胎儿脐动脉彩超检查在监测SLE合并妊娠期高血压疾病不良妊娠结局中的作用

Clinical value of fetal umbilical artery Doppler in monitoring adverse pregnancy outcome of patients with systemic lupus erythematosus complicated with hypertensive disorders in pregnancy

目的探讨胎儿脐动脉彩色多普勒超声(彩超)检查对SLE合并妊娠期高血压疾病(HDP)患者不良妊娠结局(APO)的监测作用。方法收集285例妊娠合并SLE患者的临床资料,记录SLE合并HDP者的母儿结局,比较SLE合并HDP者(HDP组,30例)与无合并HDP且无发生APO者(对照组,86例)在脐动脉彩超检查搏动指数、阻力指数、脐动脉收缩末期血流峰值与舒张末期血流峰值比值(S/D)的差异。绘制受试者工作特征(ROC)曲线,分析搏动指数、阻力指数和S/D监测SLE合并HDP者发生APO的作用。结果 285例妊娠合并SLE患者中,合并HDP 38例(13.3%)。38例SLE合并HDP孕妇中,妊娠期高血压4例、子痫前期34例,无子痫患者;32例(84.2%)发生1种或1种以上APO,其中早产20例、宫内发育迟缓9例,胎儿宫内窘迫7例、妊娠丢失6例、新生儿SLE 5例。HDP组的脐动脉血流搏动指数、阻力指数、S/D均高于对照组(P均﹤0.05),该3项指标的ROC曲线下面积分别为0.78(95%CI 0.67~0.89)、0.72(95%CI 0.61~0.84)和0.76(95%CI0.65~0.87)。选取搏动指数、阻力指数、S/D的最佳诊断界值(分别为1.01、0.67、3.36),其预测SLE合并HDP者发生APO的灵敏度分别为30.0%、63.6%、43.3%,特异度分别为88.4%、83.7%、88.4%。结论 SLE合并HDP患者的APO发生率高,尤其是早产。脐动脉彩超检查是监测SLE合并HDP患者胎儿生长情况的有效手段。

Objective To investigate the clinical value of fetal umbilical artery Doppler in the prediction of adverse pregnancy outcome(APO)of patients with hypertensive disorders in pregnancy(HDP)complicated with systemic lupus erythematosus(SLE).Methods Clinical data of 285 pregnant women complicated with SLE were collected.The maternal and neonatal outcomes of SLE complicated with HDP patients were recorded.All patients were divided into the SLE complicated with HDP(HDP group,n=30)and SLE without HDP/APO groups(control group,n=86).Thepulsatilityindex(PI),resistance index(RI)and the ratio of systolic valueand diastolic value(S/D value)were analyzed and statistically compared between two groups.The area below the receiver operating characteristic(ROC)curve was delineated to assess the efficiency of PI,RI and S/D value in predicting the incidence of SLE complicated with HDP.Results Among 285 pregnant women complicated with SLE patients,38 patients(13.3%)were complicated with HDP.Among these 38 cases,3 women were diagnosed with gestational hypertension and 34 with preeclampsia.No eclampsia occurred.One or more APOs occurred in 32 patients(84.2%)with SLE.Among them,20 women presented with preterm birth,9 with intrauterine growth retardation(IUGR),7 with fetal distress,6 with fetal loss and 5 with neonatal lupus.In the HDP group,the PI,RI and S/D value were significantly higher compared with those in the control group(all P<0.05).The area under the ROC curve for PI,RI and S/D value was 0.78(95%CI 0.67~0.89),0.72(95%CI 0.61~0.84)and 0.76(95%CI 0.65~0.87),respectively.The optimal cut-off values for PI,RI and S/D value were 1.01,0.67 and 3.36,respectively.The sensitivity of three indexes at the cut-off values was 30.0%,63.6%and 43.3%,and 88.4%,83.7%and 88.4%for the specificity,respectively.Conclusions The incidence of APO is high in SLE pregnant women complicated with HDP,especially the preterm delivery.Umbilical artery Doppler is an efficacious monitoring approach for the fetal growth in SLE pregnant women complicated with HDP.