基于MRI-IVIM评价妊娠期糖尿病胎盘灌注及扩散特征的研究

Evaluation of Placental Perfusion and Diffusion in Gestational Diabetes Mellitus using MRI-IVIM

目的利用MRI-体素内不相干运动(IVIM)观察不同糖化血红蛋白(HbA1c)水平妊娠期糖尿病(GDM)胎盘扩散灌注特征及对胎儿体重的影响。方法回顾性分析2014年6月至2020年9月本院孕28~34周31例GDM患者和42名正常对照组,GDM患者按照HbA1c水平分为GDM-HbA1c<5.5%和GDM-HbA1c≥5.5%两组,所有患者均经IVIM和超声评估,获取胎盘真实扩散系数(D),假性扩散系数(D*),灌注分数(f)值和胎儿体重(EFW)。采用单因素ANOVA分析、SNAK法分析三组数据特征,采用Pearson相关分析胎盘IVIM定量参数与EFW的相关性。结果正常组、GDM-HbA1c<5.5%组和GDM-HbA1c≥5.5%组胎盘f值、D值之间有统计学差异(P_(正常组&GDM-HbA1c<5.5%)<0.05,P_(正常组&GDM-HbA1c≥5.5%)<0.05,P_(GDM-HbA1c<5.5%&GDM-HbA1c≥5.5%)<0.05),GDM-HbA1c<5.5%组高于其他两组;GDM-HbA1c<5.5%和GDM-HbA1c≥5.5%组EFW高于正常组,差异有统计学意义(P_(正常组&GDM-HbA1c<5.5%)<0.05,P_(正常组&GDM-HbA1c≥5.5%)<0.05)。GDM-HbA1c<5.5%组患者胎盘f值与EFW呈正相关关系(r^(2)=0.602,P=0.002),GDM-HbA1c≥5.5%组患者胎盘f值与EFW呈负相关关系(r^(2)=0.315,P=0.015)。结论MRI-IVIM D和f值有助于识别GDM不同血糖控制状态对胎盘结构和功能的影响。

Objective To observe the placental diffuse and perfusion characteristics of gestational diabetes mellitus(GDM)with different levels of glycosylated hemoglobin(HbA1 c)and its effect on fetal weight by intravoxel incoherent motion MR imaging.Methods From June 2014 to October 2020,gestational diabetes mellitus(n=31)and healthy control group(n=42)were analyzed retrospectively.31 patients with gestational diabetes mellitus were divided into GDM-HbA1 c<5.5%and GDM-HbA1 c≥5.5%groups.All patients were evaluated by MRI-IVIM and ultrasound to obtain the placental D,D*,f value and fetal weight(EFW).Univariate ANOVA and SNK analysis were used to analyze the characteristics of the three groups of data,and Person correlation was used to analyze the correlation between the quantitative parameters of IVIM in placenta and EFW.Results There were significant differences in f value and D value of placenta among healthy control group,GDM-HbA1c<5.5%group and GDM-HbA1c≥5.5%group(P_(healthy control group&GDM-HbA1 c<5.5%)<0.05,P_(healthy control group&GDM-HbA1 c≥5.5%)<0.05,P_(GDM-HbA1c<5.5%&GDM-HbA1c)≥5.5%<0.05),GDM-HbA1 c<5.5%group was higher than the other two groups.The fetal weight of GDM group was higher than healthy control group(P _(healthy control group&GDM-HbA1c≥5.5%)<0.05,Phealthy control group&GDM-HbA1 c<5.5%<0.05).There was a positive correlation between f value and EFW in GDM patients with HbA1 c<5.5%(r^(2)=0.602,P=0.002),and a negative correlation between f value and EFW in GDM patients with HbA1 c≥5.5%(r^(2)=0.315,P=0.015).Conclusion The D and F values of MRI-IVIM are helpful to identify the changes of placental structure and function in different blood glucose control states of gestational diabetes mellitus.