双模态超声定量或半定量评估妊娠高血压患者胎盘功能的研究

Research on quantitative or semi-quantitative assessment of placental function in pationts with hypertension of pregnancy by dual-mode ultrasound

目的探讨双模态超声定量或半定量评价妊娠高血压患者胎盘功能的价值。方法选取宿州市立医院2018年1月—2021年6月接诊的163例孕妇,孕周为30~41周,其中103例为妊娠高血压疾病患者(重度子痫前期38例、子痫前期65例),60例为正常妊娠孕妇。采用三维能量多普勒超声监测胎盘血流充盈,获取胎盘能量直方图[胎盘血管指数(VI)、血流指数(FI)、血管血流指数(VFI)],采用频谱多普勒超声监测胎儿脐动脉、大脑中动脉、孕妇子宫动脉频谱[搏动指数(PI)、阻力指数(RI)、收缩期/舒张期血流比值(S/D)]。结果随着病情进展,妊娠高血压疾病患者的三维能量胎盘血流充盈直方图数据(VI、FI、VFI)降低,差异均有统计学意义(均P<0.05);胎儿脐动脉血流频谱(PI、RI、S/D)增高,差异均有统计学意义(均P<0.05);胎儿大脑中动脉血流频谱(PI、RI、S/D)降低,差异均有统计学意义(均P<0.05);孕妇子宫动脉血流频谱(PI、RI、S/D)增高,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,胎儿脐动脉S/D、大脑中动脉PI、孕妇子宫动脉频谱PI和直方图数据VFI对子痫前期/重度子痫前期具有较高的诊断价值(AUC=0.893、0.827、0.912、0.880,均P<0.05),且4项联合检测诊断价值最高(AUC=0.957,P<0.05);得出截断值,孕30周后当脐动脉S/D高于3.010,大脑中动脉PI低于1.575,子宫动脉PI高于1.215,胎盘VFI低于4.755时诊断妊娠高血压疾病胎盘功能受损有较高的灵敏度及特异度。结论双模态超声成像可以定量或半定量分析胎盘血流灌注变化,为临床评估妊娠高血压疾病患者的胎盘功能提供指导意见。

Objective To explore the value of dual-modal ultrasound in quantitative or semi-quantitative evaluation of placental function in patients with hypertension of pregnancy.Methods A total of 163 pregnant women admitted to Suzhou Municipal Hospital from January 2018 to June 2021 were selected,and their gestational weeks were 30-41 weeks.Among them,103 were patients with hypertension in pregnancy(38 cases of severe preeclampsia,65 cases of preeclampsia),and 60 were normal pregnant women.The placental blood flow filling was monitored by three-dimensional power Doppler ultrasound,and placental energy histograms(VI,FI,VFI)were obtained.The fetal umbilical artery,middle cerebral artery,maternal uterine artery spectrum(PI,RI,S/D)were monitored by spectral Doppler ultrasound.Results With the disease progresses,three-dimensional power placental blood flow filling histogram data(VI,FI,VFI)of patients with hypertension of pregnancy decreased(P<0.05),the fetal umbilical artery blood flow spectrum(PI,RI,S/D)increased(P<0.05),the fetal middle cerebral artery blood flow spectrum(PI,RI,S/D)decreased(P<0.05),and the pregnant women’s uterine artery blood flow spectrum(PI,RI,S/D)increased(P<0.05).The ROC curve analysis found that monitor fetal umbilical artery S/D,middle cerebral artery PI,maternal uterine artery spectrum PI and energy histograms VFI had high diagnostic value for severe preeclampsia/preeclampsia(AUC=0.893,0.827,0.912,0.880,all P<0.05),and the diagnostic value of combined detection of the four was the highest(AUC=0.957,P<0.05).After 30 weeks of gestation,when umbilical artery S/D was higher than 3.010,middle cerebral artery PI was lower than 1.575,uterine artery PI was higher than 1.215,placental VFI was lower than 4.755,there was a high sensitivity and specificity in the diagnosis of impaired placental function in gestational hypertension.Conclusion Dual-modal ultrasound imaging can quantitatively or semi-quantitatively analyze the changes of placental blood perfusion,and provide guidance for clinical evaluation of placental function in patients with hypertension of pregnancy.