子宫动脉血流超声多普勒分析对复发性流产的评估价值  

The value of uterine artery flow ultrasound Doppler analysis in the evaluation of recurrent miscarriage

作　　者：刘耘利[1] 刘彦红[1] 暴络宁 尹保民[1,2] LIU Yunli;LIU Yanhong;BAO Luoning;YIN Baomin(Department of Ultrasound,Zhuhai Center for Maternal and Child Health Care,Zhuhai,Guangdong 519000,China;Department of Obstetrics,Zhuhai Center for Maternal and Child Health Care,Zhuhai,Guangdong 519000,China)

机构地区：[1]珠海市妇幼保健院超声科,广东珠海519000 [2]珠海市妇幼保健院产科,广东珠海519000

出　　处：《安徽医药》2023年第4期778-782,共5页Anhui Medical and Pharmaceutical Journal

基　　金：中国疾病预防控制中心妇幼保健中心妇幼保健分子遗传医学研究专项计划(Fy-ZX-ZD-0193)。

摘　　要：目的探讨子宫动脉血流的超声多普勒对复发性流产(RSA)的评估价值。方法选取2020年6月至2021年6月于珠海市妇幼保健院就诊的96例有至少2次流产史的孕早期女性(早孕组),根据妊娠28周内是否流产分为流产组(28例)与未流产组(68例)。另见同期的96例无流产史的孕早期女性作为对照组。比较三组年龄、孕周、体质量指数、血清睾酮(T)、雌二醇(E2)、促黄体生成素(LH)、促卵泡生成素(FSH)、绒毛膜促性腺激素(β-HCG)、孕酮(P)水平、血流搏动指数(PI)、阻力指数(RI)及收缩期峰值流速与舒张末期峰值流速的比值(S/D)。采用Pearson相关法分析血清指标与子宫动脉血流参数的相关性。绘制PI、RI、S/D及三者联合预测RSA的价值。结果流产组、未流产组与对照组年龄、孕周、体质量指数、血清T、E2、LH的比较,差异无统计学意义(P>0.05)。流产组血清β-HCG、P水平低于未流产组与对照组,同时未流产组低于对照组,差异有统计学意义(P<0.05)。流产组PI、RI、S/D(2.79±0.47、0.96±0.22、8.55±1.78)高于未流产组(2.37±0.41、0.81±0.18、7.34±1.59)与对照组(2.02±0.35、0.67±0.16、6.47±1.33),同时未流产组高于对照组,差异有统计学意义(P<0.05)。血清β-HCG及P与子宫动脉血流参数PI、RI、S/D均呈显著负相关(P<0.05)。PI、RI、S/D预测RSA的ROC曲线下面积分别为0.80[95%CI:(0.68,0.92)]、0.64[95%CI:(0.63,0.83)]、0.79[95%CI:(0.65,0.90)]。三者联合预测RSA的ROC曲线下面积最高,为0.91[95%CI:(0.74,0.99)],对RSA的预测价值最高。结论经阴道多普勒超声能很好地检测子宫动脉血流参数,反映滋养细胞侵袭能力和子宫-胎盘血流灌注情况,可有效预测RSA发生风险,且简便、易行,对RSA的预测和治疗有一定指导价值。Objective To investigate the value of ultrasound Doppler of uterine artery flow for the assessment of recurrent miscarriage(RSA).Methods A total of 96 women with a history of at least 2 miscarriages in early pregnancy(early pregnancy group)attending the Zhuhai Center for Maternal and Child Health Care from June 2020 to June 2021 were divided into a miscarriage group(28 cases)and a nonmiscarriage group(68 cases)according to whether they miscarried within 28 weeks of gestation.Another 96 women with no history of miscarriage in early pregnancy during the same period were considered the control group.The age,gestational week,body mass index,serum testosterone(T),estradiol(E2),luteinizing hormone(LH),follicle stimulating hormone(FSH),chorionic gonadotropin(β-HCG),progesterone(P)level,pulsatility index(PI),resistance index(RI)and the ratio of peak systolic flow rate to peak end-diastolic flow rate(S/D)were compared among the three groups.The correlation between serum indices and uterine artery flow parameters was analyzed by the Pearson correlation method.The values of PI,RI,and S/D and the combination of the three were plotted to predict RSA.Results There was no statistically significant difference in age,gestational week,body mass index,serum T,E2,or LH between the miscarriage group,the nonmiscarriage group and the control group(P>0.05).Serumβ-HCG and P levels in the miscarriage group were lower than those in the nonmiscarriage group and the control group,while those in the nonmiscarriage group were lower than those in the control group,with statistically significant differences(P<0.05).PI,RI,S/D were higher in the miscarriage group(2.79±0.47,0.96±0.22,8.55±1.78)than in the nonmiscarriage group(2.37±0.41,0.81±0.18,7.34±1.59)versus the control group(2.02±0.35,0.67±0.16,6.47±1.33),while the nonmiscarriage group was higher than the control group,and the difference was statistically significant(P<0.05).Serumβ-HCG and P were significantly negatively correlated with the uterine artery flow parameters PI,RI,and

关 键 词：流产 习惯性 子宫动脉血流 超声多普勒 预测价值 

分 类 号：R714.21[医药卫生—妇产科学] R445.1[医药卫生—临床医学]