定量胎儿大脑中动脉、肾动脉、静脉导管多普勒血流参数结合心室Tei指数在预测高危胎儿宫内缺氧中的价值

Value of fetal cerebral artery,renal artery,and venous catheter blood flow parameters combined with ventricular Tei index on predicting intrauterine hypoxia in high risk fetation

目的探讨胎儿大脑中动脉、肾动脉、静脉导管多普勒血流参数结合心室Tei指数在预测高危胎儿宫内缺氧中的价值。方法选取我院产检并分娩的单胎孕妇189例孕妇,孕周为36~42周,根据高危孕产妇评分评定结果将91例为高危孕妇设为观察组,98例为正常孕妇为对照组。采用频谱多普勒超声测量胎儿肾动脉和大脑中动脉的阻力指数比值(RIRA/RIMCA)、肾动脉和大脑中动脉的搏动指数比值(PIRA/PIMCA)、肾动脉和大脑中动脉的收缩期最大血流速度和舒张期末期血流速度比值之比(S/DRA/S/DMCA)、静脉导管阻力指数(RIDV)、静脉导管搏动指数(PIDV)、静脉导管收缩期最大血流速度和舒张期末期血流速度比值(S/DDV),并计算两组胎儿的心室Tei指数,同时测定出生后新生儿脐静脉血液缺氧诱导因子-1α(HIF-1α)水平并分析各指标与HIF-1α水平的关系。结果观察组胎儿的RIRA/RIMCA、PIRA/PIMCA、S/DRA/S/DMCA、RIDV、PIDV、S/DDV数据均明显高于对照组,差异均有统计学意义(t分别=17.71、20.24、23.70、2.75、15.06、75.36,P均<0.05)。观察组胎儿的左、右心室Tei指数明显低于对照组,HIF-1α水平明显高于对照组,差异均有统计学意义(t分别=10.99、11.59、37.28,P均<0.05)。Pearson相关结果显示,孕期胎儿的RIRA/RIMCA、PIRA/PIMCA、S/DRA/S/DMCA、RIDV、PIDV、S/DDV与HIF-1α水平均呈正相关(r分别=0.54、0.53、0.63、0.55、0.54、0.63,P均<0.05),左、右心室Tei指数与HIF-1α水平呈负相关(r分别=-0.64、-0.65,P均<0.05)。结论胎儿的RIRA/RIMCA,PIRA/PIMCA、S/DRA/S/DMCA、RIDV、PIDV、S/DDV和Tei指数均与其缺氧损伤指标具有一定关系,检测相关指标在高危胎儿宫内缺氧具有一定的预测价值。

Objective To study the value of doppler blood flow parameters of fetal cerebral middle artery(CMA),renal artery(RA),and venous catheter combined with ventricular Tei index in predicting intrauterine hypoxia in high risk fetation.Methods One hundred and eighty-nine singleton pregnant women examinated and delivered in our hospital were selected,the gestational weeks were 36~42 weeks.According to high risk score of pregnant women,91 high-risk pregnant women were enrolled as the observation group and 98 normal pregnant women were enrolled as the control group.Color doppler ultrasound was used to evaluate their resistance indexrenal artery/resistance indexmiddle cerebral artery(RIRA/RIMCA),pulsatility indexrenal artery/pulsatility indexmiddle cerebral artery(PIRA/PIMCA),the ratio of peak systolic velocity/end diastolic velocityrenal arteryand peak systolic velocity/end diastolic velocitymiddle cerebral artery(S/DRA/S/DMCA),resistance indexductus venosus(RIDV),pulsation indexductus venosus(PIDV),peak systolic velocity/end diastolic velocityductus venosus(S/DDV).At the same time,all infants’umbilical vein blood were extracted during delivery,and their HIF-1αlevels were detected by Elisa,pearson correlation analysis was used to analyze their relationship between indexs including RIRA/RIMCA,PIRA/PIMCA,S/DRA/S/DMCA,RIDV,PIDV,S/DDV,ventricular Tei index and HIF-1αlevels in the observation group.Results The RIRA/RIMCA,RIRA/RIMCA,S/DRA/S/DMCA,RIDV,PIDV,S/DDV of the obser-vation group were significantly higher than those ofthe control group(t=17.71,20.24,23.70,2.75,15.06,75.36,P<0.05).But the ventricular Tei index of the observation group were significantly lower than the control group,while the HIF-1αlevels were significantly higher than that in the control group(t=10.99,11.59,37.28,P<0.05).Pearson correlation analysis showed that RIRA/RIMCA,PIRA/PIMCA,S/DRA/S/DMCA,RIDV,PIDV,and S/DDVof the fetus during pregnancy were positively correlated with their HIF-1αlevels(r=0.54,0.53,0.63,0.55,0.54,0.63,P<0.05),and the left and right ventricular Tei index of the fetus during pregnancy were negatively correlated with their HIF-1αlevels(r=-0.64,-0.65,P<0.05).Conclusion The RIRA/RIMCA,PIRA/PIMCA,S/DRA/S/DMCA,RIDV,PIDV,S/DDV,and Tei index are correlated with the HIF-1αlevels,which have predictive value in the intrauterine hypoxia of high^risk fetuses.