妊娠期高血压疾病产妇子宫动脉和胎儿脐动脉超声参数预测妊娠结局的临床价值
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摘要
目的探讨妊娠期高血压疾病(hypertensive disorder complicating pregnancy,HDCP)产妇子宫动脉和胎儿脐动脉超声参数与胎儿预后的关系。方法选择秦皇岛市妇幼保健院2015年3月至2017年3月收治的147例HDCP患者为观察组,同期153例正常孕妇为对照组。分别于妊娠早期(10～14周)、妊娠中期(20～26周)、妊娠晚期(30～36周)对两组产妇进行多普勒超声血流成像检查,比较两组子宫动脉和胎儿脐动脉的动脉搏动指数(pulsation index,PI)、阻力指数(resistance index,RI)、收缩压最大血流速度/舒张末期最大血流速度(systolic/diastolic,S/D),并比较两组的妊娠过程、结局及新生儿体重、Apgar评分。采用ROC曲线判断晚期超声参数对不良妊娠结局的诊断价值。结果两组子宫动脉PI、RI、S/D在妊娠早期差异无统计学意义(P>0. 05)。观察组子宫动脉PI、RI、S/D在妊娠早、中、晚期先升高后降低,且在妊娠中、晚期均高于对照组;对照组则持续降低,差异均有统计学意义(P <0. 05)。两组脐动脉的PI、RI、S/D在妊娠中晚期均持续降低,且观察组显著高于对照组(P <0. 05)。观察组早产、剖宫产、胎儿生长受限、胎儿窘迫、新生儿窒息等不良预后发生率均显著高于对照组(P <0. 05),新生儿体重低于对照组(P <0. 05),新生儿出生后1 min、5 min的Apgar评分<7分的比例均高于对照组(P <0.05)。晚期子宫动脉和胎儿脐动脉PI、RI、S/D的ROC曲线下面积为0. 742～0. 785,灵敏度77. 55%～87. 75%,特异度77. 78%～88. 24%。结论多普勒超声可准确检测孕妇子宫动脉和胎儿脐动脉的PI、RI、S/D指数变化,可为HDCP的诊断及干预提供参考,晚期参数对不良妊娠结局具有较高的诊断价值。
Objective To analyze clinical value of ultrasonic parameters of uterine artery and fetal umbilical artery in predicting pregnancy outcome of women with hyportensive disonder complicating pregnancy( HDCP). Methods 147 cases of patients with HDCP from March 2015 to March 2017 in Qinhuangdao Maternal and Child Health Hospital were selected as observation group,153 cases of normal pregnant women in the same period were selected as control group. Doppler ultrasound imaging was performed on two groups of women in early pregnancy( 10 ～ 14 weeks),mid pregnancy( 20 ～ 26 weeks) and late pregnancy( 30 ～ 36 weeks) separately. The pulsatility index( PI),resistance index( RI),systolic blood flow velocity( S)/diastolic maximum blood flow velocity( D) of uterine artery and fetal umbilical artery of two groups were compared. The pregnancy course,outcome,neonatal weight and Apgar score were compared between the two groups. The ROC curve was used to evaluate the diagnostic value of late ultrasound parameters for adverse pregnancy outcomes. Results In early pregnancy,PI,RI,S/D of two groups showed no significant difference( P > 0. 05); the PI,RI,S/D of fetal umbilical artery of observation group increased then decreased during early,mid and late pregnancy,which were significantly higher than control group in mid pregnancy and late pregnancy( P < 0. 05); while the PI,RI,S/D in the control group were decreased continuously. The PI,RI,S/D of umbilical artery of two groups were decreased significantly,and observation group significantly higher than control group( P < 0. 05). The incidence of premature delivery,cesarean section,fetal growth restriction,fetal distress and neonatal asphyxia in the observation group were significantly higher than those in the control group( P < 0. 05). The neonatal weight of the observation group was significantly lower than that of the control group( P < 0. 05),and proportion of Apgar score < 7 points in 1 min and 5 min after birth in the observation group was more than that of the control group( P < 0. 05). The area under ROC curve of late pregnancy of PI,RI,S/D were 0. 742 ～ 0. 785,the sensitivity were 77. 55 % ～ 87. 75 %,the specificity were77. 78 % ～ 88. 24 %. Conclusion Doppler ultrasonic can precisely detect the change of PI,RI,S/D of uterine artery and fetal umbilical artery of pregnant women,which can provide reference for the diagnosis and intervention of HDCP,and late pregnancy parameters have a high value in the diagnosis of adverse pregnancy outcome.
