超声测量胎儿腹内段脐静脉和大脑中动脉血流参数与ABO血型不合致胎儿贫血的关系研究

ASSOCIATION OF FETAL ANEMIA DUE TO MATERNAL-FETAL ABO BLOOD GROUP INCOMPATIBILITY WITH THE FLOW PARAMETERS OF FETAL INTRA-ABDOMINAL UMBILICAL VEIN AND MIDDLE CEREBRAL ARTERY

目的:应用超声多普勒测量胎儿腹内段脐静脉(FIUV)和大脑中动脉(MCA)血流参数,探讨其预测因ABO血型不合所致胎儿贫血的价值。方法:对75例(母子ABO血型不合组35例和正常妊娠组40例)单胎孕妇在孕24,32,38周时行二维及多普勒超声检查,测量FIUV最大速度(Vmax)、FIUV内径(D)和MCA收缩期峰值流速(PSV),并检测ABO血型不合组孕妇的血清IgG抗-A(B)效价。结果:孕24周时两组的FIUV-Vmax、FIUV-D、MCA-PSV比较差异无统计学意义(P>0.05),孕32,38周时ABO血型不合组中FIUV-Vmax、FIUV-D、MCA-PSV均高于正常妊娠组,差异有统计学意义(P<0.05)。孕38周时孕妇IgG抗-A(B)效价≥1∶128各组的MCA-PSV明显高于抗体效价为1∶64组,而FIUV-Vmax、FIUV-D在各组比较中差异无统计学意义(P>0.05),以MCA-PSV>64.5cm/s为异常,其预测胎儿宫内贫血的敏感度和特异度分别为93.33%、94.11%。结论:超声多普勒测量FIUV-Vmax、FIUV-D、MCA-PSV对预测因ABO血型不合所致胎儿贫血有一定的临床价值。当晚孕期孕妇IgG抗-A(B)效价≥1∶128时,结合超声监测MCA和FIUV血流速度,若其异常增高,提示胎儿可能发生溶血性贫血,需引起重视和随访。

Objective：To investigate the association of fetal anemia due to maternal-fetal ABO blood group incompatibility with measuring the flow parameters of fetal intra-abdominal umbilical vein（FIUV） and middle cerebral artery（MCA） by color Doppler ultrasonography.Methods： Seventy-five singleton pregnancies at 24,32,38 weeks’ gestation,underwent two dimensional ultrasound and Doppler imaging.FIUV maximum velocity（Vmax）,diameter（D） and the MCA peak systolic velocity were measured.There were 35 pregnancies of maternal-fetal ABO blood group incompatibility and 40 normal pregnancies.All of the pregnancies in group of maternal-fetal ABO blood group incompatibility were tested tilter of serum IgG antibody.Results： FIUV Vmax,FIUV-ID and MCA-PSV were increased along with gestational age increasing in all fetuses.At the 24th weeks’ gestation,there was no significant difference in the FIUV Vmax,FIUV-D and MCA-PSV between the two groups.But at the same weeks’ gestation of the 3rd trimester,the group with ABO blood group incompatibility had higher FIUV Vmax,FIUV-D and MCA-PSV than normal fetus group.In the 3rd trimester,the group of the efficiency ≥1∶128 had higher MCA-PSV than the group of the efficiency 1∶64,but there was no significant difference in the FIUV Vmax and FIUV-D between other groups.Provided MCA-PSV 〉 64.5 cm/s at 38th weeks’ gestation,the sensitivity and specificity of MCA-PSV in prediction of fetal anemia were 93.33% and 94.11%,respectively.Conclusion： There is clinical value using Color Doppler to monitor FIUV Vmax,FIUV-D,MCA-PSV and predict fetal anemia due to ABO blood group incompatibility.When the efficiency is ≥1∶128 in the 3rd trimester,combined monitoring the flow velocity of FIUV and MCA,if the flow parameters increase significantly,we should be draw enough attention and observation as it may point to fetal anemia.