血管紧张素原基因多态孕妇子宫动脉血流异常的临床意义

Clinical significance of abnormal blood flow of uterine artery in pregnant women with angiotensinogen gene polymorphism

目的:通过检测具有血管紧张素原(AGT)基因多态孕妇的子宫动脉血流,探讨AGT基因多态与子宫动脉血流异常在子痫前期发病中的作用。方法:对80例来广州军区武汉总医院分娩的具有AGT基因多态的孕妇,行彩色超声检查,发现子宫动脉血流参数异常或多普勒频谱异常按照所具基因型(MM、MT、TT)分为2组:子痫前期组(PIH组)和正常妊娠组(对照组),观察两组子宫动脉收缩末期最大血流速度和舒张末期最大血流速度之比(S/D),搏动指数(PI),阻力指数(RI),胎儿宫内发育迟缓(FGR),低体重儿的发生率及T等位基因频率。结果:PIH组子宫动脉的S/D、PI、RI值均高于对照组,差异有统计学意义(P<0.05)。PIH组FGR,低体重儿的发生率及T等位基因频率均高于对照组,差异有统计学意义(P<0.05)。结论:AGT基因多态TT型孕妇子宫动脉血流异常提示子痫前期发病危险升高,此类患者存在子宫-胎盘循环障碍,子宫动脉阻抗增高,血供不足,导致不良妊娠结局。早期普查AGT基因多态孕妇,结合彩色超声检查子宫动脉血流在预测子痫前期及围产儿结局方面有重要临床价值。

Objective：To explore the effects of angiotensinogen gene polymorphism and abnormal blood flow of uterine artery on pathogenesis of preeclampsia by detecting uterine artery blood flow in pregnant women with angiotensinogen gene polymorphism.Methods：80 pregnant women with angiotensinogen gene polymorphism received color Doppler ultrasound examination,abnormal uterine artery blood flow parameters and Doppler spectrum were found,then the women were divided into preeclampsia group（PIH group） and normal pregnancy group（control group） according to genotypes（MM,MT,TT）,the largest uterine artery end-systolic blood flow velocity/the largest end-diastolic blood folw velocity（S/D）,pulsatility index（PI）,resistant index（RI）,incidences of intrauterine growth retardation and low birth weight infants and frequency of T allele were observed in the two groups.Results：The uterine artery S/D,PI,RI values in PIH group were significantly higher than those in control group（P0.05）;the incidences of intrauterine growth retardation and low birth weight infants and frequency of T allele in PIH group were significantly higher than those in control group（P0.05）.Conclusion：The abnormal blood flow of uterine artery of pregnant women with angiotensinogen gene polymorphism TT genotype indicates increased risk of preeclampsia,and dysfunction of uterine-placental circulation exists in these patients,increase of uterine artery resistance and lack of blood supply lead to adverse pregnancy.Early screening pregnant women with angiotensinogen gene polymorphism and examining blood flow of uterine artery with color Doppler ultrasound may play an important role in predicting preeclampsia and perinatal outcomes.