早孕期子宫动脉搏动指数联合全胎盘血管形成-血流指数预测子痫前期的价值

Prediction of Pre-eclampsia by Uterine Artery Pulsatility Index Combined with Total Placenta Vessel Flow Index during Early Pregnancy

目的探讨早孕期子宫动脉搏动指数(PI)联合全胎盘血管形成-血流指数(VFI)预测高风险孕妇发生子痫前期(PE)的价值。方法取PE高风险孕妇200例(孕龄11-13+6周),经腹部测量孕妇双侧子宫动脉PI,采用三维能量多普勒超声(3D-PD)进行胎盘全容积扫查,用能量直方图计算全胎盘VFI。随访结果:44例发生PE的孕妇归入试验组,156例未发生PE的孕妇归入对照组。比较试验组与对照组早孕期子宫动脉PI及全胎盘VFI的差异,分析子宫动脉PI、全胎盘VFI预测PE的能力及其预测的临界值,比较子宫动脉PI、全胎盘VFI及子宫动脉PI联合全胎盘VFI预测PE的诊断效能。结果试验组早孕期子宫动脉PI值明显高于对照组,而全胎盘VFI则明显降低,差异有统计学意义(P<0.05)。子宫动脉PI预测PE的曲线下面积0.743,以PI=1.95为临界值,预测PE的敏感度、特异度、阳性预测值、阴性预测值、准确率为77.27%、74.35%、45.90%、92.06%、75.00%。全胎盘VFI预测PE的ROC曲线下面积为0.865,以VFI=5.21为界值,其预测PE的敏感度为81.82%、特异度为79.48%、阳性预测值为52.94%、阴性预测值为93.94%、准确率为80.00%。子宫动脉PI联合全胎盘VFI预测PE的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为90.90%、79.48%、54.05%、98.40%、82.00%。结论早孕期子宫动脉PI及全胎盘VFI均能提高预测高风险孕妇子痫前期发生的能力,特别是子宫动脉PI联合全胎盘VFI是更为高效的预测指标。

Objective To investigate the value of uterine artery pulsatility index(PI)combined with placental Vascularization-flow index(VFI)in predicting pre-eclampsia(PE)in high-risk pregnant women during early pregnancy.Methods 200 pregnant women(gestational age 11-13+6 weeks)with high-risk of PE were selected.The PI of bilateral uterine arteries was measured by abdominal method and three-dimensional energy Doppler ultrasound(3D-PD)was used to scan the placenta full volume,and the whole placental VFI was calculated by the energy histogram.According to the occurrence of PE,the pregnant women were divided into experimental group(44 cases)and control group(156 cases),and the differences between the two groups were compared.The ability of PI and VFI to predict PE and their predictive threshold were analyzed,and the diagnostic efficacy of PI,VFI and PI combined with VFI to predict PE was compared.Results Compared with the control group,PI increased,VFI decreased in the experimental group,and the difference was statistically significant(P<0.05).The areas under ROC curve predicted by the PI and VFI were 0.743 and 0.865.PI=1.95 as the threshold value,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate of predicting PE were 77.27%,74.35%,45.90%,92.06%,75.00%,and with VFI=5.21,were 81.82%,79.48%,52.94%,93.94%,80.00%.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate of PI combined with VFI in predicting PE were 90.90%,79.48%,54.05%,98.40%,82.00%.Conclusions PI and VFI can improve the ability to predict the occurrence of pre-eclampsia in high-risk pregnant women,especially PI combined with VFI,which is a more efficient predictor.