胎儿肾动脉与大脑中动脉阻力比值对妊娠期肝内胆汁淤积症导致胎儿缺氧的诊断价值

Value of resistant parameter ratios of fetal renal artery to middle cerebral artery in diagnosis of intrauterine fetal hypoxia induced by intrahepatic cholestasis of pregnancy

目的探讨胎儿肾动脉(RA)与大脑中动脉(MCA)阻力比值预测妊娠期肝内胆汁淤积症(ICP)胎儿宫内缺氧的诊断价值。方法应用彩超分别检测50例妊娠期肝内胆汁淤积症胎儿(ICP组)和50例正常妊娠胎儿(对照组)的RA与MCA的S/D值、阻力指数(RI)、搏动指数(PI),计算RA与MCA指标的比值,并与妊娠结局对照。结果与对照组相比,ICP组胎儿肾动脉的S/D、RI和PI阻力指标均显著升高,而大脑中动脉S/D、RI和PI阻力指标均显著降低。ICP组胎儿RA和MCA的阻力指标比值均比对照组高,差异有统计学意义(P<0.05)。当S/D_(RA/MCA)>1.45,RI_(RA/MCA)>1.12,PI_(RA/MCA)>1.32时,预测胎儿在宫内缺氧的敏感性、特异性分别为90.48%、96.56%。结论胎儿RA与MCA阻力指标比值可以有效监测ICP胎儿宫内缺氧状况。

Objective To investigate the predictive value of resistant parameter ratios of fetal renal artery （RA） to middle cerebral artery （MCA） in the early diagonsis of intrauterine fetal hypoxia induced by intrahepatic cholestasis of pregnancy. Methods Color Doppler was used to measm＇e the peak systolic to end diastolic ratio （S/D）, the resistant index （RA） and pulsatility index （PI） of the fetal RA and MCA in the two groups： ICP group （u = 50） and normal group （u = 50）. The resistant parameter ratios of fetal RA to MCA were counted and the preg- nancy outcome was recorded and analyzed as well Results Compared with those of the control group, the S/D, RI and PI of fetal RA of the ICP group were significantly higher while the resistance indexes of fetal MCA were just the opposite. The resistant parameter ratios of fetal RA to MCA of the ICP group was significantly higher when com- pared with those of the control group （P 〈 0.05）. When S/D RA/MCA 〉 1.45, RI RA/MCA 〉 1.12, PI RA/MCA 〉 1.32, the sensi- tivity and specificity to predict intrauterine fetal hypoxia in intrahepatic cholestasis of pregnancy were 90.48% and 96.56% respectively while the positive predictive value, the negative predictive value, the false positive rate and the false negative rate were 94% , 6%, 5% and 6.67% respectively. Conclusion The resistant parameter ratios of fetal RA and MCA can predict fetal intrauterine hypoxia induced by intrahepatic cholestasis of pregnancy.