妊娠中晚期胎盘血管化参数与妊娠期高血压疾病患者不良妊娠结局的关系研究
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摘要
目的观察妊娠中晚期胎盘血管化参数[胎盘容积及胎盘血管化指数(vascularization index,VI)、血流指数(flow index,FI)、血管化血流指数(vascularization-flow index,VFI)]与妊娠期高血压疾病患者不良妊娠结局的关系。方法回顾性分析2014年1月至2017年1月青岛市妇女儿童医院收治的100例妊娠期高血压疾病患者的临床资料,按照妊娠结局将患者分为正常妊娠结局组(69例)和不良妊娠结局组(31例)。统计两组三维能量多普勒超声测量数据,包括胎盘容积及VI、FI、VFI,分析妊娠中晚期胎盘血管化参数与妊娠期高血压疾病患者不良妊娠结局的关系。结果 100例妊娠期高血压疾病患者中新生儿窒息、胎儿宫内窒息、胎盘早剥、产后出血、围生儿死亡、早产、剖宫产、低体重儿、巨大儿发生率分别为2.00%(2/100)、1.00%(1/100)、1.00%(1/100)、3.00%(3/100)、1.00%(1/100)、3.00%(3/100)、16.00%(16/100)、2.00%(2/100)、2.00%(2/100)。不良妊娠结局组胎盘血管容积及VI、FI、VFI均低于正常妊娠结局组(P<0.05)。经ROC曲线处理,结果显示胎盘血管容积及VI、FI、VFI对妊娠期高血压疾病患者不良妊娠结局均有一定预测价值,曲线下面积分别为0.870、0.932、0.889、0.929。结论妊娠中晚期胎盘血管化参数与妊娠期高血压疾病患者不良妊娠结局密切相关,临床应引起足够重视。
Objective To observe the relationship between placental vascularization parameters [placental volume and placental vascularization index(VI), blood flow index(FI), vascular flow index(VFI)] and adverse pregnancy outcomes in patients with hypertensive disorder complicating pregnancy(HDCP).Methods Data of 100 cases of HDCP from January 2014 to January 2017 in Qingdao Women and Children's Hospital were analyzed retrospectively.According to the outcome of pregnancy, the patients were divided into normal pregnancy outcome group(69 cases) and adverse pregnancy outcome group(31 cases).The three-dimensional power Doppler ultrasound measurement data, including placental volume and VI, FI, VFI, were collected and to analyze the relationship between the placental vascularization parameters in the middle and late pregnancy and the adverse pregnancy outcomes in patients with HDCP. Results The incidence of neonatal asphyxia, fetal intrauterine asphyxia, placental abruption, postpartum hemorrhage, perinatal death, preterm birth, cesarean section, low weight infants, and gigantic infants were 2 %(2/100), 1 %(1/100), 1 %(1/100), 3 %(3/100), 1 %(1/100), 3 %(3/100), 16 %(16/100), 2 %(2/100), 2 %(2/100).The placental vessel volume and VI, FI and VFI in the adverse pregnancy outcome group were significantly lower than those in the normal pregnancy outcome group(P<0.05).The results of ROC curve showed that the placenta blood vessel and VI, FI and VFI had a certain predictive value for adverse pregnancy outcome in patients with HDCP. The area under the curve was 0.870, 0.932, 0.889 and 0.929, respectively. Conclusion The parameters of placental vascularization in pregnancy are closely related to the adverse pregnancy outcomes of patients with HDCP,which should be paid enough attention clinically.
Objective To observe the relationship between placental vascularization parameters [placental volume and placental vascularization index(VI), blood flow index(FI), vascular flow index(VFI)] and adverse pregnancy outcomes in patients with hypertensive disorder complicating pregnancy(HDCP).Methods Data of 100 cases of HDCP from January 2014 to January 2017 in Qingdao Women and Children's Hospital were analyzed retrospectively.According to the outcome of pregnancy, the patients were divided into normal pregnancy outcome group(69 cases) and adverse pregnancy outcome group(31 cases).The three-dimensional power Doppler ultrasound measurement data, including placental volume and VI, FI, VFI, were collected and to analyze the relationship between the placental vascularization parameters in the middle and late pregnancy and the adverse pregnancy outcomes in patients with HDCP. Results The incidence of neonatal asphyxia, fetal intrauterine asphyxia, placental abruption, postpartum hemorrhage, perinatal death, preterm birth, cesarean section, low weight infants, and gigantic infants were 2 %(2/100), 1 %(1/100), 1 %(1/100), 3 %(3/100), 1 %(1/100), 3 %(3/100), 16 %(16/100), 2 %(2/100), 2 %(2/100).The placental vessel volume and VI, FI and VFI in the adverse pregnancy outcome group were significantly lower than those in the normal pregnancy outcome group(P<0.05).The results of ROC curve showed that the placenta blood vessel and VI, FI and VFI had a certain predictive value for adverse pregnancy outcome in patients with HDCP. The area under the curve was 0.870, 0.932, 0.889 and 0.929, respectively. Conclusion The parameters of placental vascularization in pregnancy are closely related to the adverse pregnancy outcomes of patients with HDCP,which should be paid enough attention clinically.
