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研究

Diagnostic value of ratio of fetal renal artery to middle cerebral artery resistance in fetal hypoxia caused by intrahepatic cholestasis of pregnancy

目的探讨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。方法选取2017年1月~2018年5月期间本院收治的76例妊娠期肝内胆汁淤积症产妇,根据胎心监护和超声诊断结果分为胎儿宫内缺氧组(38例)、非宫内缺氧组(38例);另选择同期在本院产检的38例健康产妇作为对照组。三组产妇均采用彩色多普勒超声检查,探查大脑中动脉(MCA)和肾动脉(RA)的血流频谱,对比三组RA及MCA阻力指数(RI)和搏动指数(PI)和(S/D),并比较两组RA/MCA阻力比值。结果胎儿宫内缺氧组和非宫内缺氧组RA S/D值、RI值、PI值均显著高于对照组,MCA S/D值、RI值、PI值均显著低于对照组,差异均具有统计学意义(P <0.05)。胎儿宫内缺氧组RA S/D值、RI值、PI值均显著高于非宫内缺氧组,MCA S/D值、RI值、PI值均显著低于非宫内缺氧组,差异均具有统计学意义(P <0.05)。胎儿宫内缺氧组和非宫内缺氧组S/D_(RA/MCA)、RI_(RA/MCA)及PI_(RA/MCA)均显著高于对照组,差异均具有统计学意义(P<0.05)。胎儿宫内缺氧组S/D_(RA/MCA), RI_(RA/MCA)、及PI_(RA/MCA)均显著高于非宫内缺氧组,差异均具有统计学意义(P <0.05)。结论妊娠期肝内胆汁淤积症导致宫内缺氧胎儿肾动脉与大脑中动脉阻力比值存在明显升高表现,可为该病临床诊断与监测提供一定参考依据。

Objective To explore the diagnostic value of ratio of fetal renal artery to middle cerebral artery resistance in fetal hypoxia caused by intrahepatic cholestasis of pregnancy. Methods 76 parturient women with intrahepatic cholestasis of pregnancy who were admitted and treated in our hospital from January 2017 to May 2018 were selected. According to results of fetal heart monitoring and ultrasonic diagnosis, they were divided into the fetal intrauterine hypoxia group and the non-intrauterine hypoxia group, with 38 in each group. In addition, 38 parturient women in the same period were selected as the control group. Parturient women in three groups were all given color Doppler ultrasonography to detect the blood flow spectrum of middle cerebral artery(MCA) and renal artery(RA). RA resistance index(RI), MCA resistance index(RI), pulsatile index(PI) and(S/D) of the three groups were compared and RA/MCA resistance ratio of the two groups was compared. Results RAS/D value, RI value and PI value of the fetal intrauterine hypoxia group and the non-intrauterine hypoxia group were all significantly higher than those of the control group, and MCA S/D value, RI value and PI value were significantly lower than those of the control group.Differences were statistically significant(P < 0.05). RAS/D value, RI value and PI value of the fetal intrauterine hypoxia group were all significantly higher than those of thenon-intrauterine hypoxia group, and MCA S/D value,RI value and PI value were significantly lower than those of the non-intrauterine hypoxia group. Differences were statistically significant(P < 0.05). The S/DRA/MCA, RIRA/MCA and PIRA/MCA in fetal intrauterine hypoxia group and nonintrauterine hypoxia group were significantly higher than those in the control groupof the fetal intrauterine hypoxia group and the non-intrauterine hypoxia group were all significantly higher than those of the control group and the difference was statistically significant(P < 0.05). The S/DRA/MCA, RIRA/MCA and PIRA/MCA in fetal intrauterine hypoxia group were all significantly higher than those in the non-intrauterine hypoxia group. The difference was statistically significant(P < 0.05). Conclusion Ratio of fetal renal artery to middle cerebral artery resistance in fetal hypoxia caused by intrahepatic cholestasis of pregnancy is significantly increased, which can provide certain reference for clinical diagnosis and monitoring of the disease.