不同病因的复发性流产患者妊娠期子宫动脉血流变化及其临床意义

The uterine artery blood flow changes of patients with recurrent spontaneous of different etiologies absortion during pregnancy and its clinical significance

目的研究复发性流产(RSA)患者不同妊娠时期的子宫动脉血流搏动指数(PI)和阻力指数(RI)以指导临床治疗。方法198例患者依据RSA的主要病因分为4组:自身免疫性疾病组、易栓症组、多囊卵巢综合征组、甲状腺疾病组,于妊娠7、12、24、32周监测子宫动脉血流阻力,并随访母胎结局。结果198例患者中,不良妊娠结局75例。发生不良妊娠结局的患者各时期的子宫动脉PI及RI在不同病因组间差异无统计学意义(P>0.05);不同病因组间不良妊娠结局患者妊娠7、32周时的子宫动脉PI及RI均显著高于同组正常妊娠结局患者,差异有统计学意义(P<0.05);自身免疫性疾病组中,发生不良妊娠结局的患者各时期的子宫动脉PI及RI均显著高于本组正常妊娠结局患者,差异有统计学意义(P<0.05)。结论RSA患者在妊娠7、32周时的子宫动脉PI及RI与妊娠结局有关,但与母体病因无关。自身免疫性疾病的RSA患者妊娠早、中、晚期的PI及RI与妊娠结局有关。妊娠期间的子宫动脉PI及RI可用来预测不良妊娠结局。

Objective To monitor the changes of the resistance index(RI)and pulsatility index(PI)of uterine artery blood flow in patients with recurrent spontaneous abortion at different gestational period,and guide clinical treatment.Methods 198 patients were classified into four groups,autoimmune diseases group,thrombophilia group,polycystic ovary syndrome group and parathyroid diseases group.The PI and RI were measured at 7,12,24,32 weeks of gestation.The pregnancy outcomes were followed up.Results In 198 patients,75 patients had adverse pregnancy outcomes.There was no difference in PI and RI of uterine artery in the patients with different etiologies of adverse pregnancy outcomes.PI and RI were significantly higher in the patients with adverse pregnancy outcomes than those in normal pregnancy outcomes at 7,32 weeks of gestation.In autoimmune diseases group,patients with adverse pregnancy outcomes had markedly higher PI and RI than those in normal pregnancy outcomes at 7,12,24,32 weeks of gestation.Conclusion Uterine artery blood flow PI and RI at 7,32 weeks of gestation may be concerned with pregnancy outcomes,not concerned with maternal comorbidities.The PI and RI at early,middle and late pregnancy of recurrent spontaneous abortion patients with autoimmune diseases may concerned with pregnancy outcomes.PI and RI during pregancy may be used to predict adverse pregnancy outcomes.