子宫动脉阻力评分预测子痫前期-子痫及胎儿宫内缺氧

Eclampsism, eclampsia and fetal intrauterine hypoxia predicted by uterine artery resistance scrore

目的:建立子宫动脉阻力评分,探讨预测子痫前期-子痫及胎儿宫内缺氧的临床价值。方法:335例正常孕妇于孕24～28周时,彩色多普勒超声测定左、右侧子宫动脉阻力指数(RI)、搏动指数(PI)、收缩期与舒张期血流速度比(S/D)、血流频谱中舒张早期切迹共4项指标。新生儿出生后进行1分钟阿氏评分。分别以子宫动脉RI、PI、S/D的第90、95、97·5百分位值作为各单项指标的候选界值,通过统计学确定各单项指标的预测界值,综合舒张早期切迹观测结果,建立评分系统(UARS),评价预测效果。结果;335例孕妇中25例发展为子痫前期-子痫,310例血压始终保持正常。RI、PI、S/D的预测界值分别为0·65、1·012、3·490。舒张早期切迹的预测界值是单侧或双侧出现舒张早期切迹。各单项指标预测子痫前期-子痫均具有统计学意义(P<0·01)。以UARS≥4分作为预测界值具有显著统计学意义(P<0·01),其RR值为20·439,预测特异性为99·3%,阳性预测值为86·6%,预测效果明显优于各单项预测指标。UARS=4分时,新生儿阿氏1分钟评分均值为7分,随UARS增高,阿氏评分降低。结论:综合子宫动脉相关指标建立的UARS预测子痫前期-子痫及胎儿宫内缺氧具有重要临床意义。

Objective： To establish uterine arterial resistance scores （UARS） in order to discuss the clinical value of predicting preeclampsia- clampsia and fetal intrauterine hypoxia. Methods： 335 normal pregnancy women at antenatal clinic received uterine artery Doppler ultrasound test on both sides at 24 ～ 28 weeks＇gestation. The parameters of the test included RI, PI, S/D and early diastolic notch. The information about Apgar score in a minute was recorded. Firstly, the authors used the 90th, 95th, 97. 5th centile of every single parameter as three alternative cutoff levels to predict preeclampsia - clampsia respectively. With statistical analysis, the optimal cutoff level of every single parameter was selected respectively from alternative cutoff levels for prediction of preeclampsia - eclampsia. Secondly, the UARS was established according to the optimal cutoff levels of these four single parameters （ total scores： 0 ～ 8 ） and used to predict preeclampsia - clampsia and fetal intrauterine hypoxia. Results： 25 of 335 pregnant women developed preeclampsia - clampsia later, the blood pressure in the rest of them remained normal. The optimal cutoff levels of RI, PI and S/D were 0. 65, 1. 012, 3. 490 respectively. The cutoff level of early diastolic notch was one notch found on one or both sides. The four single parameters for prediction of preeclampsia - clampsia all appeared statistical significance （ P 〈 0. 01 ） . The UARS for prediction of preeclampsia - clampsia also appeared statistical significance （ P 〈 0. 01 ） and its optimal cutoff level was ≥4 scores. The value of UARS for prediction of preeclampsia - clampsia was much better than that of the every single parameter with RR of 20. 439 and specificity of 99. 3% and positive predictive valve of 86. 6%. When its optimal cutoff level was 4 scores, the Apgar score in a minute was 7. Conclusion： UARS is of great value in predicting the development of preeclampsia - clampsia and fetal intrauterine hypoxia.