引文
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[11] 马斌,王艺璇,李天刚,等.三维能量多普勒超声在妊娠期高血压疾病胎盘血流灌注监测中的价值 [J].中国妇幼保健,2018,33(4):918-921.
[12] 张彦华,林海英,高宇.三维能量多普勒超声联合孕妇血清中TNF-α检测妊娠期高血压疾病的研究 [J].中国妇幼保健,2015,30(17):2818-2820.
[13] 杨瑞琦,张嘉玲,朱崇磊,等.应用三维多普勒超声定量测量胎盘对高血压孕妇胎儿状态的评估 [J].中华医学杂志,2015,95(31):2551-2553.
[14] Scifres CM,Parks WT,Feghali M,et al.Placental maternal vascular malperfusion and adverse pregnancy outcomes in gestational diabetes mellitus[J].Placenta,2017,49(12):10-15.
[15] 吴娟,黎全华,袁瑞,等.中晚孕期重度子痫前期孕妇胎盘-胎儿血流动力学变化 [J].中华围产医学杂志,2016,19(12):943-947.
[16] Altorjay áT,Surányi A,Nyári T,et al.Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes,chronic or gestational hypertension,and preeclampsia at risk [J].Croat Med J,2017,58(2):161-169.
[2] 李志强,徐英姿.多普勒超声在妊娠期高血压疾病孕妇子宫动脉及脐动脉血流检测中的应用[J].中国妇幼保健,2017,32(15):3686-3688.
[3] Rossi A,Citossi A,Cagnacci A,et al.P25.01:assessment of placental vascularisation using three imensional power doppler angiography(3D PDA)in normal fetuses and fetuses affected by fetal growth restriction(FGR)[J].Ultrasound in Obstetrics & Gynecology,2017,50(S1):235.
[4] Reddy A,Malik R,Mehra S,et al.Correlation of doppler studies at 34 weeks of gestation with perinatal outcome in high risk pregnancies [J].Curr Opin Rheumatol,2017,42(17):1894-1899.
[5] 中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2012版)[J].中华妇产科杂志,2012,47(6):476-480.
[6] 丰有吉,沈铿.妇产科学 [M] .北京:人民卫生出版社,2002.
[7] 胡亚美,江载芳.诸福棠实用儿科学 [M] .第7版.北京:人民卫生出版社,2002.
[8] 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.
[9] 厉进,雷慧,范雪梅.妊高征孕妇髂内动脉血流与胎盘病理学改变的相关性分析[J].中国超声医学杂志,2016,32(7):667-669.
[10] 蔡小平,许晓芬.三维彩色能量多普勒超声对胎盘植入的诊断价值研究 [J].医疗卫生装备,2017,38(11):65-68,89.
[11] 马斌,王艺璇,李天刚,等.三维能量多普勒超声在妊娠期高血压疾病胎盘血流灌注监测中的价值 [J].中国妇幼保健,2018,33(4):918-921.
[12] 张彦华,林海英,高宇.三维能量多普勒超声联合孕妇血清中TNF-α检测妊娠期高血压疾病的研究 [J].中国妇幼保健,2015,30(17):2818-2820.
[13] 杨瑞琦,张嘉玲,朱崇磊,等.应用三维多普勒超声定量测量胎盘对高血压孕妇胎儿状态的评估 [J].中华医学杂志,2015,95(31):2551-2553.
[14] Scifres CM,Parks WT,Feghali M,et al.Placental maternal vascular malperfusion and adverse pregnancy outcomes in gestational diabetes mellitus[J].Placenta,2017,49(12):10-15.
[15] 吴娟,黎全华,袁瑞,等.中晚孕期重度子痫前期孕妇胎盘-胎儿血流动力学变化 [J].中华围产医学杂志,2016,19(12):943-947.
[16] Altorjay áT,Surányi A,Nyári T,et al.Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes,chronic or gestational hypertension,and preeclampsia at risk [J].Croat Med J,2017,58(2):161-169.