胎儿Tei指数在子痫前期中的临床价值
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摘要
目的应用彩色多普勒超声心动图检测中晚孕正常发育胎儿和不同程度子痫前期胎儿左、右心室Tei指数,观察其变化并探讨其在子痫前期中的临床价值。
材料和方法2009年2月至2009年12月苏州大学附一院产科门诊产前检查和住院治疗的孕20～41+6周孕妇193例,正常组125例,研究组68例,研究组根据病情轻重分为重度子痫前期(severe preeclampsia SPE )组:32例,轻度子痫前期(mild preeclampsia MPE )组:14例,妊娠期高血压(gestational hypertension GH)组:22例。应用彩色多普勒超声仪器SIEMENS ACUSON Antares,测得每例研究对象左、右室等容时间和射血时间并计算得到胎儿左、右室Tei指数,及常规胎儿测量指标。
结果1、正常组不同孕周组间胎儿心室功能各指标比较,不同孕周组间平均心率、左、右室射血时间、等容时间、Tei指数之间均示无统计学差异(P>0.05);2、总体分析左、右心室Tei指数均呈正态分布,右室Tei指数略大于左室Tei指数,但无统计学差异(P>0.05),而左室射血时间和等容时间均低于右室射血时间和等容时间,有统计学差异(P <0.05);3、正常组胎儿左、右室Tei指数与孕龄、平均心率、出生体重均无相关性;4、GH组与正常组左、右室功能各指标无统计学差异(P>0.05);MPE组左、右室等容时间和Tei指数均高于正常组,有统计学差异(P<0.05);SPE组与正常组心室功能各指标比较均有统计学差异(P<0.05),且SPE组右室Tei指数高于左室Tei指数,有显著性统计学差异(P<0.01);5、SPE胎儿右心室Tei指数分别与胎儿出生孕周、体重、新生儿1,Apgar评分及5,Apgar评分呈负相关性。
结论Tei指数可以作为胎儿心室功能评价的良好指标,特别是右室功能评价,且评价正常中晚孕期胎儿心室整体功能趋于稳定;不同程度子痫前期胎儿左、右心室整体功能均受损害,尤以SPE胎儿心功能损伤较重,且以右心室功能受损更为显著;Tei指数在监测SPE胎儿宫内窘迫,预测胎儿预后有一定的临床价值。
PURPOSE: Color Doppler echocardiography was used to measure fetal ventricu- lar Tei index of normal fetuses in the middle and late gestation and Tei index of varying degrees of preeclampsia fetuses to observe the trend and explore the clinical value of fetal ventricular Tei index in preeclampsia.
MATERIALS AND METHODS: 193 sdudies from 20 to 41+6 gestational age were included in this research who visited doctors and were treated in the first hospital of soochow university from Feb 2009 to Dec 2009. There were 125 normal fetuses and 68 preeclampsia fetuses who were divided according to severity.There are 32 cases in severe preeclampsia group,14 cases in mild preeclampsia group,22 cases in gestational hypertension group. All fetuses were carefully examined with SIEMENS Antares Doppler ultrasound of left and right ventricular isovolumic time and ejection time, and conventional indicators of fetal.
RESULTS: 1.There were no significant difference on average heart rate ,LV and RV isovolumic time, ejection time, Tei index in different gestational age groups of normal fetuse(sP>0.05); 2. Overall analysis of LV and RV Tei index showed a normal distribution, RV Tei index was slightly higher than LV Tei index, but no significant difference (P>0.05), while LV ejection time and isovolumic time were significantly smaller than RV ejection time and isovolumic time in normal fetuses (P<0.05);3. LV and RV Tei index of normal fetuses were not related to gestational age, average heart rate and fetal birth weight; 4. Left and right ventricular function were no significant difference between GH and normal fetuses (P>0.05); LV and RV isovolumic time and Tei index in MPE fetuses were significantly higher than in normal fetuses (P<0.05); Left and right ventricular function were significant difference between SPE fetuses and normal ones(P<0.05), and RV Tei index was statistically significantly higher than LV Tei index in SPE group(P<0.01);5. RV Tei index of SPE fetuses had the negative correlation with gestational age at birth, fetal birth weight, 1,and 5,Apgar score.
CONCLUTIONS: Tei index can be used in the assessment of fetal ventricular function as a good indicator, especially in the assessment of right ventricular function;fetal global ventricular function is constant in the whole middle and late gestation; fetal left and right ventricular function in preeclampsia are impaired, especially in SPE; and right ventricular function was influenced heavier than left;Tei index has some clinical value in monitoring fetal distress,and forecasting the outcome of SPE fetus.
