探讨多普勒超声心动图评价妊娠期肝内胆汁淤积症胎儿肺损害的临床价值  

To explore the clinical value of doppler echocardiography in the evaluatingfetal lung injury during intrahepatic cholestasis of pregnancy

作　　者：王连双 殷志勇 白莉 张记 王雪梅 付丽华[2] 刘军[2] 张瑶 WANG Lianshuang;YIN Zhiyong;BAI Li;ZHANG Ji;WANG Xuemei;FU Lihua;LIU Jun;ZHANG Yao(Department of Ultrasound,Beijing Titan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院超声科,100015 [2]首都医科大学附属北京地坛医院妇产科,100015

出　　处：《心肺血管病杂志》2018年第7期670-674,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医科大学附属北京地坛医院院内科研基金(DTYM201613)

摘　　要：目的:寻找提示妊娠期肝内胆汁淤积症(ICP)胎儿肺损害的产前超声指标及与围产儿肺损害事件的相关性。方法:分析2016年11月至2017年11月,于北京地坛医院超声科检查发现的36例ICP胎儿超声及临床资料,孕周31~33周^(+6)。将研究对象分为两组,10≤TBA<40μmol/L为轻度ICP组,入组18例;TBA≥40μmol/L为重度ICP组,入组18例;选择同孕周的正常胎儿为对照组,入组36例。观察并测量左(右)肺动脉起始段(PA1)、左(右)肺动脉中间段(PA2)、肺门处肺动脉(PA3)、肺内动脉第一级分支起始部(PA4)多普勒指标,测量参数包括加速时间(ACT)、射血时间(ET)、计算ACT/ET、收缩期峰值流速(PSV)、舒张末期流速(EDV)、舒张早期反向峰值速度(PEDRF)、搏动指数(PI)、阻力指数(RI)。分析三组胎儿间各项指标间的差异及与围产儿肺损害事件的相关性。结果:重度ICP组肺损害事件发生率(27.8%)明显高于轻度ICP组(5.6%)和正常组(5.6%),差异有统计学意义(P<0.001)。(2)重度ICP组PA1~4段ACT均低于轻度ICP组和正常组,差异均有统计学意义(P均<0.01);PA1~4段ACT减低与围产儿肺损害事件正相关,相关系数为(r=0.545,P=0.019)、(r=0.636,P=0.003)、(r=0.500,P=0.004)、(r=0.701,P=0.000)。(3)重度ICP组PA1~4段ACT/ET均低于轻度ICP组和正常组,差异均有统计学意义(P均<0.01);PA1~4段ACT/ET减低与围产儿肺损害事件正相关,相关系数为(r=0.599,P=0.031)、(r=0.565,P=0.012)、(r=0.500,P=0.042)、(r=0.685,P=0.001)。(4)PA1~4段ET、PEDRF、PSV、EDV、RI、PI于三组间比较,差异均无统计学意义(P均>0.05)。结论:PA1-4段ACT、ACT/ET减低提示ICP胎儿肺损害,围产儿可能发生肺损害事件。Objective： Looking forprenatal ultrasound indicatoroffetal lung damage during intrahepatic cholestasis of pregnancy（ ICP） and its relevance with the perinatal lung damage incidence. Methods： analysis fetal ultrasound and clinical data with the 36 cases of ICP from November 2016 to November 2017 in Beijing ditan hospital,gestational age from 31w（＋0） to 33w（＋6）. The subjects were divided into 2 groups. 10 ≤ TBA 〈 40μmol/Lwith the mild ICP group,18 patients were enrolled. The TBA≥40 mol/L withthe severe ICP group,18 patients were enrolled. 36 patients were enrolled in the control group. Observe and measure the beginning of left（ or right） pulmonary artery（ PA1）,the middlesectionof left（ or right） pulmonary artery（ PA2）,pulmonary artery in lung door（ PA3）,the initial department on the first branch within the pulmonary artery（ PA4） doppler indexes,including acceleration time（ ACT）,ejection time（ ET）,computing ACT/ET,the peak systolic velocity（ PSV）,end-diastolic velocity（ EDV）,peak early-diastolic reversed flow（ PEDRF）,pulse index（ PI） and resistance index（ RI）. The statistical differencesof the indicatorsamong the three groups were analyzed,andanalyze the correlation between the difference indicators and the perinatal lung injury incidence. Results： The incidence of lung injury events in the severe ICP group（ 27. 8%） was significantly higher than that in the mild ICP group（ 5. 6%） and the normal group（ 5. 6%）,andthe difference was statistically significant（ P〈 0. 001）.（2）The ACT of PA1-4 in the severe ICP group was lower than that in the mild ICP group and the normal group,and the difference was statistically significant（ Pall 〈 0. 01）. There is moderate correlation between ACTreduction of PA1-4 and lung injury incidence,the correlation coefficient were（ r = 0. 545,P = 0. 019）,（ r =0. 636,P = 0. 003）,（ r = 0. 500,P = 0. 004）,（ r = 0. 701,P = 0. 000）.（3）The ACT/ET of PA1-4 in the severe ICP

关 键 词：超声心动图 妊娠期肝内胆汁淤积症 胎儿 肺损害 

分 类 号：R54[医药卫生—心血管疾病]