The value of uterine arteries hemodynamic indexes in predicting adverse outcomes of pregnancy-induced hypertension
WANG Ya-yun1, SU Hai-li2, TUO Sheng-jun1, YU Ming1, LIU Zhi-ling1, QIAO Yuan3, CHEN Xiao-yuan3
1. Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, China;
2. University of Cincinnati Medical Center, Cincinnati Ohio 45242, USA;
3. The Northwest Women and Children Hospital, Xi’an 710061, China
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（P<0.05）。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，RI>0.51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 discuss the value of the clinical data and hemodynamic indexes of uterine arteries in predicting adverse outcomes in patients with pregnancy-induced hypertension(PIH). Methods: Eighty-seven PIH patients in second-third trimester complicated with fully follow-up materials were chosen for this study. The general clinical data were recorded. A series of dynamics indexes of uterine artery were detected by conventional abdominal ultrasound. All the patients were followed-up through the whole pregnant period. Eclampsia, fetal distress in uterus and early pregnancy termination were recorded as the adverse outcomes. The patients were divided into benign group and adverse group based on the outcomes. Results: Sixty-three PIH patients(72.4%) presented adverse outcomes during the followed-up period. The proportion of severe preeclampsia in adverse group increased significantly compared with the benign group(58.7% vs 20.8%, P=0.003). In adverse group, patients were more likely to have the early diastolic notch in both sides of uterine arteries compared to the patients in begin group(39.7% vs 16.7%, P=0.042). The PI, RI and S/D values of uterine artery were increased significantly in PIH patients presented adverse outcomes in late pregnancy(P<0.05). When the cut-off value of PI was 0.97, the sensitivity and specificity of predicting adverse outcomes were 50.8% and 83.8% respectively. When the cut-off value of RI was 0.51, the sensitivity and specificity of predicting adverse outcomes were 63.5% and 70.8% respectively; When the cut-off value of S/D was 2.1, the sensitivity and specificity of predicting adverse outcomes were 65.1% and 70.8% respectively. The multinomial logistic regression analysis showed that RI>0.51 was the independent predictive factor of adverse outcomes of PIH patients(OR=4.224, P=0.006). Conclusions: PIH can cause multiple hemodynamic changes. Hemodynamic changes of the uterine arteries which could be assessed by ultrasound has certain significance for the prognosis of PIH, and our study suggests that the RI could be the independent predictive factor of adverse pregnancy outcomes.
王雅韵1，苏海砾2，拓胜军1，于 铭1，刘志玲1，乔 媛3，陈晓媛3. 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[J]. 中国临床医学影像杂志, 2017, 28(4): 268-272.
WANG Ya-yun1, SU Hai-li2, TUO Sheng-jun1, YU Ming1, LIU Zhi-ling1, QIAO Yuan3, CHEN Xiao-yuan3 . The value of uterine arteries hemodynamic indexes in predicting adverse outcomes of pregnancy-induced hypertension. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(4): 268-272.
[1]李晓菲，吴青青，王琪，等. 妊娠中晚期子宫-胎盘-胎儿循环与妊娠期高血压疾病进展程度的相关研究[J]. 中国妇产科临床杂志，2013，14（2）：123-127.
[2]潘华，陈桂荣，吴锡金，等. 子宫动脉多普勒参数预测异常妊娠结局的价值[J]. 中国超声医学杂志，2011，27（9）：838-840.
[3]田宁，于松. 彩色多普勒超声监测子宫动脉血流的研究进展[J]. 新乡医学院学报，2014，31（9）：766-768.
[4]Meler E, Figueras F, Bennasar M, et al. The prognostic role of uterine artery Doppler investigation in patients with severe early-onset preeclampsia[J]. Am J Obstet Gynecol, 2010, 202(6): 551-559.
[5]乐杰. 妇产科学[M]. 7版. 北京：人民卫生出版社，2009：150-154.
[6]McCowan LM, North RA, Harding JE. Abnormal uterine artery Doppler in small-for-gestational-age pregnancies is associated with later hypertension[J]. Aust N Z J Obstet Gynaecol, 2001, 41(1): 56-60.
[7]Luttun A, Brusselmans K, Fukao H, et al. Loss of placental growth factor protects mice against vascular permeability in pathological conditions[J]. Biochem Biophys Res Commun, 2002, 295(2): 428-434.
[8]Papageorghiou AT, Leslie K. Uterine artery Doppler in the prediction of adverse pregnancy outcome[J]. Curr Opin Obstet Gynecol, 2007, 19(2): 103-109.
[9]Cnossen JS, Morris RK, ter Riet G, et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis[J]. CMAJ, 2008, 178(6): 701-711.
[10]Palmsten K, Buka SL, Michels KB. Maternal pregnancy-related hypertension and risk for hypertension in offspring later in life[J]. Obstet Gynecol, 2010, 116(4): 858-864.
[11]潘华，陈桂荣，吴锡金，等. 子宫动脉多普勒在妊娠高血压孕妇与妊娠不良结局关系中的应用价值[J]. 海南医学，2011，22（21）：90-92.
[12]Asnafi N, Hajian K. Mid-trimester uterine artery Doppler ultrasound as a predictor of adverse obstetric outcome in high-risk pregnancy[J]. Taiwan J Obstet Gynecol, 2011, 50(1): 29-32.
[13]Sciscione AC, Hayes EJ. Uterine artery Doppler flow studies in obstetric practice[J]. Am J Obstet Gynecol, 2009, 201(2): 121-126.
[14]李学广. 子宫动脉多普勒超声对妊娠期高血压疾病妊娠不良结局的预测价值分析[J]. 中国妇幼保健，2015，30（21）：3644-3646.
[15]Axt-Fliedner R, Schwarze A, Nelles I, et al. The value of uterine artery Doppler ultrasound in the prediction of severe complications in a risk population[J]. Arch Gynecol Obstet, 2005, 271(1): 53-58.
