妊娠早期子宫动脉血流动力学参数对抗磷脂综合征患者妊娠结局的预测价值  

Value of Early Pregnancy Uterine Artery Doppler Hemodynamic Parameters in Predicting Pregnancy Outcome in Patients with Antiphospholipid Syndrome

作　　者：严宝妹[1] 蔡款[1] 刘韬 刘倩 梁伟翔[1] Yan Baomei;Cai Kuan;Liu Tao;Liu Qian;Liang Weixiang(Department of Ultrasound Medicine,The Third Affiliated Hospital of Guangzhou Medical University,Key Laboratory of Obstetric Diseases of Guangdong Province,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院超声医学科,广东省产科重大疾病重点实验室,广州市510150

出　　处：《中国超声医学杂志》2022年第5期554-557,共4页Chinese Journal of Ultrasound in Medicine

基　　金：广东省医学科研基金项目(No.B2021350)。

摘　　要：目的 探讨妊娠早期子宫动脉血流动力学参数对抗磷脂综合征(APS)患者妊娠结局的预测价值。方法 回顾性选取孕5~10周APS孕妇109例,根据妊娠结局分为持续妊娠组与停育组,分别测量双侧子宫动脉RI、PI、S/D及观察频谱形态。根据孕囊着床位置及子宫动脉RI的高低将两侧子宫动脉分为优势侧及非优势侧,频谱形态分为A、B型两大类。A型包括无切迹及浅切迹(舒张期切迹NI<0.5),B型包括深切迹(NI≥0.5)、舒张期缺失及舒张期负向。结果 两组频谱形态优势侧与非优势侧间差异均有统计学意义(P<0.001);持续妊娠组优势侧PI、RI、S/D比非优势侧低(P<0.01);持续妊娠组两侧频谱形态以A型为主,停育组两侧频谱形态以B型为主(P<0.01);持续妊娠组优势侧PI、RI、S/D及非优势侧RI均比停育组低(P<0.05),ROC曲线显示,各指标单独诊断APS患者胚胎停育的AUC分别为0.741、0.725、0.610和0.685,最佳截断值分别为2.52、0.88、8.31和0.90;联合双侧频谱形态的预测指标显著提升诊断效能,AUC为0.820,最佳截断值为0.38,95%置信区间为(0.751,0.888)。结论 妊娠早期子宫动脉血流动力学参数具有预测APS患者妊娠结局的临床价值,联合子宫动脉PI、RI、S/D及频谱形态诊断效能最高,能为临床进一步治疗干预提供有效依据。Objective To investigate the value of early pregnancy uterine artery Doppler hemodynamic parameters in predicting pregnancy outcome in patients with antiphospholipid syndrome(APS). Methods 109 pregnant women with APS at 5-10 weeks of gestation were retrospectively selected and divided into ongoing pregnancy group andpregnancy loss group according to the pregnancy outcome. The resistance index(RI), pulsatility index(PI), peak systolic velocity/end-diastolic velocity(S/D) and flow waveforms of bilateral uterine arteries were measured. According to the implantation position of gestational sac and the RI of uterine artery, the uterine arteries on both sides were divided into dominant side and non-dominant side, and the flow waveforms of uterine artery were divided into type A and type B. Type A includes no notch and shallow notch(Notch Index, NI<0.5), while type B includes deep notch(NI≥0.5), diastolic absence and diastolic negative direction. Results There was significant difference between the dominant and non-dominant sides of flow waveforms between the two groups(P<0.001);The PI, RI and S/D of the dominant side in the ongoing pregnancy group were lower than those in the non-dominant side(P<0.01);The flow waveforms of both sides in ongoing pregnancy group were mainly type A, and that of both sides in pregnancy loss group were mainly type B(P<0.01);The PI, RI, S/D of the dominant side and RI of the non-dominant side in the ongoing pregnancy group were lower than those in the pregnancy loss group(P<0.05);The Receiver operating characteristic curve(ROC) showed that the Area Under Curve(AUC) of embryo demise in APS patients diagnosed by each index alone were 0.741, 0.725, 0.610 and 0.685 respectively, and the best cut-off values were 2.52, 0.88, 8.31 and 0.90 respectively. Combined with the predictors of bilateral flow waveforms, the diagnostic efficiency was significantly improved with AUC of 0.820, the best cutoff value of 0.38, and 95% confidence interval(0.751,0.888). Conclusions Uterine artery Doppler hemodynam

关 键 词：抗磷脂综合征 妊娠早期 子宫动脉 血流动力学参数 频谱形态 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]