孕中期子宫动脉收缩期与舒张期流速比对重度子痫前期的预测及诊断价值
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摘要
目的探讨孕产妇子宫动脉收缩期与舒张期流速比(systolic to diastolic velocity ratio,S/D)对重度子痫前期(PE)的早期预测价值。方法收集2016年1月至2018年6月在我院产科定期产检并住院分娩的PE患者75例为研究对象(PE组),同期正常妊娠的孕妇75例为对照组。两组孕妇20～28周测量双侧子宫动脉S/D,24～28周测母亲血浆维生素D,比较两组孕妇子宫动脉S/D、子宫动脉搏动指数与维生素D水平的差异,采用Pearson相关分析子宫动脉S/D与维生素D水平的相关性,采用受试者工作特征曲线评价子宫动脉S/D对重度子痫前期的诊断价值。结果与对照组比较,PE组孕妇双侧子宫动脉S/D平均水平、[(4.12±0.34)vs.(2.83±0.43)]、子宫动脉搏动指数[(1.44±0.62)vs.(0.96±0.49)]显著上升(P<0.05),25-羟维生素D平均水平[(33.46±12.13)μg/L vs.(42.14±10.52)μg/L]显著降低(P<0.05)。相关性分析显示,PE组双侧子宫动脉S/D值平均值与25-羟维生素D水平呈负相关(r=-0.79,P<0.001)。子宫动脉S/D值曲线下面积0.831,最佳截断值3.75,诊断灵敏度为81.33%,特异度为86.67%。结论子宫动脉S/D值对重度子痫前期具有较好的预测及诊断价值,可联合维生素D作为孕中期子痫的重要观测指标。
Objective:To investigate the predictive value of uterine artery systolic to diastolic velocity ratio(S/D)in severe ectopic preeclampsia(PE).Methods:Seventy five patients with severe PE who underwent regularly inspected and hospitalized for childbirth in our hospital from January 2016 to June 2018 were enrolled in the PE group,and 75 normal pregnant women in the same period were included in the control group.Bilateral uterine artery S/D was measured at 20-28 weeks.The plasma vitamin D was measured at 24-28 weeks.The uterine artery S/D,uterine artery pulsation index and vitamin D level were compared between the two groups.Pearson correlation was used to analyze the correlation between uterine artery S/D and vitamin D.The value of uterine artery S/D in the diagnosis of severe preeclampsia is evaluated by receiver operating characteristic curve.Results:Compared with the control group,the average level of bilateral uterine artery S/D [(4.12±0.34)vs.(2.83±0.43),P<0.05]and the uterine artery pulsation index[(1.44±0.62)vs.(0.96±0.49),P<0.05]were increased significantly,but the average level of 25-hydroxy vitamin D was significantly decreased[(33.46±12.13)vs.(42.14±10.52)μg/L,P<0.05]in the PE group.Correlation analysis showed that the mean value of bilateral uterine artery S/D values was negatively correlated with 25-hydroxyvitamin D levels in the PE group(r=-0.79,P<0.001).The ROC area of S/D was 0.831,and the optimal cut-off value was 3.75,with diagnostic sensitivity of 81.33%and the specificity of 86.67%.Conclusions:The S/D value of uterine artery has a good predictive and diagnostic value for preeclampsia,and it can be combined with vitamin D as an important indicator for the monitoring of preeclampsia in the second trimester.
Objective:To investigate the predictive value of uterine artery systolic to diastolic velocity ratio(S/D)in severe ectopic preeclampsia(PE).Methods:Seventy five patients with severe PE who underwent regularly inspected and hospitalized for childbirth in our hospital from January 2016 to June 2018 were enrolled in the PE group,and 75 normal pregnant women in the same period were included in the control group.Bilateral uterine artery S/D was measured at 20-28 weeks.The plasma vitamin D was measured at 24-28 weeks.The uterine artery S/D,uterine artery pulsation index and vitamin D level were compared between the two groups.Pearson correlation was used to analyze the correlation between uterine artery S/D and vitamin D.The value of uterine artery S/D in the diagnosis of severe preeclampsia is evaluated by receiver operating characteristic curve.Results:Compared with the control group,the average level of bilateral uterine artery S/D [(4.12±0.34)vs.(2.83±0.43),P<0.05]and the uterine artery pulsation index[(1.44±0.62)vs.(0.96±0.49),P<0.05]were increased significantly,but the average level of 25-hydroxy vitamin D was significantly decreased[(33.46±12.13)vs.(42.14±10.52)μg/L,P<0.05]in the PE group.Correlation analysis showed that the mean value of bilateral uterine artery S/D values was negatively correlated with 25-hydroxyvitamin D levels in the PE group(r=-0.79,P<0.001).The ROC area of S/D was 0.831,and the optimal cut-off value was 3.75,with diagnostic sensitivity of 81.33%and the specificity of 86.67%.Conclusions:The S/D value of uterine artery has a good predictive and diagnostic value for preeclampsia,and it can be combined with vitamin D as an important indicator for the monitoring of preeclampsia in the second trimester.
