实时剪切波弹性成像技术对孕晚期子痫前期胎盘的评估价值  

Value of Real-time Shear Wave Elastography for Evaluating Placental Elasticity in Women with Preeclampsia in the Third Trimester

作　　者：陈璐[1] 陈莉[1] 刘志兴[1] CHEN Lu;CHEN Li;LIU Zhi-xing(Department of Ultrasound Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院超声医学科,南昌330006

出　　处：《实用临床医学（江西）》2022年第3期59-63,I0003,共6页Practical Clinical Medicine

基　　金：江西省卫生健康委员会科研项目(20203133)。

摘　　要：目的探讨实时剪切波弹性成像技术(SWE)测量胎盘杨氏模量Emean值对孕晚期子痫前期(PE)的临床评估价值。方法连续性收集孕晚期健康孕妇(正常组,n=171)和孕晚期PE孕妇(PE组,n=60),均随访至新生儿出生并记录1 min Apgar评分。均利用SWE测量不同部位(中央和边缘)胎盘的Emean值;比较正常组孕妇不同孕周(28~32周,>32~36周,>36~40周)的胎盘整体Emean值,分析该量值诊断PE的诊断效能,并用Spearman等级相关性分析该量值与新生儿1 min Apgar评分的关系。结果2组孕妇胎盘中央和胎盘边缘Emean值比较,差异无统计学意义(P>0.05)。较正常对照组:PE组孕妇胎盘中央和边缘的Emean值更高(P<0.05),PE组孕妇胎盘整体Emean值亦更高(P<0.05)。正常组孕妇不同孕周的胎盘整体Emean值比较,差异无统计学意义(P>0.05)。胎盘中央、边缘及整体Emean值诊断PE的ROC曲线下面积(AUC)分别为0.915、0.896、0.908;以截断值8.385、7.865、8.245 kPa为临界值诊断PE,其敏感性及特异性分别为0.800与0.947、0.800与0.918、0.783与0.947。PE组孕妇胎盘整体Emean值与新生儿1 min Apgar评分无关(r=0.037,P=0.779)。结论健康孕妇胎盘Emean值在孕晚期不随孕周改变。以8.245 kPa为截断值诊断PE的灵敏度和特异度均较高。SWE具有诊断准确性高、无创、价廉、便捷等优点,可为临床早期预测及诊断PE提供参考。Objective To investigate the clinical value of the Emean value of Young’s modulus of placenta measured by real-time shear-wave elastography(SWE)in women with preeclampsia(PE)in the third trimester of pregnancy.Methods One hundred and seventy-one healthy pregnant women in the third trimester(normal group)and 60 pregnant women with PE in the third trimester(PE group)were continuously collected and followed up until the birth of the newborns.The 1-min Apgar score was recorded,and the Emean values of central and marginal parts of placenta were measured by SWE.Furthermore,the Emean values of whole placenta in normal group were compared among different gestational age(28-32 weeks,>32-36 weeks,>36-40 weeks)to analyze the efficiency for diagnosing PE.Spearman’s rank correlation test was used to analyze the relationship between PE and 1-min Apgar score.Results There were no significant differences in the Emean values between central placenta and marginal placenta in both groups(P>0.05).However,the Emean values of central,marginal and whole placenta,in PE group were higher than those in the normal group(P<0.05).The differences in the Emean values of whole placenta were not significant among different gestational weeks in normal group(P>0.05).The area under ROC curve(AUC)of the Emean values of central,marginal and whole placenta for PE diagnosis were 0.915,0.896 and 0.908,respectively.With the cut-off values of 8.385,7.865 and 8.245 kPa,the sensitivity and specificity were 0.800 and 0.947,0.800 and 0.918,and 0.783 and 0.947,respectively.The Emean value of whole placenta was not correlated with 1-min Apgar score in PE group(r=0.037,P=0.779).Conclusion The Emean value of placenta does not change with gestational age in healthy pregnant women in the third trimester.The cut-off value of 8.245 kPa is associated with high sensitivity and specificity in the diagnosis of PE.SWE is an accurate,non-invasive,inexpensive and convenient method,that can provide a reference for early clinical prediction and diagnosis of PE.

关 键 词：子痫前期 剪切波弹性成像 杨氏模量Emean值 胎盘功能 诊断效能 孕晚期 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.244[医药卫生—诊断学]