早孕期子宫动脉搏动指数对双胎妊娠子痫前期的预测价值:前瞻性队列研究  

First-trimester uterine artery Doppler pulsatility index for prediction of preeclampsia in twin pregnancies:a prospective cohort study

作　　者：张蕴 刘阳 陈建平 孙路明 Zhang Yun;Liu Yang;Chen Jianping;Sun Luming(Fetal Medicine Unit and Prenatal Diagnosis Center,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai 201204,China;Department of Obstetrics and Gynecology,Shanghai Putuo District Maternity and Infant Hospital Corporation,Shanghai 200060,China)

机构地区：[1]同济大学附属第一妇婴保健院胎儿医学科&产前诊断中心,上海201204 [2]上海市普陀区妇婴保健院妇产科,200060

出　　处：《中华围产医学杂志》2020年第5期324-329,共6页Chinese Journal of Perinatal Medicine

基　　金：国家重点研发计划(2018YFC1002900);上海市科学技术委员会基金(16411963100);申康新兴前沿技术联合攻关项目(SHDC12016117)。

摘　　要：目的探讨早孕期子宫动脉搏动指数(pulsatility index,PI)预测双胎妊娠子痫前期的价值。方法本研究为前瞻性队列研究。纳入2014年4月至2016年10月在同济大学附属第一妇婴保健院行早孕期唐氏综合征筛查的孕11^+0~13周^+6的双胎妊娠孕妇。采用多普勒彩色超声诊断仪检测其双侧子宫动脉PI,随访妊娠结局和子痫前期的发生情况。根据随访结果,将研究对象分为早发型子痫前期(<34孕周)、晚发型子痫前期(≥34孕周)、妊娠期高血压与正常组,采用Kruskal-Wallis检验及χ2检验或Fisher精确概率法比较4组间PI中位数倍数及其异常(≥P90)率的差异。采用受试者工作特性曲线评估子宫动脉PI对子痫前期的预测价值。结果本研究共入组1223例孕妇,剔除185例不符合分析标准者后,共1038例双胎妊娠孕妇纳入分析,包括单绒毛膜双羊膜囊双胎231例和双绒毛膜双羊膜囊双胎807例。早发型子痫前期、晚发型子痫前期和妊娠期高血压的发生率分别为3.47%(36/1038)、7.03%(73/1038)和2.79%(29/1038)。早发型子痫前期、晚发型子痫前期、妊娠期高血压和正常组孕妇早孕期子宫动脉PI中位数倍数[M(P25~P75)分别为1.06(0.80~1.32)、1.05(0.75~1.30)、0.99(0.73~1.23)和1.03(0.80~1.27),χ2=0.396,P=0.941]及其异常率[8.33%(3/36)、6.85%(5/73)、13.79%(4/29)和10.11%(91/900),Fisher精确概率法,P=0.703]差异均无统计学意义;且单绒毛膜双羊膜囊和双绒毛膜双羊膜囊双胎中正常组的PI中位数倍数差异也无统计学意义[1.04(0.81~1.29)与1.03(0.79~1.27),χ2=0.095,P=0.758]。早孕期子宫动脉PI对于双胎妊娠子痫前期的预测价值较有限,预测早发型和晚发型子痫前期及妊娠期高血压时曲线下面积分别为0.514(95%CI:0.413~0.615)、0.499(95%CI:0.428~0.570)和0.530(95%CI:0.418~0.643)。结论早孕期子宫动脉PI预测双胎妊娠早发型、晚发型子痫前期和妊娠期高血压的价值较有限。Objective To investigate the value of first-trimester uterine artery Doppler pulsatility index (PI) in the prediction of preeclampsia (PE) in twin pregnancies.Methods From April 2014 to October 2016, women with twin pregnancies undergoing Down's screening at 11^+0-13^+6 gestational weeks in Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine were recruited in this prospective cohort study. Bilateral uterine artery PI values were measured by Doppler ultrasound at the first trimester. Pregnancy outcomes and the incidence of PE were followed up. The participants were classified into four groups according to their pregnancy outcomes: early-onset PE (<34 weeks), late-onset PE (≥34 weeks), gestational hypertension and normal groups. Differences in the multiples of median of uterine artery PI (PI MoM) and rates of abnormal PI MoM (≥P90) were compared among the four groups using the Kruskal-Wallis test, Chi-square test or Fisher exact test. The performance of uterine artery PI in the prediction of PE was evaluated using receiver operating characteristic (ROC) curve.Results A total of 1 223 twin pregnancies were recruited and 185 of them were excluded for not meeting the eligibility criteria. The 1 038 cases enrolled successfully were 231 monochorionic diamniotic (MCDA) and 807 dichorionic diamniotic (DCDA) twin pregnancies. The incidences of early-onset PE, late-onset PE and gestational hypertension were 3.47% (36/1 038), 7.03% (73/1 038) and 2.79% (29/1 038), respectively. No significant difference was observed in PI MoM [M(P25~P75), 1.06 (0.80-1.32), 1.05 (0.75-1.30), 0.99 (0.73-1.23), 1.03 (0.80-1.27);χ2=0.396, P=0.941] or the rates of abnormal PI MoM [8.33% (3/36), 6.85% (5/73), 13.79% (4/29), 10.11% (91/900);Fisher's exact test, P=0.703] among the four groups. Furthermore, there was no significant difference in PI MoM between normal MCDA and DCDA twin pregnancies [1.04 (0.81-1.29) vs 1.03 (0.79-1.27), χ2=0.095, P=0.758]. The area under the ROC curve showed that first-trimester ut

关 键 词：子痫前期 妊娠 双胎 妊娠初期 子宫动脉 搏动血流 预测 队列研究 

分 类 号：R714.244[医药卫生—妇产科学]