孕早期血清Hcy联合子宫动脉多普勒血流评分对妊娠结局的预测

摘要

目的 评价孕早期血清同型半胱氨酸(Hcy)联合子宫动脉多普勒血流评分对妊娠结局的预测作用.方法 选择2013年1月至2016年6月在石家庄市第六医院就诊孕期11 ～14周的孕妇197例,检测所有孕妇的Hcy、叶酸、维生素B12(VitB 12),并评价双例子宫动脉血流评分,随访至妊娠结束并分析各指标与不良妊娠的相关性.结果 共192例完成研究,21例孕妇发生不良妊娠,其中先兆子痫5例、妊娠期高血压3例、妊娠期糖尿病1例、胎儿生长受限(FGR)3例、胎盘早剥1例、早产8例、死胎0例;不良妊娠组血Hcy水平、高Hcy比例高于非不良妊娠组(t/x2值分别为6.672、87.861,均P＜0.05),而血清叶酸、VitB12水平两组无明显差别(t值分别为3.326、2.648,均P＞0.05);不良妊娠组多普勒评分和多普勒评分≥1的比例高于非不良妊娠组(Z/x2值分别为5.553、124.903,均P＜0.05);随着多普勒评分的增加,不良妊娠预测特异度下降,而敏感度上升,联合Hcy＞ 4.46mmol/L不能增加预测的特异度和敏感度.结论 子宫动脉多普勒评分联合Hcy不能提高不良妊娠的预测效能.%Objective To evaluate the predictive value of serum homocysteine (Hcy) combined with uterine artery Doppler blood flow score on pregnancy outcomes in early pregnancy.Methods From January 2013 to June 2016,197 pregnant women (11-14 gestational weeks) visiting the Sixth Hospital of Shijiazhuang City were enrolled in this study.Hcy,folic acid and vitamin B12 (VitB12) were detected and bilateral uterine arterial hlood flow was measured for all cases.The cases were followed-up till the end of pregnancy and the correlation between indicators and adverse pregnancy was analyzed.Results A total of 192 eases completed the study.There were 21 cases complaining of adverse pregnancy,including 5 cases of preeclampsia,3 cases of gestational hypertension,1 case of gestational diabetes,3 cases of fetal growth restriction (FGR),1 case of placental abruption,and 8 cases of premature labor.Level of Hcy and proportion of cases with hyperhomocysteine in adverse pregnancy group were significantly higher than those in non-adverse pregnancy group (t/x2 value was 6.672 and 87.861,respectively,both P ＜ 0.05).There was no significant difference in serum folic acid and VitB12 level between two groups (t value was 3.326 and 2.648,respectively,both P ＞ 0.05).The Doppler score and proportion of cases with Doppler score ≥ 1 in adverse pregnancy group were higher than in non-adverse pregnancy group (Z/x2 value was 5.553 and 124.903,respectively,both P ＜ 0.05).With the increase of Doppler score,the predictive specificity for adverse pregnancy decreased but sensitivity increased.Combined with Hcy ＞ 4.46 mmol/L did not increase the predictive specificity and sensitivity.Conclusion Uterine artery Doppler score combined with Hcy can not improve the predictive efficacy of adverse pregnancy.