孕中期子宫动脉收缩期与舒张期流速比对重度子痫前期的预测及诊断价值

Predictive and diagnostic value of uterine artery systolic and diastolic flow ratio for preeclampsia in the second trimester

目的探讨孕产妇子宫动脉收缩期与舒张期流速比(systolic to diastolic velocity ratio,S/D)对重度子痫前期(PE)的早期预测价值。方法收集2016年1月至2018年6月在我院产科定期产检并住院分娩的PE患者75例为研究对象(PE组),同期正常妊娠的孕妇75例为对照组。两组孕妇20～28周测量双侧子宫动脉S/D,24～28周测母亲血浆维生素D,比较两组孕妇子宫动脉S/D、子宫动脉搏动指数与维生素D水平的差异,采用Pearson相关分析子宫动脉S/D与维生素D水平的相关性,采用受试者工作特征曲线评价子宫动脉S/D对重度子痫前期的诊断价值。结果与对照组比较,PE组孕妇双侧子宫动脉S/D平均水平、[(4.12±0.34)vs.(2.83±0.43)]、子宫动脉搏动指数[(1.44±0.62)vs.(0.96±0.49)]显著上升(P<0.05),25-羟维生素D平均水平[(33.46±12.13)μg/L vs.(42.14±10.52)μg/L]显著降低(P<0.05)。相关性分析显示,PE组双侧子宫动脉S/D值平均值与25-羟维生素D水平呈负相关(r=-0.79,P<0.001)。子宫动脉S/D值曲线下面积0.831,最佳截断值3.75,诊断灵敏度为81.33%,特异度为86.67%。结论子宫动脉S/D值对重度子痫前期具有较好的预测及诊断价值,可联合维生素D作为孕中期子痫的重要观测指标。

Objective:To investigate the predictive value of uterine artery systolic to diastolic velocity ratio(S/D)in severe ectopic preeclampsia(PE).Methods:Seventy five patients with severe PE who underwent regularly inspected and hospitalized for childbirth in our hospital from January 2016 to June 2018 were enrolled in the PE group,and 75 normal pregnant women in the same period were included in the control group.Bilateral uterine artery S/D was measured at 20-28 weeks.The plasma vitamin D was measured at 24-28 weeks.The uterine artery S/D,uterine artery pulsation index and vitamin D level were compared between the two groups.Pearson correlation was used to analyze the correlation between uterine artery S/D and vitamin D.The value of uterine artery S/D in the diagnosis of severe preeclampsia is evaluated by receiver operating characteristic curve.Results:Compared with the control group,the average level of bilateral uterine artery S/D [(4.12±0.34)vs.(2.83±0.43),P<0.05]and the uterine artery pulsation index[(1.44±0.62)vs.(0.96±0.49),P<0.05]were increased significantly,but the average level of 25-hydroxy vitamin D was significantly decreased[(33.46±12.13)vs.(42.14±10.52)μg/L,P<0.05]in the PE group.Correlation analysis showed that the mean value of bilateral uterine artery S/D values was negatively correlated with 25-hydroxyvitamin D levels in the PE group(r=-0.79,P<0.001).The ROC area of S/D was 0.831,and the optimal cut-off value was 3.75,with diagnostic sensitivity of 81.33%and the specificity of 86.67%.Conclusions:The S/D value of uterine artery has a good predictive and diagnostic value for preeclampsia,and it can be combined with vitamin D as an important indicator for the monitoring of preeclampsia in the second trimester.