Objective To analyze clinical value of ultrasonic parameters of uterine artery and fetal umbilical artery in predicting pregnancy outcome of women with hyportensive disonder complicating pregnancy( HDCP). Methods 147 cases of patients with HDCP from March 2015 to March 2017 in Qinhuangdao Maternal and Child Health Hospital were selected as observation group,153 cases of normal pregnant women in the same period were selected as control group. Doppler ultrasound imaging was performed on two groups of women in early pregnancy( 10 ～ 14 weeks),mid pregnancy( 20 ～ 26 weeks) and late pregnancy( 30 ～ 36 weeks) separately. The pulsatility index( PI),resistance index( RI),systolic blood flow velocity( S)/diastolic maximum blood flow velocity( D) of uterine artery and fetal umbilical artery of two groups were compared. The pregnancy course,outcome,neonatal weight and Apgar score were compared between the two groups. The ROC curve was used to evaluate the diagnostic value of late ultrasound parameters for adverse pregnancy outcomes. Results In early pregnancy,PI,RI,S/D of two groups showed no significant difference( P > 0. 05); the PI,RI,S/D of fetal umbilical artery of observation group increased then decreased during early,mid and late pregnancy,which were significantly higher than control group in mid pregnancy and late pregnancy( P < 0. 05); while the PI,RI,S/D in the control group were decreased continuously. The PI,RI,S/D of umbilical artery of two groups were decreased significantly,and observation group significantly higher than control group( P < 0. 05). The incidence of premature delivery,cesarean section,fetal growth restriction,fetal distress and neonatal asphyxia in the observation group were significantly higher than those in the control group( P < 0. 05). The neonatal weight of the observation group was significantly lower than that of the control group( P < 0. 05),and proportion of Apgar score < 7 points in 1 min and 5 min after birth in the observation group was more than that of the control group( P < 0. 05). The area under ROC curve of late pregnancy of PI,RI,S/D were 0. 742 ～ 0. 785,the sensitivity were 77. 55 % ～ 87. 75 %,the specificity were77. 78 % ～ 88. 24 %. Conclusion Doppler ultrasonic can precisely detect the change of PI,RI,S/D of uterine artery and fetal umbilical artery of pregnant women,which can provide reference for the diagnosis and intervention of HDCP,and late pregnancy parameters have a high value in the diagnosis of adverse pregnancy outcome.
引文
[1]Habas E,Rayani A,Ganterie R.Thrombocytopenia in hypertensive disease of pregnancy[J].J Obstet Gynaecol India,2013,63(2):96-100.
[2]洪喜萍.彩色多普勒超声检测脐动脉和子宫动脉血流在妊娠期高血压疾病诊治中的应用价值[J].中国妇幼保健,2017,32(17):4260-4262.
[3]黄祯,余玉华,陈丽珍,等.子宫动脉超声多普勒血流监测在妊娠期高血压疾病晚期中的应用价值分析[J].河北医学,2015,21(8):1373-1376.
[4]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013:64-65.
[5]SHI Qingquan,LENG Wenying,YAO Qiang,et al.Oral nifedipine versus intravenous labetalol for the treatment of severe hypertension in pregnancy[J].Int J Cardiol,2015,178(178c):162-164.
[6]Podymow T,August P.New evidence in the management of chronic hypertension in pregnancy[J].Semin Nephrol,2017,37(4):398-403.
[7]Payne BA,Groen H,Ukah UV,et al.Development and internal validation of a multivariable model to predict perinatal death in pregnancy hypertension[J].Pregnancy Hypertension:An International Journal of Women's Cardiovascular Health,2015,5(4):315-321.
