系统性红斑狼疮患者胎儿脐动脉血流彩色多普勒超声对早产的监测作用  

Predictive value of fetal umbilical artery Doppler in preterm birth in patients with Systemic Lupus Erythematosus

作　　者：王晓东[1] 陈冬莹[2] 田媛媛[1] 王竹[3] 冯洁玲[3] 詹雁峰[4] 梁柳琴[2] 詹钟平[2] 

机构地区：[1]广州中医药大学第一附属医院超声科,广州510405 [2]中山大学附属第一医院风湿免疫科,广州510405 [3]中山大学附属第一医院超声科,广州510405 [4]中山大学附属第一医院妇产科,广州510080

出　　处：《实用医学杂志》2018年第4期572-575,共4页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81603435;81601403);广东省科技计划项目(编号:2014A020221009;2016A020215043;2016ZC0104);广州中医药大学单位青年科研人才培优项目(编号:2016QN01)

摘　　要：目的探讨胎儿脐动脉彩色多普勒超声对系统性红斑狼疮(SLE)孕妇早产的监测作用。方法回顾性分析于中山大学附属第一医院、广州中医药大学附属第一医院活胎分娩的160例SLE孕妇。结果 SLE孕妇妊娠时平均年龄为(29.7±3.7)岁(20~37岁),早产52例(32.5%),未出现不良妊娠结局足月产76例(47.5%)。<34周的早产发生率为26.9%,≥34周的早产发生率为73.1%。早产原因依次为治疗性早产(30例)、自发性早产(12例)和未足月胎膜早破早产(10例)。胎儿脐动脉血流彩色多普勒超声检查提示早产组脐动脉血流搏动指数(PI)、阻力指数(RI)、S/D值均高于足月产组(P<0.05)。受试者运算特征曲线(ROC)中PI、RI、S/D曲线下面积分别为0.6(95%CI 0.5~0.7)、0.7(95%CI 0.6~0.8)、0.6(95%CI 0.5~0.7)。选取PI、RI、S/D的最佳截点:1.0、0.7、2.8,其敏感性分别为34.6%、50.0%、50.0%,特异性分别为84.2%、81.6%、81.6%。结论 SLE妊娠早产发生率较高。脐动脉血流多普勒彩超检查可作为SLE患者孕晚期的无创监测手段,对指导分娩时机有重要的临床意义。Objective To examine the predictive value of fetal umbilical arteIy Doppler in preterm birth in pregnant women with systemic lupus erythematosus （SLE）. Methods The clinical data from 160 live births of SLE patients were analyzed retrospectively. Results The mean age of SLE patients at pregnancy was （29.7 ±3.7 ） years （20 - 37 years）. Totally, 56 patients （32.5%） were preterm births and 76 （47.5%） were full-term births without any other adverse pregnancy outcomes. The rate of preterm birth before 34 weeks was 26.9% and that was 73.1% for those preterm deliveries after 34 weeks. Iatrogenic preterm birth was the most common cause of preterm birth （32 cases）, followed by spontaneous preterm birth （12 cases） and preterm premature rupture of membranes （10 cases）. The pulsatility index （PI）, resistance index （RI） as well as S/D value of SLE patients with pre-term delivery was higher than those of patients with full-term delivery （P 〈 0.05 ）. The area below the ROC curve for PI, RI and S/D was 0.6 （95%CI 0.5 - 0.7）, 0.7 （95%CI 0.6 - 0.8 ） and 0.6 （95%CI 0.5 - 0.7）, respectively. PI with cut-off value of 1.0 indicated the highest risk of preterm birth, with sensitivities of 34.6% and 84.2. The optimal cut- off value for RI and S/D was 0.7 and 2.8 respeetivly, at which sensitivity and specificity had the best combination. Conclusions Pregnancies in lupus still have an increased risk of preterm birth. Umbilical artery Doppler was a useful monitoring tool for preterm birth in lupus pregnancies.

关 键 词：系统性红斑狼疮 胎儿脐动血流脉彩色多普勒超声 早产 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.21[医药卫生—诊断学] R714.25[医药卫生—临床医学]