速度向量成像技术监测妊娠期肝内胆汁淤积症孕妇胎儿左右心纵向整体功能的初步研究

Velocity vector imaging technique to monitor the longitudinal whole function of the heart of pregnant women with intrahepatic cholestasis of pregnancy

目的:探讨速度向量成像技术(VVI)监测妊娠期肝内胆汁淤积症(ICP)孕妇胎儿左右心纵向整体心功能的临床价值。方法:以2016年11月至2017年11月,于首都医科大学附属北京地坛医院超声科检查发现的ICP胎儿为研究对象。母体血清总胆汁酸浓度10≤TBA<40μmol/L为ICP轻度组,入组28例;TBA≥40μmol/L为ICP重度组,入组28例;选择同孕周的正常孕妇胎儿,为正常对照组,入组56例。对所有入组胎儿行超声心动图检查,留存动态四腔心声像图,将图像导入VVI处理软件脱机分析,获得左右心室VVI参数,包括收缩期峰值速度(Vs)、舒张期峰值速度(Vd)、收缩期峰值应变(S)、收缩期峰值应变率(SRs)、舒张期峰值应变率(SRd)。结果:ICP重度组胎儿左心室整体SRs、SRd及S较ICP轻度组和对照组减低(P<0.01),但左心室整体SRs、SRd及S于ICP轻度组和对照组间,差异无统计学意义(P>0.05);ICP重度组胎儿右室整体Vd较ICP轻度组、对照组减低(P<0.01),但于ICP轻度组和对照组间,差异无统计学意义(P>0.05);ICP重度组胎儿右心室整体SRs、SRd及S较ICP轻度组和对照组减低(P<0.01),但于ICP轻度组和对照组间,差异无统计学意义(P>0.05)。结论:母体重度胆汁酸增高损害胎儿左心及右心整体收缩及舒张功能;母体轻度胆汁酸增高对胎儿左右心整体心功能无明确影响。

Objective： to investigate the clinical value of velocity vector imaging（ VVI） in monitoring the longitudinal whole cardiac function of pregnant women with intrahepatic cholestasis ofpregnancy（ ICP）.Methods： ICP fetus who were detected by ultrasonography in Beijing Ditan hospital affiliated to the Capital Medical University from November 2016 to November 2017 were studied. The maternal serum total bile acid level 10≤TBA 40μmol/L was determined as the ICP mild group,with 28 cases in the group. The maternal TBA≥40 umol/L was determined as the ICP severe group,with 28 cases in the group. The normal pregnant fetus was selected as normal control group,and 56 patients were enrolled in the normal control group. For fetal four cavity echocardiography of all the groups,will be imported VVI image processing software offline analysis,and get the left and right ventricular VVI parameters,including systolic peak velocity（ Vs）,diastolic peak velocity（ Vd）,the peak systolic strain（ S）,the peak systolic strain rate（ SRs）,diastolic peak strain rate（ SRd）.Results： in ICP severe group fetal left ventricular whole SRs,SRd and S were lower than that in the ICP mild group and the control group（ P〈0. 01）,but left ventricular whole SRs,SRd and S were no difference between the mild group and the control group（ P〈0. 05）; The whole Vd of the fetal right ventricle in the ICP severe group was lower than that in the ICP mild group and the control group（ P〈0. 01）,but there was no difference between the ICP mild group and the control group（ P〈0. 05）. The whole SRs,SRd and S in the right ventricle of the ICP severe group were lower than that in the ICP mild group and the control group（ P〈0. 01）,but there was no difference between the ICP mild group and the control group（ P〈0. 05）. Conclusion： the severe increase of the maternal bile acid damage diastolic and systolic function of the left and right ventricular of the fetus; the mild increase of the maternal bile acid has no definite effect on the whole heart function of the fetus.