妊娠高血压综合征孕妇子宫动脉血流频谱变化特点及其与炎性指标的关系

Characteristics of blood flow spectrum of uterine artery in pregnant women with hypertensive pregnancy and its relationship with inflammatory media

目的探讨妊娠高血压综合征孕妇子宫动脉血流频谱变化特点及其与炎性指标的关系。方法回顾性分析陕西中医药大学第二附属医院2016年7月至2018年7月期间诊治的70例妊娠高血压孕妇(妊娠高血压组)、50例子痫前期孕妇(子痫前期组)和55例子痫期孕妇(子痫期组)的临床资料。所有孕妇均在孕中期后开始常规应用彩色多普勒检测子宫动脉血流频谱的变化,包括搏动指数(PI)、阻力指数(RI)和收缩期与舒张期动脉血流速比值(S/D),同时检测各组孕妇的血清炎性因子C反应蛋白(CRP)和肿瘤坏死因子α(TNF-α)水平,采用Spearmen相关分析血流频谱与炎性因子的关系。结果子痫期组孕妇的S/D、PI和RI水平明显高于妊娠高血压组和子痫前期组,子痫前期组上述指标又明显高于妊娠高血压组,组间比较差异均具有统计学意义(P<0.05);子痫期组孕妇的CRP和TNF-α水平明显高于妊娠高血压组和子痫前期组,子痫前期组上述指标又明显高于妊娠高血压组,组间比较差异均具有统计学意义(P<0.05);单因素分析结果显示,S/D≥3组孕妇的CRP和TNF-α的水平明显高于S/D<3组,而PI异常组、RI异常组孕妇的CRP和TNF-α水平明显低于PI正常组、RI正常组,差异均有统计学意义(P<0.05);经Spearmen相关性分析结果显示,随着S/D、PI和RI水平的升高,CRP和TNF-α水平亦呈升高趋势,两者之间均呈正相关(P<0.05)。结论随着病情发展,子宫动脉血流频谱及炎症因子变化明显,并与炎性因素水平呈正相关,常规检测血流频谱及炎性指标有助于早期诊断和判断病情发展,对改善围产儿预后具有重要临床价值。

Objective To explore the characteristics of blood flow spectrum changes of uterine artery in pregnant women with pregnancy-induced hypertension and their relationship with inflammatory mediators.Methods The clinical data of 70 cases of pregnancy-induced hypertension(PIH group),50 cases of preeclampsia(preeclampsia group),and 55 cases of eclampsia pregnant women(eclampsia group)treated in the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from July 2016 to July 2018 were retrospectively analyzed.Color Doppler was applicated for all pregnant women after the second trimester of pregnancy to detect the changes of uterine artery blood flow spectrum,including pulsatility index(PI),resistance index(RI),systolic and diastolic arterial blood flow rate ratio(S/D),and serum inflammatory factors C-reactive protein(CRP)and tumor necrosis factor alpha(TNF-α)levels were detected.Spearman correlation analysis was used to analyze the relationship between blood flow spectrum and inflammatory factors.Results The levels of S/D,PI,and RI of pregnant women in the eclampsia group were significantly higher than those in the pregnancy-induced hypertension group and the preeclampsia group,and the above indicators in the preeclampsia group were significantly higher than those in the pregnancy-induced hypertension group(all P<0.05).The levels of CRP and TNF-αof pregnant women in the eclampsia group were significantly higher than those in the pregnancy-induced hypertension group and the preeclampsia group,and the above indicators in the preeclampsia group were significantly higher than those in the pregnancy-induced hypertension group(all P<0.05).Univariate analysis showed that the levels of CRP and TNF-αin S/D≥3 group were significantly higher than those in S/D<3 group,while CRP and TNF-αlevels of pregnant women in PI abnormal group and RI abnormal group were significantly lower than those in normal PI Group and normal RI group(P<0.05).Spearmen correlation analysis showed that with the increase of S/D,PI and RI levels,the levels of CRP and TNF-αalso showed an upward trend,and there was a positive correlation between the two(P<0.05).Conclusion With the development of the disease,the changes of uterine artery blood flow spectrum and inflammatory factors are obvious,and they are positively correlated with the level of inflammatory factors.Routine detection of blood flow spectrum and inflammatory indicators is helpful for early diagnosis and judgment of disease development,and has important clinical value for improving the prognosis of perinatal infants.