孕晚期糖耐量受损初产妇左室心肌做功改变及其对围生期不良事件预测价值初探  

Application of left ventricular myocardial function in pregnant women with impaired glucose tolerance in the third trimester and the predictive value on perinatal adverse events

作　　者：朱丽敏 叶婷 袁建军 刘婷婷 刘冰冰 朱好辉 Zhu Limin;Ye Ting;Yuan Jianjun;Liu Tingting;Liu Bingbing;Zhu Haohui(Department of Ultrasound,Henan Provincial People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院郑州大学人民医院超声科,郑州450003

出　　处：《中华超声影像学杂志》2022年第10期845-851,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目(82171963);河南省医学科技攻关计划省部共建项目(SB201901093)。

摘　　要：目的应用压力-应变环(PSL)技术定量评估晚孕期糖耐量受损(IGT)孕妇左室心肌做功改变,并探讨其在预测围生期不良事件发生风险方面的应用价值。方法纳入2020年10月至2021年10月在河南省人民医院确诊的IGT孕妇70例(IGT组)和同期健康孕妇50例(对照组)。受试者均于孕24~28周时行口服75 g葡萄糖耐量试验(OGTT),跟踪随访其常规产检直至分娩后1周,记录临床诊断的巨大儿、糖尿病母亲婴儿综合征等围生期不良事件发生情况,并于孕36周以后分娩前行母体超声心动图检查,存储心尖四腔、三腔、两腔三个长轴切面各3~5个心动周期的动态图像,导入EchoPAC 203软件获取PSL曲线及左室整体纵向应变(GLS)、左室心肌整体做功指数(GWI)、整体做功效率(GWE)、整体有用功(GCW)、整体无用功(GWW),对两组间参数进行分析比较。同时应用二元Logistic回归分析构建围生期不良事件预测模型,并应用ROC曲线分析预测模型和各独立影响因子预测效能。结果IGT组GLS绝对值、GWI、GCW低于对照组,差异有统计学意义(均P<0.05);IGT组围生期不良事件包括妊娠期不良结局及新生儿不良结局发生率高于对照组(P<0.05);二元Logistic回归分析结果显示GLS、GWI、GCW和餐后2 h血糖水平(2-hPBG)是孕妇围生期并发症的独立影响因素(均P<0.05);ROC曲线分析结果显示,基于影响因素构建的预测模型和GLS、GWI、GCW、2-hPBG的曲线下面积分别为0.903、0.820、0.879、0.854、0.771。结论PSL参数可以定量评估IGT孕妇孕晚期母体左室心肌做功改变;IGT孕妇围生期不良事件发生率高于健康孕妇,且基于GLS、GWI、GCW和2-hPBG构建的模型和GWI、GCW对预测围生期不良事件发生风险具有潜在的应用价值。Objective To evaluate left ventricular myocardial work in pregnant women with impaired glucose tolerance(IGT)in the third trimester by the non-invasive technical parameters of pressure-strain loop(PSL),and to explore its predictive value of risk of perinatal adverse events.Methods From October 2020 to October 2021,70 pregnant women of IGT and 50 healthy pregnant women in Henan Provincial People′s Hospital were included,and a 75 g oral glucose tolerance test(OGTT)was performed at 24-28 weeks.Then their routine obstetric examinations were followed up until one week postpartum and perinatal adverse events were recorded,such as diabetic mother-infant syndrome,macrosomia,et al.After 36 weeks of pregnancy before childbirth,echocardiography was performed and dynamic images of 3-5 cardiac cycles at apical four-chamber view,three-chamber view,and two-chamber view were recorded.Simultaneously,pressure-strain loop(PSL)curve,left ventricular global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE)were calculated through the EchoPAC 203 workstation.Then the differences of all parameters were compared between the two groups.And a prediction model for perinatal adverse events was built by binary logistic regression,and ROC curve was used to analyze the prediction efficiencies of the prediction model and each independent influencing factor.Results Compared with the control group,the absolute values of GLS,GWI and GCW of IGT group were lower(all P<0.05).The incidence of perinatal adverse events of the IGT group,including adverse pregnancy outcomes and neonatal adverse outcomes,was higher than that in the control group(P<0.05).According to logistic regression model,the GLS,GWI,GCW and 2-hour postprandial blood glucose(2-hPBG)were independent influencing factors for perinatal complications(all P<0.05);in addition,ROC curve anaysis showed the area under the curve of the predictive model based on the influencing factors,GLS,GWI,GWE and 2-h PBG were r

关 键 词：压力-应变环 糖耐量受损 妊娠期糖尿病 心肌做功 心室功能 左 

分 类 号：R714[医药卫生—妇产科学]