[8]Yu N,CUI Hongyan,CHEN Xu,et al.First trimester maternal serum analytes and second trimester uterine artery Doppler in the prediction of preeclampsia and fetal growth restriction[J].Taiwan JObstet Gynecol,2017,56(3):358-361.
[9]Kumar M,Sharma K,Singh R,et al.Role of maternal factors,PAPP-A,and Doppler in screening for early-and late-onset pregnancy hypertension in Asian population[J].Hypertension in Pregnancy,2016,35(3):382-393.
[10]安景,白睿.妊娠期高血压患者子宫动脉及胎儿脐动脉血流动力学研究[J].海南医学院学报,2017,23(2):152-154.
[11]肖学茹,张陈彦,孙东霞,等.妊娠中期脐动脉血流S/D值变化与围产儿不良结局的关系[J].山东医药,2015,55(30):51-52.
[12]张陈彦,肖学茹,刘慧,等.胎儿脐动脉舒张末期血流缺失与母婴结局的病情观察与分析[J].河北医科大学学报,2016,37(8):975-978.
[13]姬冬辉.彩色多普勒超声在妊娠期高血压疾病患者胎儿宫内窘迫诊断中的应用价值[J].中国妇幼保健,2015,30(3):477-478.
[14]赵红.妊高症对母婴预后影响的临床分析[J].中国现代药物应用,2017,11(5):184-186.
[15]彭静,柳杨.正常妊娠妇女和HDP孕妇妊娠早、中、晚期子宫动脉及其胎儿脐动脉血流动态变化的比较[J].医学综述,2016,22(10):1996-1998.
[2]洪喜萍.彩色多普勒超声检测脐动脉和子宫动脉血流在妊娠期高血压疾病诊治中的应用价值[J].中国妇幼保健,2017,32(17):4260-4262.
[3]黄祯,余玉华,陈丽珍,等.子宫动脉超声多普勒血流监测在妊娠期高血压疾病晚期中的应用价值分析[J].河北医学,2015,21(8):1373-1376.
[4]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013:64-65.
[5]SHI Qingquan,LENG Wenying,YAO Qiang,et al.Oral nifedipine versus intravenous labetalol for the treatment of severe hypertension in pregnancy[J].Int J Cardiol,2015,178(178c):162-164.
[6]Podymow T,August P.New evidence in the management of chronic hypertension in pregnancy[J].Semin Nephrol,2017,37(4):398-403.
[7]Payne BA,Groen H,Ukah UV,et al.Development and internal validation of a multivariable model to predict perinatal death in pregnancy hypertension[J].Pregnancy Hypertension:An International Journal of Women's Cardiovascular Health,2015,5(4):315-321.
[8]Yu N,CUI Hongyan,CHEN Xu,et al.First trimester maternal serum analytes and second trimester uterine artery Doppler in the prediction of preeclampsia and fetal growth restriction[J].Taiwan JObstet Gynecol,2017,56(3):358-361.
[9]Kumar M,Sharma K,Singh R,et al.Role of maternal factors,PAPP-A,and Doppler in screening for early-and late-onset pregnancy hypertension in Asian population[J].Hypertension in Pregnancy,2016,35(3):382-393.
[10]安景,白睿.妊娠期高血压患者子宫动脉及胎儿脐动脉血流动力学研究[J].海南医学院学报,2017,23(2):152-154.
[11]肖学茹,张陈彦,孙东霞,等.妊娠中期脐动脉血流S/D值变化与围产儿不良结局的关系[J].山东医药,2015,55(30):51-52.
[12]张陈彦,肖学茹,刘慧,等.胎儿脐动脉舒张末期血流缺失与母婴结局的病情观察与分析[J].河北医科大学学报,2016,37(8):975-978.
[13]姬冬辉.彩色多普勒超声在妊娠期高血压疾病患者胎儿宫内窘迫诊断中的应用价值[J].中国妇幼保健,2015,30(3):477-478.
[14]赵红.妊高症对母婴预后影响的临床分析[J].中国现代药物应用,2017,11(5):184-186.
[15]彭静,柳杨.正常妊娠妇女和HDP孕妇妊娠早、中、晚期子宫动脉及其胎儿脐动脉血流动态变化的比较[J].医学综述,2016,22(10):1996-1998.