多普勒超声在预测妊娠期高血压疾病中的应用研究进展
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摘要
妊娠期高血压疾病(hypertension in pregnancy,HIP)是妊娠与血压升高并存的一种疾病,可对孕产妇全身各器官产生不良影响,如可导致胎盘早剥、弥散性血管内凝血、心肝肾衰竭、肺水肿、高血压脑病,甚至死亡,亦可造成胎儿生长受限、羊水过少、早产、宫内窘迫、神经系统损伤,甚至死亡,为产科严重并发症之一,是孕产妇及围产儿高发病率及死亡率的主要原因。多普勒超声因具有无创、价格低廉等优点,广泛用于产前超声诊断,常规用于监测妊娠期并发症及评价围产儿结局。该文对多普勒超声检查在妊娠期高血压疾病中的应用研究进展进行综述。
Hypertension in pregnancy(HIP) is a disease that pregnancy coexists with elevated blood pressure. It has adverse effects on all organs in preg nant and parturient wo men, resulting in complications such as placental abruption, disseminated intravascular coagulation, maternal heart, liver, renal failure, pulmonary e dema, hypertensive encephalopathy and even death. Also, it may cause fetal growth restriction, oligohydramnios, premature delivery, fetal distress, nervous system injuries and even fetal death.It is one of the serious obstetric complications, and the main cause of high morbidity and mortality of pregnant women and perinatal infants. Doppler ultrasound is widely used in prenatal diagnosis because of non-invasion and low cost. It is routinely applied to monitor pregnancy complications and evaluate perinatal outcomes. The present paper reviews the application of Doppler ultrasound in hypertension in pregnancy.
Hypertension in pregnancy(HIP) is a disease that pregnancy coexists with elevated blood pressure. It has adverse effects on all organs in preg nant and parturient wo men, resulting in complications such as placental abruption, disseminated intravascular coagulation, maternal heart, liver, renal failure, pulmonary e dema, hypertensive encephalopathy and even death. Also, it may cause fetal growth restriction, oligohydramnios, premature delivery, fetal distress, nervous system injuries and even fetal death.It is one of the serious obstetric complications, and the main cause of high morbidity and mortality of pregnant women and perinatal infants. Doppler ultrasound is widely used in prenatal diagnosis because of non-invasion and low cost. It is routinely applied to monitor pregnancy complications and evaluate perinatal outcomes. The present paper reviews the application of Doppler ultrasound in hypertension in pregnancy.
引文
[1]YE C, RUAN Y, ZOU L, et al. The 2011 survey on hypertensive disorders of pregnancy(HDP)in China:prevalence, risk factors,complications, pregnancy and perinatal outcomes[J]. PLoS One, 2014, 9(6):e100180.
[2]BURTON G J, WOODS A W, JAUNIAUX E, et al. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy[J]. Placenta, 2009, 30(6):473-482.
[3]MORRIS E A, HALE S A, BADGER G J, et al. Pregnancy inducespersistentchangesinvascularcompliancein primiparous women[J]. Am J Obstet Gynecol, 2015, 212(5):633. e1-6.
[4]WALLACE A E, WHITLEY G S, THILAGANATHAN B, et al. Decidual natural killer cell receptor expression is altered in pregnancies with impaired vascular remodeling and a higher risk of pre-eclampsia[J]. J Leukoc Biol, 2015, 97(1):79-86.
[5]ERGIN R N, YAYLA M. Uterine artery pulsatility index and diastolic notch laterality according to the placental location[J]. Clin Exp Obstet Gynecol, 2015, 42(5):640-643.
[6]KARAMAN E, ARSLAN H,?ETIN O, et al. Comparison of placental elasticity in normal and pre-eclamptic pregnant women by acoustic radiation force impulse elastosonography[J]. J Obstet Gynaecol Res, 2016, 42(11):1464-1470.