材料和方法2009年2月至2009年12月苏州大学附一院产科门诊产前检查和住院治疗的孕20～41+6周孕妇193例,正常组125例,研究组68例,研究组根据病情轻重分为重度子痫前期(severe preeclampsia SPE )组:32例,轻度子痫前期(mild preeclampsia MPE )组:14例,妊娠期高血压(gestational hypertension GH)组:22例。应用彩色多普勒超声仪器SIEMENS ACUSON Antares,测得每例研究对象左、右室等容时间和射血时间并计算得到胎儿左、右室Tei指数,及常规胎儿测量指标。
结果1、正常组不同孕周组间胎儿心室功能各指标比较,不同孕周组间平均心率、左、右室射血时间、等容时间、Tei指数之间均示无统计学差异(P>0.05);2、总体分析左、右心室Tei指数均呈正态分布,右室Tei指数略大于左室Tei指数,但无统计学差异(P>0.05),而左室射血时间和等容时间均低于右室射血时间和等容时间,有统计学差异(P <0.05);3、正常组胎儿左、右室Tei指数与孕龄、平均心率、出生体重均无相关性;4、GH组与正常组左、右室功能各指标无统计学差异(P>0.05);MPE组左、右室等容时间和Tei指数均高于正常组,有统计学差异(P<0.05);SPE组与正常组心室功能各指标比较均有统计学差异(P<0.05),且SPE组右室Tei指数高于左室Tei指数,有显著性统计学差异(P<0.01);5、SPE胎儿右心室Tei指数分别与胎儿出生孕周、体重、新生儿1,Apgar评分及5,Apgar评分呈负相关性。
结论Tei指数可以作为胎儿心室功能评价的良好指标,特别是右室功能评价,且评价正常中晚孕期胎儿心室整体功能趋于稳定;不同程度子痫前期胎儿左、右心室整体功能均受损害,尤以SPE胎儿心功能损伤较重,且以右心室功能受损更为显著;Tei指数在监测SPE胎儿宫内窘迫,预测胎儿预后有一定的临床价值。
PURPOSE: Color Doppler echocardiography was used to measure fetal ventricu- lar Tei index of normal fetuses in the middle and late gestation and Tei index of varying degrees of preeclampsia fetuses to observe the trend and explore the clinical value of fetal ventricular Tei index in preeclampsia.
MATERIALS AND METHODS: 193 sdudies from 20 to 41+6 gestational age were included in this research who visited doctors and were treated in the first hospital of soochow university from Feb 2009 to Dec 2009. There were 125 normal fetuses and 68 preeclampsia fetuses who were divided according to severity.There are 32 cases in severe preeclampsia group,14 cases in mild preeclampsia group,22 cases in gestational hypertension group. All fetuses were carefully examined with SIEMENS Antares Doppler ultrasound of left and right ventricular isovolumic time and ejection time, and conventional indicators of fetal.
RESULTS: 1.There were no significant difference on average heart rate ,LV and RV isovolumic time, ejection time, Tei index in different gestational age groups of normal fetuse(sP>0.05); 2. Overall analysis of LV and RV Tei index showed a normal distribution, RV Tei index was slightly higher than LV Tei index, but no significant difference (P>0.05), while LV ejection time and isovolumic time were significantly smaller than RV ejection time and isovolumic time in normal fetuses (P<0.05);3. LV and RV Tei index of normal fetuses were not related to gestational age, average heart rate and fetal birth weight; 4. Left and right ventricular function were no significant difference between GH and normal fetuses (P>0.05); LV and RV isovolumic time and Tei index in MPE fetuses were significantly higher than in normal fetuses (P<0.05); Left and right ventricular function were significant difference between SPE fetuses and normal ones(P<0.05), and RV Tei index was statistically significantly higher than LV Tei index in SPE group(P<0.01);5. RV Tei index of SPE fetuses had the negative correlation with gestational age at birth, fetal birth weight, 1,and 5,Apgar score.
CONCLUTIONS: Tei index can be used in the assessment of fetal ventricular function as a good indicator, especially in the assessment of right ventricular function;fetal global ventricular function is constant in the whole middle and late gestation; fetal left and right ventricular function in preeclampsia are impaired, especially in SPE; and right ventricular function was influenced heavier than left;Tei index has some clinical value in monitoring fetal distress,and forecasting the outcome of SPE fetus.
引文
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[2] Rizzo G, Capponi A, Cavicchioni O,et al .Low cardiac output to the placenta: an early hemodynamic adaptive mechanism in intrauterine growth restriction[J]. Ultrasound Obstet Gynecol, 2008,32(2): 155～159.
[3] Davie AP,Francis CM.Caruana L,et a1.The prevalence of left ventficular diastolic filling abnormalities in patients with suspected heart failure[J].Eur Heart J,1997, 18(6):981.
[4] Tei C, Ling LH, Hodge DO, et a1.New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function-a study in normals and dilated cardiomyopathy[J].J Cardiol.,1995,26(6):357～366.
[5] Dujardin KS,Tei C,Yeo TC,et a1.Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy[J]. Am J Cardiol,1998,82(9):1071～1076.
[6] Yeo TC,Dujardin KS,Tel C,et a1.Value of a Doppler-derived MPI combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension[J]. Am J Cardiol,1998,81(9):1157～1161.
[7] Poulsen SH,Jensen SE,Nielsen JC,et a1.Serial changes and prognostic implications of a Doppler-derived index of combined left ventricular systolic and diastolic myocardial performance in acute myocardial infarction[J]. Am J Cardiol,2000,85(1):19～25.
[8] Harjai KJ, Scott L, Vivekananthan K, et a1.The Tei index: a new prognostic index for patients with symptomatic heart failure[J]. J Am Soc Echocardiogr,2002,15(9):864～868.
[9] Ishii M,Eto G,Tet C,et al.Quantitation of the global right ventricular function in children with normal heart and congenital heart disease:a right ventricular myocardial performance index[J].Pediatr Cardiol,2000,21(5):416～421.
[10] Baysal T, Oran B, Do?an M, et al.The myocardial performance index in children with isolated left-to-right shunt lesions[J]. Anadolu Kardiyol Derg. 2005,5(2):108～111.
[11] Dyer KL, Pauliks LB, Das B, et al. Use of myocardial performance index in pediatric patients with idiopathic pulmonary arterial hypertension[J]. J Am Soc Echocardiogr ,2006,19(1):21～27.
[12] Eidem BW, Edwards JM, Cetta F. Quantitative assessment of fetal ventricular function: establishing normal values of the myocardial performance index in the fetus[J]. Echocardiography, 2001,18(1):9～13.
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