超声心动图评价妊娠期糖尿病胎儿心脏功能

Evaluation of Fetal Heart Function of Gestational Diabetes by Echocardiography

目的应用超声心动图评价妊娠期糖尿病(GDM)胎儿心脏构型及功能变化。资料与方法48例GDM孕妇按照母体血糖水平分为GDM1组和GDM2组,应用超声心动图测量胎儿心脏二尖瓣环内径(MVA)、三尖瓣环内径(TVA)、主动脉瓣环内径(AVA)、肺动脉瓣环内径(PVA)、左/右室舒张末期内径(LVDd、RVDd)、左/右室收缩末期内径(LVDs、RVDs)、左/右室壁厚度(LVWT、RVWT)、室间隔舒张末期厚度(IVSd)、室间隔收缩末期厚度(IVSs)、左室射血分数(LVEF)、左/右室短轴缩短率(LVFS、RVFS)、二、三尖瓣E、A峰值速度比值(E/AMV、E/ATV)、左/右室Tei指数(LVMPI、RVMPI)。选择同期96例正常妊娠孕妇作对照。结果 GDM2组胎儿MVA、TVA、PVA、LVMPI、RVMPI均大于对照组,差异有统计学意义(P<0.05)。GDM1组胎儿MVA、TVA、AVA、PVA和RVMPI均小于GDM2组,差异有统计学意义(P<0.05)。GDM1组各瓣环内径与对照组差异无统计学意义(P<0.05);LVMPI、RVMPI较对照组增大,差异有统计学意义(P<0.05)。结论母体血糖水平越高,胎儿心脏构型及功能改变越明显。超声心动图是评价妊娠期糖尿病胎儿心脏功能的重要方法。

Purpose To explore the influence of ultrasonic irradiation combined with ultrasound contrast agents on the ultrastructure of human first trimester chorionic villi and apoptosis.Materials and Methods Thirty-six women requesting voluntary abortion were chosen and randomly assigned into control group,low mechanical index （MI） contrast group （MI≤0.15） and high mechanical index contrast group （MI=1.0）.The low mechanical index group was divided into MI=0.07,0.09,0.13 and 0.15 subgroups.After ultrasound studies,the chorionic villi tissue was taken out after induced-abortion in 24 hours.The ultrastructure of chorionic villi was observed on transmission electron microscopy.The expression of apoptosis-related gene Bcl-2 protein was detected using immunohistochemical staining method.Results Electron microscopy results showed more villi damage in high mechanical index group than in control and low mechanical index groups.There was no difference in villi damage between low mechanical index and control groups.Immunohistochemical results showed significant decrease of Bcl-2 protein expression in syncytiotrophoblast cells in high mechanical index contrast group （P〈 0.05） compared with the control group and the low mechanical index contrast groups,Bcl-2 expression was not significantly different between control and low MI groups （P〉 0.05）.Conclusion High mechanical index ultrasound irradiation combined with ultrasound contrast agent causes human embryo injury.Low mechanical index ultrasonography is safer in obstetric applications.