超声检测妊娠期糖尿病孕妇胎儿肾动脉血流动力学的价值

Value of color Doppler flow imaging in monitoring fetal renal artery hemodynamics in patients with gestational diabetes mellitus

目的探讨超声检测胎儿肾动脉血流动力学指标在妊娠期糖尿病(GDM)孕妇中的临床价值。方法 GDM孕妇83例,同期分娩正常孕妇80例为对照组,于妊娠晚期超声检测胎儿肾动脉阻力指数、搏动指数及收缩期峰值流速和舒张末期流速的比值(S/D),比较两组肾动脉血流动力学变化及妊娠结局。结果 GDM组胎儿肾动脉阻力指数、搏动指数及S/D均高于对照组(P<0.05),GDM组围产儿结局不良高于对照组(P<0.05);在GDM组中胎儿肾动脉阻力指数≥0.85,S/D≥6.5,其预测围产儿结局不良的敏感性分别为72.2%、77.8%,特异性分别为87.7%、84.6%,二者预测差异无统计学意义(P>0.05)。结论超声检测GDM孕妇的胎儿肾动脉血流动力学的指标,是了解围产儿预后的有效监护手段,而胎儿肾动脉阻力指数和S/D异常预测围产儿结局不良具有较高的敏感性和特异性。

Objective To investigaie the clinical value of ultrasound in monitoring tetal renal artery hemodynamics in patients with gestaional diahetes mellitus （GDM）. Methods Eighty -three pregnant women with GDM and 80 normal pregnant women were enrolled in this study. The resistant index （RI）, pulsatility index （PI） and peak systolic velocity to end diastolic velocity ratio（S/D） were detected by color Doppler uhrasonography, then the hemndynamics changes of renal artery and pregnant outcomes in two groups were compared. Results RI , PI and S/D of fetal RA ira the GDM group were higher than those in control group （P 〈0.05 ）, the adverse perinatal outcome in GDM group was higher than that in control group （P 〈0.05 ）. The sensitivity and speeificity of R1 ≥0.85, S/D≥6.5 of fetal RA in predicting adverse perinatal outcome were 72.2cA and 87.7% , 77.8% and 84.6% , respectively, there was no significant difference between the two groups（ P〉 0.05 ）. Conclusion The index of fetal renal artery hemodynamics in GDM women is an effective method to predict the perinatal outcomes. While abnormal RI and S/D of fetal RA have high sensitivity anti specificity in predicting adverse perinatal outcome.