孕中期子宫动脉血流多普勒检查预测妊娠期高血压疾病初探

摘要

目的:探讨孕中期行彩色多普勒超声检测子宫动脉血流阻力即搏动指数(PI)、阻力指数(RI)值与妊娠期高血压疾病(HDCP)患者围生儿预后的关系.方法:回顾分析在我院行孕期产前检查并资料齐全的HDCP患者78例,分为妊娠期高血压组、轻度子痫前期组和重度子痫前期3组,选择同期无任何妊娠合并症的正常孕妇72例作为对照组,比较4组孕24～28周子宫动脉PI、RI值与母儿预后之间的关系.结果:重度子痫前期患者子宫动脉血流PI、RI值明显高于对照组、妊娠期高血压组和轻度子痫前期组(P<0.01);重度子痫前期患者围生儿预后明显较正常对照组、妊娠期高血压组和轻度子痫前期组差(P<0.01);HDcP中孕期彩色多普勒超声双侧子宫动脉PI、RI值与新生儿出生时体重、分娩孕龄及1分钟Apgar评分呈明显负相关(P<0.01);妊娠24～28周右侧子宫动脉PI、RI在最佳切点预测子痫前期的特异性分别为92.3%、92.0%;敏感性分别为47.4%、56.3%.结论:孕24～28周多普勒超声检测子宫动脉血流阻力是一种有效预测HDCP严重程度及新生儿预后的方法,其预测子痫前期特异性高,敏感性偏低,因此,应用该指标指导I临床进行早期预防性药物干预值得商酌.%Objectives: To investigate the relationship between perinatal outcomes in hypertensive disorder complicating pregnancy (HDCP) and uterine arteries resistance index(RI) and pulsatility index(PI) values by Doppler ultrasound. in the second trimester. Methode: 78 cases with HDCP in our hospital were retrospectively reviewed, which were divided into gestational hypertension (GH), mild preeclampsia (MP) and severe preeclampsia(SP) and 72 women with normal pregnancies were as control group. The relationship between maternal-fetal outcomes and uterine artery PI, RI were compared in 4 groups from 24 to 28 gestational weeks. Results:The uterine artery PI and RI of SP was significantly higher than that of normal pregnancy women ,GH and MP (P ＜0. 01 ); Fetal outcomes of SP was significantly less than that of normal pregnancy women, GH and MP ( P＜0. 01 ); PI and RI of uterine artery in the second trimester was negatively correlated with the fetal weigh, gestational age at delivery and Apgar scores at one minute. (P ＜0. 01 ) ;At the best cut point, the specificity of right-PI/RI predicting on the preeclampsia between 24 to 28 gestational weeks were 92. 3％ and 92. 0％ respectively, the sensitivity were 47.4％ and 56. 3％. Conclusions:Doppler ultrasound of the uterine arteries RI and PI values at 24 -28 weeks is a useful method to predict the severity of HDCP and perinatal outcomes, with high specificity and Iow sensitivity for predicting preeclampsia. However, there has been controversial for early medical intervention by these two parameters.