引文
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[12]Ma R,Gu Y,Zhao S.Expressions of vitamin D metabolic components VDBP,CYP2R1,CYP27B1,CYP24A1,and VDRin placentas from normal and preeclamptic pregnancies[J].Am J Physiol Endocrinol Metab,2012,303:E928-935.
[13]朱学创.维生素D和高血压发病的研究进展[J].中国动脉硬化杂志,2010,18:1001-1003.
[14]张难,徐新娟,珠勒皮亚·司马义.补充维生素D对血压影响的系统评价[J].中国循证医学杂志,2013,13:86-92.
[15]余华,朱再胜,高志立,等.维生素D缺乏与老年高血压的相关性研究[J].中国全科医学,2012,15:3345-3347.
[2]孙敏雅,朱燕,肖建平.妊娠晚期母儿维生素D水平与重度子痫前期相关性研究[J].中国妇幼保健,2014,29:2900-2902.
[3]谢幸,苟文丽.妇产科学[M],第8版.北京:人民卫生出版社,2013:43-44.
[4]Shah DA,Khalil RA.Bioactive factors in uteroplacental and systemic circulation link placental ischemia to generalized vascular dysfunction in hypertensive pregnancy and preeclampsia[J].Biochem Pharmacol,2015,95:211-226.
[5]蒋艳敏,方大俊,刘慧姝.美国妇产科医师协会(ACOG)妊娠期高血压疾病小组最新报告解析[J].中国实用妇科与产科杂志,2014,30:493-495.
[6]林建华,梁阿娟,林其德,等.正常妊娠和妊娠期高血压疾病孕妇子宫动脉及其胎儿脐动脉血流动态变化规律的多中心研究[J].中华妇产科杂志,2010,45:583-587.
[7]Ali SM,Khalil RA.Genetic,immune and vasoactive factors in the vascular dysfunction associated with hypertension in pregnancy[J].Expert Opin Ther Targets,2015,19:1495-1515.
[8]李敏,于伟,李翠玲,等.多普勒超声测量孕妇子宫动脉血流在妊娠期高血压疾病中的研究进展[J].中国妇幼保健,2014,29:3359-3362.
[9]Robinson CJ,Wagner CL,Hollis BW,et al.Maternal vitamin D and fetal growth in early-onset severe preeclampsia[J].Am J Obstet Gynecol,2011,204:556e1-4.
[10]Novakovic B,Sibson M,Ng HK,et al.Placenta-specific methylation of the vitamin D24-hydroxylase gene:implications for feedback autoregulation of active vitamin Dlevels at the fetomaternal interface[J].J Biol Chem,2009,284:14838-14848.
[11]罗颖贞,侯延庆,尹昕.子痫前期患者血清25-羟维生素D水平检测的临床意义[J].国际检验医学杂志,2013,24:3318-3319.
[12]Ma R,Gu Y,Zhao S.Expressions of vitamin D metabolic components VDBP,CYP2R1,CYP27B1,CYP24A1,and VDRin placentas from normal and preeclamptic pregnancies[J].Am J Physiol Endocrinol Metab,2012,303:E928-935.
[13]朱学创.维生素D和高血压发病的研究进展[J].中国动脉硬化杂志,2010,18:1001-1003.
[14]张难,徐新娟,珠勒皮亚·司马义.补充维生素D对血压影响的系统评价[J].中国循证医学杂志,2013,13:86-92.
[15]余华,朱再胜,高志立,等.维生素D缺乏与老年高血压的相关性研究[J].中国全科医学,2012,15:3345-3347.