上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

子宫动脉血流值在子痫前期中的预测价值

顾 玮1，周雷平2，林 婧1，侯燕燕1，蔡彦卿1，施立晔1   

  1. 上海交通大学 医学院附属国际和平妇幼保健院 1.妇产科， 2.超声科， 上海 200030
  • 出版日期:2015-02-28 发布日期:2015-02-27
  • 作者简介:顾 玮（1970—）， 女， 副主任医师， 硕士; 电子信箱: krisgu70@163.com。
  • 基金资助:

    上海市卫生局基金（20114146）

Value of indexes of uterine artery blood flow for prediction of preeclampsia

GU Wei1, ZHOU Lei-ping2, LIN Jing1, HOU Yan-yan1, CAI Yan-qing1, SHI Li-ye1   

  1. 1.Department of Gynecology & Obstetrics, 2.Department of Ultrasound, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2015-02-28 Published:2015-02-27
  • Supported by:

    Foundation of Shanghai Municipal Health Bureau, 20114146

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摘要：

目的 探讨子宫动脉血流值在子痫前期中的预测价值。方法 选取2012年4月—2013年6月1 630例孕妇，分别于孕11~14周及孕22~24周时采用多普勒彩色超声诊断仪检测其双侧子宫动脉收缩期与舒张期流速比(S/D)、搏动指数(PI) 、阻力指数(RI)和血流频谱中的舒张早期切迹等4项指标，并随访至产后，按照妊娠结局分为发生子痫前期和对照组。先分别以S/D、PI和RI作为检验变量作ROC曲线，通过统计学检验比较预测结果，取约登指数最大者作为各单项指标的预测界值，再以各单项指标的预测界值作为评分标准建立综合评分，并采用此方法进行子痫前期的预测研究，确定其预测分值并评价其预测效果。结果 1 630例孕妇中1 482例未发生子痫前期，52例发生子痫前期，另外96例为妊娠期高血压，孕22~24周时其S/D、PI及RI的预测界值分别为2.355 0、0.877 5及0.580 0。分别将S/D值、PI值和RI值这3项单项指标作为子痫前期的预测方法均具有显著的统计学意义(P<0.01)。以综合评分指数3分作为预测界值预测子痫前期具有统计学意义(P=0.012)，其预测特异性为97.33%。且此评分方法预测结果与新生儿出生体质量及出生孕周均呈负相关。结论 运用子宫动脉血流指标用于预测子痫前期，具有很好的临床应用价值。

关键词: 子痫前期, 预测, 多普勒超声检查, 子宫动脉血流值评分法

Abstract:

Objective To explore the value of indexes of uterine artery blood flow for the prediction of preeclampsia. Methods A total of 1 630 pregnant women who were registered in our hospital from April, 2012 to June, 2013 were selected. The systolic to diastolic velocity ratio (S/D), pulsation index (PI), resistance index (RI), and early diastolic notch of blood flow spectrum of both sides of uterine artery were measured in 11-14 and 22-24 weeks of pregnancy by the color Doppler ultrasonic diagnostic apparatus and were followed up till puerperium. Pregnant women were divided into the preeclampsia group and control group according to the pregnancy outcome. S/D, PI, and RI were used as test variables for the ROC curve and the predicted results were compared by the statistical test. The maximal Youden index was used as the predicted cut-off value for each index, which was then used as the scoring criterion to establish comprehensive scores. This method was adopted for preeclampsia prediction to determine the prediction scores and to evaluate the prediction effect. Results Among 1 630 pregnant women, 52 of them developed preeclampsia and 96 of them suffered from gestational hypertension, while 1 482 of them remained normal. The predicted cut-off values of S/D, PI and RI in the second trimester were 2.355 0, 0.877 5, and 0.580 0, respectively. Methods that adopted these three indexes for the prediction of preeclampsia showed statistical significance (P<0.01). It was statistically significant to use the comprehensive score of 3 as the cut-off value for predicting the preeclampsia (P=0.012) and the prediction specificity was 97.33%. Results of the prediction method negatively correlated with the birth weight and gestational weeks (P<0.01). Conclusion Indexes of uterine artery blood flow have a good clinical application value for the prediction of preeclampsia.

Key words: preeclampsia, forecasting, Doppler ultrasonography, scoring of uterine artery blood flow