磁共振联合超声评估妊高症对早产儿脑发育的影响  

Application Value of Ultrasound Combined with Magnetic Resonance Imaging in Evaluating the Effect of Hypertensive Disorder Complicating Pregnancy on Brain Development of Premature Infants

作　　者：邢庆娜[1] 赵鑫[1] 陆林[1] 刘彦超 刘真真[1] 宣德胜 宋娟[1] 张小安[1] XIN Qingna;ZHAO Xin;LU Lin(Department of Radiology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450051,P.R.China)

机构地区：[1]郑州大学第三附属医院影像科,450051

出　　处：《临床放射学杂志》2021年第6期1186-1192,共7页Journal of Clinical Radiology

基　　金：河南省医学科技攻关联合共建项目(编号:LHGJ20190375);国家自然科学基金项目(编号:81870983)。

摘　　要：目的探讨脐动脉(UA)及大脑中动脉(MCA)血流频谱联合扩散张量成像(DTI)在妊娠期高血压疾病对早产儿脑发育影响中的应用价值。方法选取妊娠期高血压疾病的孕妇分娩的早产儿55例作为观察组,分为子痫前期(PE)组、妊娠合并慢性高血压(CH)组、慢性高血压并发子痫前期(CHWPE)组及妊娠期高血压(GH)组等4亚组,选取同期孕龄相匹配且无高危围产因素的孕妇分娩的早产儿43例作为对照组,比较观察组各亚组与对照组胎儿期血流频谱值,包括UA及MCA的搏动指数(UA-PI、MCA-PI)、血流速度峰谷比(UA-S/D、MCA-S/D)、UA和MCA的S/D比值[(UA/MCA)-S/D]、MCA和UA的PI比值[(MCA/UA)-PI],比较新生儿期脑多部位各向异性分数(FA)及早产儿临床预后的差异;对血流频谱与内囊后肢FA值及NICU住院时间进行相关性分析。结果各观察亚组的UA-S/D、UA-PI及(UA/MCA)-S/D高于对照组,而MCA-PI、MCA-S/D及(MCA/UA)-PI低于对照组;PE组及CHWPE组的MCA-S/D、MCA-PI低于CH组及GH组(以上P值均<0.001)。PE组及CHWPE组内囊后肢及额叶白质的FA值低于对照组,PE组顶叶白质及CHWPE组尾状核的FA值低于对照组,PE组、CHWPE组及CH组的内囊后肢的FA值低于GH组(以上P值<0.05)。与对照组相比,PE组、CH组及CHWPE组的张路指数(ZLI)偏低,PE组及CHWPE组的感染率及新生儿重症监护病房(NICU)住院时间较长(以上P值<0.001)。UA-S/D与内囊后肢FA值呈负相关(r=-0.392),与NICU住院时间呈正相关(r=0.454);NICU住院时间与出生孕周呈负相关(r=-0.199);(UA/MCA)-S/D与内囊后肢FA值呈负相关(r=-0.3727)、与NICU住院时间呈正相关(r=0.4427);(MCA/UA)-PI与内囊后肢FA值呈正相关(r=0.2985)、与NICU住院时间呈负相关(r=0.4427)。结论妊娠期高血压疾病易引起胎儿血流频谱异常、较低ZLI值、较高感染率及早产儿脑发育落后,且以CHWPE和PE较为严重;有效的胎儿期血流频谱监测及新生儿期的DTI检查可作为预后的预测工具。Objective To explore the application value of umbilical artery(UA)and middle cerebral artery(MCA)flow spectrum combined with diffusion tensor imaging(DTI)in the effect of hypertensive disorder complicating pregnancy on brain development of premature infants.Methods Fifty-five premature infants born to pregnant women with hypertensive disorder complicating pregnancy were selected as the observation group.They were divided into 4 groups:preeclampsia(PE)group,pregnancy with chronic hypertension(CH)group,chronic hypertension complicated with preeclampsia(CHWPE)group and gestational hypertension(GH)group.Forty-three premature infants with matched gestational age and no high-risk perinatal factors were selected as the control group.To compare the difference of fetal blood flow spectrum,such as the pulsatility index(UA-PI,MCA-PI)of UA and MCA,the peak-valley ratio of blood flow velocity(UA-S/D,MCA-S/D),the ratio of S/D of UA to MCA[(UA/MCA)-S/D]and the ratio of PI of MCA to UA[(MCA/UA)-PI],and neonatal brain multi-site fraction anisotropy(FA)and clinical prognosis of preterm infants between the two groups.The correlation between blood flow spectrum and FA value of posterior limb of internal capsule and length of stay of NICU were analyzed.Results UA-S/D,UA-PI and(UA/MCA)-MCA-S/D in each observation subgroup were higher than those in the control group,while MCA-PI,MCA-S/D and(MCA/UA)-PI were lower than those in the control group,MCA-S/D and MCA-PI in PE group and CHWPE group were lower than those in CH group and GH group(all P<0.001).FA values of posterior limb of internal capsule and white matter of frontal lobe in PE group,CHWPE group and CHWPE group were lower than those in control group.FA values of white matter of parietal lobe in PE group and caudate nucleus in CHWPE group were lower than those in control group;FA values of posterior limb of internal capsule in PE group and CH group were lower than those in GH group(all P<0.05).Compared with the control group,thezhanglu index(ZLI)of PE group,CH group and CHWPE grou

关 键 词：彩色超声多普勒 扩散张量成像 妊娠期高血压 早产儿 脑发育 

分 类 号：R722.6[医药卫生—儿科] R445[医药卫生—临床医学]