彩色多普勒超声检测子宫动脉及螺旋动脉血流对复发性流产发生及围产期结局的预测价值

The value of uterine artery and spiral uterine artery detected by Color Doppler Ultrasonography in predicting the incidence and perinatal outcome of recurrent spontaneous abortion

目的探讨彩色多普勒超声检测复发性流产(recurrent spontaneous abortion,RSA)患者孕11~13^(+6)周子宫动脉(uterine artery,UtA)血流搏动指数(pulsation index,PI)值及螺旋动脉(spiral artery,SA)阻力指数(resistance index,RI)、搏动指数(pulsation index,PI)及收缩期与舒张期血流比值(the ratio of systolic peak value and end-diastolic velocity of blood flow,S/D)的变化,以便发现一种早期预测RSA发生及围产期结局的方法。方法选取2017年1月至2019年5月在济宁医学院附属医院建档并行规律产检、无其他并发症的RSA患者52例(RSA组),随机选取同期类似孕周正常孕妇50例(对照组),彩色多普勒超声测定所有孕妇UtA及SA频谱,观察UtA血流频谱形态并测定PI值,测定SA的RI、PI及S/D值并随访所有胎儿结局。结果RSA组患者围产儿异常27例(51.9%),包括再次流产6例(11.5%),对照组围产儿异常5例(10%),包括流产1例(2%),RSA组围产儿异常率明显高于对照组,差异有统计学意义(P<0.05);RSA组UtA的PI值及SA的PI及S/D值均高于对照组,差异有统计学意义(P<0.05);RSA组双侧C型UtA低于对照组,而其他类型多于对照组;围产儿不良结局组SA的RI、PI、S/D值及UtA的PI值高于围产儿正常组,差异有统计学意义(P<0.05)。结论孕11~13^(+6)周彩色多普勒超声检测UtA及SA血流动力学参数与RSA的发生及围产儿结局的预测有一定相关性,有重要临床应用价值。

Objective To investigate the changes of pulsation index(PI)of uterine artery(Ut A),resistance index(RI),pulsation index(PI)and ratio of systolic and diastolic blood flow velocity(S/D)of spiral artery(SA)at 11;13+ 6 weeks of pregnancy in patients with recurrent spontaneous abortion(RSA)by color doppler ultrasound,in order to find a method for early prediction of RSA and perinatal outcome. Methods 52 RSA patients(RSA group)with regular prenatal examination and no other complications were selected from Affiliated Hospital of Jining Medical University from January 2017 to May 2019 and 50 normal pregnant women with similar gestational weeks in the same period were randomly selected(control group). PI values of Ut A,RI,PI and S/D values of SA in all pregnant women were measured,the blood spectrum morphology of bilateral Ut A was observed,and all perinatal outcomes were followed up for a controlled study. Results Among the 52 RSA patients,there were 27 perinatal abnormalities(51. 9%),including 6 cases of recurrent abortion(11. 5%),and 5 cases of perinatal abnormalities in the control group(10%),including 1 case of abortion(2%). The abnormal perinatal rate in RSA group was significantly higher than that in control group,and the difference was statistically significant(P < 0. 05). The PI value of Ut A,PI and S/D values of SA in RSA group were higher than those in control group,and the differences were statistically significant. Bilateral c-type Ut A in RSA group was significantly lower than that in control group,while other types were higher than that in control group. For all patients,the RI、PI and S/D values of SA,and PI value of Ut A in abnormal perinatal goup were higher than those in normal perinatal group,and the differences were statistically significant(P < 0. 05). Conclusion The hemodynamic parameters of Ut A and SA measured by ultrasound at 11;13+ 6 weeks of gestation are correlated with the occurrence of RSA and the prediction of perinatal outcome,and have important clinical application value.