子宫动脉血流动力学指标在预测妊娠高血压疾病不良结局中的价值

发布时间：2018-04-14 06:42

本文选题：高血压 + 妊娠性　；参考：《中国临床医学影像杂志》2017年04期

【摘要】：目的:探讨多项临床数据及子宫动脉血流动力学指标在妊娠高血压疾病(PIH)患者不良结局预测中的价值。方法:选择2016年5月—2016年8月西北妇女儿童医院有完整随访资料的中晚孕期PIH患者87例,收集常规临床数据,应用常规经腹超声检查检测双侧子宫动脉血流动力学指标,并对孕妇进行随访,以随访期发生子痫、胎儿宫内窘迫以及提前终止妊娠等为不良结局。根据妊娠最终结局将患者分为良性结局组和不良结局组,采用Logistic回归数据统计方法,筛选PIH患者不良结局的危险因素。结果:随访期有63例PIH患者(72.4%)出现不良结局。与良性结局组比较,不良结局组中重度子痫前期所占比例增加显著(58.7%vs 20.8%,P=0.003),且双侧子宫动脉舒张早期切迹的比例显著增加(39.7%vs 16.7%,P=0.042);随访期出现不良结局的孕妇其晚孕期搏动指数(PI)、阻力指数(RI)、收缩期血流速度与舒张末期血流速度比值(S/D)较良性结局组均显著增加(P0.05)。以PI取值0.97预测不良结局的敏感度为50.8%,特异度为83.8%;以RI取值0.51预测不良结局的敏感度为63.5%,特异度为70.8%;以S/D取值2.1预测PIH不良结局的敏感度为65.1%,特异度为70.8%;多因素Logistic回归分析显示,RI0.51可做为PIH不良结局的独立预测因子(OR=4.224,P=0.006)。结论 :PIH可造成子宫动脉血流动力学多项指标不同程度的改变,子宫动脉血流动力学参数异常对于预测PIH不良结局有一定的意义,其中RI可做为PIH不良结局的独立预测因子。
[Abstract]:Objective: to investigate the value of multiple clinical data and uterine artery hemodynamic indexes in predicting adverse outcomes in patients with pregnancy-induced hypertension (PIH).Methods: 87 PIH patients with complete follow-up data from May 2016 to August 2016 in Northwest Women's and Children's Hospital were selected. Routine clinical data were collected and hemodynamic indexes of bilateral uterine arteries were detected by routine transabdominal ultrasonography.The adverse outcomes were eclampsia, fetal distress and early termination of pregnancy.According to the final outcome of pregnancy, the patients were divided into benign outcome group and bad outcome group. Logistic regression data were used to screen the risk factors of adverse outcome of PIH patients.Results: during the follow-up period, 63 patients with PIH (72.4%) had adverse outcomes.Compared with the benign outcome group,The proportion of moderate to severe preeclampsia increased significantly in poor outcome group (58.7 vs 20.8), and the ratio of early diastolic notch of bilateral uterine artery increased significantly, and 39.7% vs 16.7g / P 0.042%; the late pregnancy pulsatility index (Pi), resistance index (RI) and resistance index (RI) of pregnant women with poor outcome during follow-up were significantly increased.The ratio of systolic velocity to end diastolic velocity (S / D) was significantly higher than that of benign outcome group (P 0.05).The sensitivity and specificity of predicting adverse outcome with Pi value 0.97 were 50.8 and 83.8 respectively; the sensitivity of 0.51 with RI value was 63.5 and the specificity was 70.8; the sensitivity with S / D value of 0.97 was 65.1 and the specificity was 70.8 with RI value 0.51; with multiple factors, the sensitivity of predicting adverse outcome of PIH was 65.1 and the specificity was 70.8 by using Pi value of 0.97; the sensitivity of 0.51 with RI value of 0.51 was 63.5 and the specificity was 70.8.Logistic regression analysis showed that RI0.51 could be used as an independent predictor of PIH adverse outcome.Conclusion the abnormal parameters of uterine artery hemodynamics can be used to predict the adverse outcome of PIH, and RI can be used as an independent predictor of adverse outcome of PIH.
【作者单位】：第四军医大学附属西京医院超声科;辛辛那提大学医学中心;西北妇女儿童医院;
【分类号】：R445.1;R714.246

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