[7]李荆,曹小娟,韦庆深,等.超声监测妊娠早期母体-胎盘循环预测妊娠期高血压疾病的临床研究[J].实用医学杂志, 2014, 30(16):2601-2603.
[8]KLEINROUWELER C E, BOSSUYT P M, THILAGANATHAN B, et al. Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia:an individual patient data Meta-analysis[J]. Ultrasound Obstet Gynecol, 2013, 42(3):257-267.
[9]肖青,彭娟.彩色多普勒超声联合监测重度子痫前期患者胎儿脐动脉及大脑中动脉的价值探讨[J].中国妇幼卫生杂志, 2016, 8(6):56-57, 60.
[10]胡国梁,朱敏,蔡洁.彩色多普勒超声监测子痫前期孕妇胎儿脐动脉以及大脑中动脉的临床意义[J].中国现代医生, 2017, 55(11):22-25.
[11]邓童宁.探讨重度子痫前期患者彩色多普勒超声检测与新生儿预后的关系[J].医学理论与实践, 2016, 29(8):1078-1079.
[12]张庆英,程海东.子痫前期并发胎儿脐动脉舒张末期血流缺失及返流的母婴结局[J].中国临床医学, 2015, 22(2):207-210.
[13]侯敏,吕国荣,唐力.多普勒超声检测大脑中动脉收缩期峰值流速与胎儿贫血[J].中国医学影像技术, 2010,26(2):310-312.
[14]GEBB J, DAR P. Colour Doppler ultrasound of spiral artery blood flow in the prediction of pre-eclampsia and intrauterine growth restriction[J]. Best Pract Res Clin Obstet Gynaecol,2011, 25(3):355-366.
[15]马一瀛,孙燕兵.彩色多普勒超声监测胎儿脐动脉和大脑中动脉对妊娠期子痫前期患者病情评估价值[J].现代中西医结合杂志, 2015, 24(21):2368-2369.
[16]DUANJ,CHABOT-LECOANETAC,PERDRIOLLEGALET E, et al. Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies:third trimester quantification using 3D power Doppler with comparison to placental vascular morphology(EVUPA):a prospective controlled study[J]. BMJ Open, 2016, 6(3):e009909.
[17]SCHWARTZ N, MANDEL D, SHLAKHTER O, et al. Placental morphologic features and chorionic surface vasculature at term are highly correlated with 3-dimensional sonographic measurements at 11 to 14 weeks[J]. J Ultrasound Med, 2011,30(9):1171-1178.
[18]MORAN M C, MULCAHY C, ZOMBORI G, et al. Placental volume, vasculature and calcification in pregnancies complicated by pre-eclampsia and intra-uterine growth restriction[J].Eur J Obstet Gynecol Reprod Biol, 2015, 195:12-17.
[19]POMORSKI M, ZIMMER M, FUCHS T, et al. Quantitative assessment of placental vasculature and placental volume in no rmal pregnancies with the use of 3D power Doppler[J].Adv Med Sci, 2014, 59(1):23-27.
[20]HAFNER E, METZENBAUER M, STüMPFLEN I, et al.Measurement of placental bed vascularization in the first trimester, using 3D-power-Doppler, for the detection of pregnancies at-risk for fetal and maternal complications[J].Placenta, 2013, 34(10):892-898.
[21]WANG H I, YANG M J, WANG P H, et al. Assessment of placental volume and vascularization at 11-14 weeks of gestation in a Taiwanese population using three-dimensional power Doppler ultrasound[J]. J Chin Med Assoc, 2014,77(12):648-652.
[22]CHENCY,WANGKG,CHENCP.Alterationof vascularization in preeclamptic placentas measured by threedimensional power Doppler ultrasound[J]. J Matern Fetal Neonatal Med, 2013, 26(16):1616-1622.
