子宫动脉血流动力学、胎盘血流灌注参数与妊娠期高血压患者发生子痫前期的相关性分析

Correlation analysis of uterine artery hemodynamics,placental blood perfusion parameters and preeclampsia in patients with hypertension in pregnancy

目的分析子宫动脉血流动力学、胎盘血流灌注参数与妊娠期高血压患者发生子痫前期之间的关系。方法选取2018年12月—2020年12月在邯郸市中心医院产科建卡的妊娠期高血压孕妇168例为研究组,依据血压情况再分为妊娠期高血压亚组64例(单纯妊娠期高血压患者),轻度子痫前期亚组58例(轻度子痫前期患者),重度子痫前期亚组46例(重度子痫前期患者),选取医院同期正常妊娠孕妇70例为正常对照组。采用三维彩色多普勒超声仪二维超声模式对所有孕妇检测子宫动脉血流动力学参数[搏动指数(PI)、阻力指数(RI)、血流速度峰谷比(S/D)],三维能量多普勒模式及三维血管模式检测孕妇胎盘,并测算胎盘血流灌注参数[胎盘血管化指数(VI)、血流指数(FI)及血管化血流指数(VFI)];Spearman法分析妊娠期高血压病情与PI、RI、S/D值及VI、FI、VFI值的相关性;受试者工作特征曲线(ROC)分析子宫动脉血流动力学参数及胎盘血流灌注参数对妊娠子痫前期的诊断价值。结果正常对照组、妊娠期高血压亚组、轻度子痫前期亚组、重度子痫前期亚组子宫动脉血流动力学参数PI、RI、S/D值均依次升高(F/P=305.147/0.000、498.516/0.000、384.268/0.000),胎盘血流灌注参数VI、FI、VFI均依次降低(F/P=280.369/0.000、74.400/0.000、51.761/0.000)。妊娠期高血压严重程度与PI、RI、S/D值呈正相关(r/P=0.682/0.000、0.727/0.000、0.567/0.000),与VI、FI、VFI值呈负相关(r/P=-0.581/0.000、-0.658/0.000、-0.430/0.000)。ROC曲线分析结果表明,PI、RI、S/D诊断子痫前期的曲线下面积(AUC)分别为0.838、0.801、0.799,三者联合诊断子痫前期的AUC为0.922;VI、FI、VFI诊断子痫前期的AUC分别为0.851、0.767、0.864,三者联合诊断子痫前期的AUC为0.915。结论子宫动脉血流动力学参数及胎盘血流灌注参数对妊娠期高血压发生子痫前期的预测有一定价值。

Objective To analyze the relationship between uterine artery hemodynamics,placental blood perfusion parameters and preeclampsia in patients with hypertension during pregnancy.Methods Selected 168 pregnant women with hypertension during pregnancy who had their card established in the Obstetrics Department of Handan Central Hospital from December 2018 to December 2020 as the study group,and divided them into the subgroup of 64 cases of hypertension during pregnancy(simple hypertension during pregnancy)based on their blood pressure.Patients,a subgroup of 58 patients with mild preeclampsia(patients with mild preeclampsia),and a subgroup of 46 patients with severe preeclampsia(patients with severe preeclampsia).70 pregnant women with normal pregnancy in the hospital were selected as the normal control group.Detecting uterine artery hemodynamic parameters[pulsation index(PI),resistance index(RI),blood flow velocity peak-to-valley ratio(S/D)]on all pregnant women using the two-dimensional ultrasound mode of a three-dimensional color Doppler ultrasound system,three-dimensional The power Doppler mode and three-dimensional vascular mode detect the placenta of pregnant women,and measure the placental blood perfusion parameters[placental vascularization index(VI),blood flow index(FI)and vascularized blood flow index(VFI)].Spearman's method analyzes the correlation between the condition of hypertension during pregnancy and the values of PI,RI,S/D and VI,FI,VFI;receiver operating characteristic curve(ROC)analysis of uterine artery hemodynamic parameters and placental blood perfusion The diagnostic value of parameters for preeclampsia in pregnancy.Results The PI,RI,and S/D values of the uterine artery hemodynamic parameters in the normal control group,pregnancy hypertension subgroup,mild preeclampsia subgroup,and severe preeclampsia subgroup increased in turn(F/P=305.147/0.000,498.516/0.000,384.268/0.000),the placental blood perfusion parameters VI,FI,and VFI all decreased sequentially(F/P=280.369/0.000,74.400/0.000,51.761/0.000).The severity of hypertension during pregnancy was positively correlated with PI,RI,and S/D values(r/P=0.682/0.000,0.727/0.000,0.567/0.000),and negatively correlated with VI,FI,and VFI values(r/P=-0.581/0.000,-0.658/0.000,-0.430/0.000).ROC curve analysis results showed that the area under the curve(AUC)of PI,RI,and S/D for the diagnosis of preeclampsia were 0.838,0.801,and 0.799,respectively,and the AUC of the three combined diagnosis of preeclampsia was 0.922.The AUCs of VI,FI,and VFI for the diagnosis of preeclampsia were 0.851,0.767,0.864,respectively,and the AUC of the three combined diagnosis of preeclampsia was 0.915.Conclusion Uterine artery hemodynamic parameters and placental blood perfusion parameters have certain value in predicting the occurrence of preeclampsia in hypertension during pregnancy.