomogram constructed with the 3 key predictors selected by LASSO regression (LMPI, LKI, and RIRT) demonstrated excellent discrimination, with an AUC of 0.960 (95% CI: 0.924-0.996). The model was well calibrated, and DCA indicated clinical utility.
CONCLUSION: Even under well-controlled glycemic conditions, fetal cardiac function is altered in GDM pregnancies. In this cohort, a model based on fetal cardiac function parameters showed good predictive performance for composite adverse perinatal outcomes. However, external validation is required before clinical implementation.
引用
- Yi L, Wang L, Sun L, et al. Assessment of Fetal Cardiac Function and Pregnancy Outcomes in Well-Controlled Gestational Diabetes Mellitus Using Novel Ultrasound Technology: A Prospective Case-Control Study. J Ultrasound Med. 2026. PMID: 42104535. doi:10.1002/jum.70249
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。