[23]SURáNYI A, ALTORJAYá, KAISER L, et al. Evaluation of placental vascularization by three-dimensional ultrasound examination in second and third trimester of pregnancies complicated by chronic hypertension, gestational hypertension or pre-eclampsia[J]. Pregnancy Hypertens, 2017, 8:51-59.
[24]NETO R M, RAMOS J G. 3D power Doppler ultrasound in early diagnosis of preeclampsia[J]. Pregnancy Hypertens, 2016,6(1):10-16.
[25]YUAN T, ZHANG T, HAN Z. Placental vascularization alterations in hypertensive disorders complicating pregnancy(HDCP)and small for gestational age with HDCP using threedimensional power Doppler in a prospective case control study[J]. BMC Pregnancy Childbirth, 2015, 15:240.
[26]HANNAFORD K E, TUULI M, GOETZINGER K R, et al. Firsttrimester 3-dimensional power Doppler placental vascularization indices from the whole placenta versus the placental bed to predict preeclampsia:does pregnancy-associated plasma protein A or uterine artery Doppler sonography help?[J]. J Ultrasound Med, 2015, 34(6):965-970.
[27]NOGUCHI J, TANAKA H, KOYANAGI A, et al. Threedimensional power Doppler indices at 18-22 weeks'gestation for prediction of fetal growth restriction or pregnancy-induced hypertension[J]. Arch Gynecol Obstet, 2015, 292(1):75-79.
[2]BURTON G J, WOODS A W, JAUNIAUX E, et al. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy[J]. Placenta, 2009, 30(6):473-482.
[3]MORRIS E A, HALE S A, BADGER G J, et al. Pregnancy inducespersistentchangesinvascularcompliancein primiparous women[J]. Am J Obstet Gynecol, 2015, 212(5):633. e1-6.
[4]WALLACE A E, WHITLEY G S, THILAGANATHAN B, et al. Decidual natural killer cell receptor expression is altered in pregnancies with impaired vascular remodeling and a higher risk of pre-eclampsia[J]. J Leukoc Biol, 2015, 97(1):79-86.
[5]ERGIN R N, YAYLA M. Uterine artery pulsatility index and diastolic notch laterality according to the placental location[J]. Clin Exp Obstet Gynecol, 2015, 42(5):640-643.
[6]KARAMAN E, ARSLAN H,?ETIN O, et al. Comparison of placental elasticity in normal and pre-eclamptic pregnant women by acoustic radiation force impulse elastosonography[J]. J Obstet Gynaecol Res, 2016, 42(11):1464-1470.
[7]李荆,曹小娟,韦庆深,等.超声监测妊娠早期母体-胎盘循环预测妊娠期高血压疾病的临床研究[J].实用医学杂志, 2014, 30(16):2601-2603.
[8]KLEINROUWELER C E, BOSSUYT P M, THILAGANATHAN B, et al. Value of adding second-trimester uterine artery Doppler to patient characteristics in identification of nulliparous women at increased risk for pre-eclampsia:an individual patient data Meta-analysis[J]. Ultrasound Obstet Gynecol, 2013, 42(3):257-267.
[9]肖青,彭娟.彩色多普勒超声联合监测重度子痫前期患者胎儿脐动脉及大脑中动脉的价值探讨[J].中国妇幼卫生杂志, 2016, 8(6):56-57, 60.
[10]胡国梁,朱敏,蔡洁.彩色多普勒超声监测子痫前期孕妇胎儿脐动脉以及大脑中动脉的临床意义[J].中国现代医生, 2017, 55(11):22-25.
[11]邓童宁.探讨重度子痫前期患者彩色多普勒超声检测与新生儿预后的关系[J].医学理论与实践, 2016, 29(8):1078-1079.
[12]张庆英,程海东.子痫前期并发胎儿脐动脉舒张末期血流缺失及返流的母婴结局[J].中国临床医学, 2015, 22(2):207-210.
[13]侯敏,吕国荣,唐力.多普勒超声检测大脑中动脉收缩期峰值流速与胎儿贫血[J].中国医学影像技术, 2010,26(2):310-312.
