脐动脉彩色多普勒对监测狼疮肾炎患者胎儿不良妊娠结局的临床意义

Predictive value of fetal umbilical artery Doppler in adverse pregnancy outcomes in patients with Lupus nephritis

目的探讨胎儿脐动脉彩色多普勒对狼疮肾炎(LN)孕妇不良妊娠结局(APOs)的监测作用。方法回顾性分析于中山大学附属第一医院、广州中医药大学第一附属医院就诊的158例LN妊娠患者。结果共有39例为妊娠期初发LN,119例为妊娠前已确诊LN。118例(74.7%)患者发生1种或1种以上胎儿APOs,40例(25.3%)未发生任何胎儿APOs。54例(34.2%)发生妊娠丢失,104例(65.8%)活胎分娩,其中足月产49例,早产55例,IUGR 24例,胎儿宫内窘迫14例,新生儿狼疮9例。胎儿脐动脉彩色多普勒检查提示出现APOs组的脐动脉血流搏动指数(PI)、阻力指数(RI)、S/D值均高于未出现APOs组(P<0.05)。受试者运算特征曲线(ROC)中三个多普勒参数曲线下面积均为0.7(95%CI 0.6~0.8)。PI、RI、S/D的最佳截点为0.9、0.6、2.5,其敏感性分别为28.3%,45.7%,39.1%,特异性分别为97.2%,80.6%,90.0%。结论 LN患者不良妊娠结局发生率高,尤其是妊娠丢失和早产。脐动脉彩色多普勒检查是监测LN患者孕晚期胎儿生长情况的重要手段。

Objective To examine the predictive value of the fetal umbilical artery Doppler on adverse pregnancy outcomes （APOs） in pregnant women with lupus nephritis （LN）. Methods The clinical data of 158 LN pregnant patients from the First Affiliated Hospital of Traditional Chinese Medicine University of Guangzhou and the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Results Totally, 119 were diagnosed before pregnancy and 39 were newly diagnosed during pregnancy. One or more APOs occurred in 74.7% of patients with LN and 40 （25.3%） patients were without any APOs. Fifty-four of pregnancies （ 34.2% ） resulted in fetal loss. A total of 55 pregnancies were preterm birth, 24 were intrauterine growth retardation （IUGR）, 14 were fetal distress and 9 were neonatal lupus. Doppler pulsatility index （PI） , resistance index （RI） as well as S/D value were significantly higher in the APOs groups than in the patients without APOs （P 〈 0.05）. The area below the receiver operating characteristic （ROC） curve for PI, RI and S/D all was 0.7 （95%CI 0.6 ~ 0.8）. PI with cut-off value of 0.9 indicated the highest risk of APOs, with sensitivity of 28.3% and specificity of 97.2%. Regarding 0.6 as the cut-off value for RI to predict APOs, the sensitivity was 45.7% and the specificity was 80.6%.The optimal cut-off value for S/D was 2.5, at which sensitivity （39.1%） and specificity （90.0%） had the best combination. Conclusions Pregnancies in LN were more prone to pregnancy loss and preterm birth. Umbili- cal artery Doppler was a useful monitoring measure for APOs in pregnancies of LN.