[14]GEBB J, DAR P. Colour Doppler ultrasound of spiral artery blood flow in the prediction of pre-eclampsia and intrauterine growth restriction[J]. Best Pract Res Clin Obstet Gynaecol,2011, 25(3):355-366.
[15]马一瀛,孙燕兵.彩色多普勒超声监测胎儿脐动脉和大脑中动脉对妊娠期子痫前期患者病情评估价值[J].现代中西医结合杂志, 2015, 24(21):2368-2369.
[16]DUANJ,CHABOT-LECOANETAC,PERDRIOLLEGALET E, et al. Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies:third trimester quantification using 3D power Doppler with comparison to placental vascular morphology(EVUPA):a prospective controlled study[J]. BMJ Open, 2016, 6(3):e009909.
[17]SCHWARTZ N, MANDEL D, SHLAKHTER O, et al. Placental morphologic features and chorionic surface vasculature at term are highly correlated with 3-dimensional sonographic measurements at 11 to 14 weeks[J]. J Ultrasound Med, 2011,30(9):1171-1178.
[18]MORAN M C, MULCAHY C, ZOMBORI G, et al. Placental volume, vasculature and calcification in pregnancies complicated by pre-eclampsia and intra-uterine growth restriction[J].Eur J Obstet Gynecol Reprod Biol, 2015, 195:12-17.
[19]POMORSKI M, ZIMMER M, FUCHS T, et al. Quantitative assessment of placental vasculature and placental volume in no rmal pregnancies with the use of 3D power Doppler[J].Adv Med Sci, 2014, 59(1):23-27.
[20]HAFNER E, METZENBAUER M, STüMPFLEN I, et al.Measurement of placental bed vascularization in the first trimester, using 3D-power-Doppler, for the detection of pregnancies at-risk for fetal and maternal complications[J].Placenta, 2013, 34(10):892-898.
[21]WANG H I, YANG M J, WANG P H, et al. Assessment of placental volume and vascularization at 11-14 weeks of gestation in a Taiwanese population using three-dimensional power Doppler ultrasound[J]. J Chin Med Assoc, 2014,77(12):648-652.
[22]CHENCY,WANGKG,CHENCP.Alterationof vascularization in preeclamptic placentas measured by threedimensional power Doppler ultrasound[J]. J Matern Fetal Neonatal Med, 2013, 26(16):1616-1622.
[23]SURáNYI A, ALTORJAYá, KAISER L, et al. Evaluation of placental vascularization by three-dimensional ultrasound examination in second and third trimester of pregnancies complicated by chronic hypertension, gestational hypertension or pre-eclampsia[J]. Pregnancy Hypertens, 2017, 8:51-59.
[24]NETO R M, RAMOS J G. 3D power Doppler ultrasound in early diagnosis of preeclampsia[J]. Pregnancy Hypertens, 2016,6(1):10-16.
[25]YUAN T, ZHANG T, HAN Z. Placental vascularization alterations in hypertensive disorders complicating pregnancy(HDCP)and small for gestational age with HDCP using threedimensional power Doppler in a prospective case control study[J]. BMC Pregnancy Childbirth, 2015, 15:240.
[26]HANNAFORD K E, TUULI M, GOETZINGER K R, et al. Firsttrimester 3-dimensional power Doppler placental vascularization indices from the whole placenta versus the placental bed to predict preeclampsia:does pregnancy-associated plasma protein A or uterine artery Doppler sonography help?[J]. J Ultrasound Med, 2015, 34(6):965-970.
[27]NOGUCHI J, TANAKA H, KOYANAGI A, et al. Threedimensional power Doppler indices at 18-22 weeks'gestation for prediction of fetal growth restriction or pregnancy-induced hypertension[J]. Arch Gynecol Obstet, 2015, 292(1):75-79.