Right heart modified myocardial performance index and ductus venosus spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes  

子痫前期胎儿右心改良心肌做功指数及静脉导管频谱参数预测不良妊娠结局

作　　者：GAO Jing LI Hezhou WANG Ming WU Juan WANG Xinxia LIU Yun ZHU Ziqi 高静;栗河舟;王铭;吴娟;王新霞;刘云;朱姿琪(郑州大学第三附属医院超声医学科,河南郑州450052)

机构地区：[1]Department of Ultrasound,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China

出　　处：《中国医学影像技术》2024年第8期1146-1150,共5页Chinese Journal of Medical Imaging Technology

基　　金：2020年度河南省医学适宜技术推广项目(SYJS2020080)。

摘　　要：Objective To observe the values of changes of right heart modified myocardial performance index(Mod-MPI)and ductus venosus(DV)spectrum parameters in pre-eclampsia fetuses for predicting adverse pregnancy outcomes.Methods Eighty-one pregnant women diagnosed as pre-eclampsia were prospectively enrolled and divided into severe pre-eclampsia(SPE)group(n=39)and mild pre-eclampsia(MPE)group(n=42),while 85 healthy pregnant women were taken as controls(control group).Fetal right heart function parameters,including right ventricular isovolumetric relaxation time(IRT),isovolumetric contraction time(ICT),ejection time(ET),total spent time(TST),Mod-MPI,tricuspid valve peak flow velocity ratio in early and late diastole(TV-E/A),as well as blood flow velocities in each waveform of DV spectrum(S,V,D,and A wave)were obtained,and the pulsatility index(PI)and the ratio of blood flow velocities in each waveform of the DV(S/V,S/D,S/A,V/D,V/A,D/A)were calculated.Intrauterine fetal distress,preterm delivery,neonatal asphyxia and newborn with low weight were considered as adverse pregnancy outcomes.The correlations of right heart Mod-MPI and TV-E/A with DV parameters in pre-eclampsia fetuses were assessed,and their predictive efficacies for adverse pregnancy outcomes were evaluated for right heart Mod-MPI and DV using the receiver operating characteristics(ROC)and the area under the curves(AUC).Results Compared with control group and MPE group,fetal right heart IRT,ICT and Mod-MPI increased and ET decreased in SPE group(all P<0.05).No significant differences of right heart TST and TV-E/A among 3 groups(both P>0.05).Fetal DV A-wave velocity and V/D values progressively decreased but PI progressively increased in control,MPE and SPE groups(all P<0.05).Fetal right heart Mod-MPI in pre-eclampsia was moderately positively correlated with DV PI(r=0.637,P=0.016),while TV-E/A was weakly negatively correlated with DV V/D(r=-0.355,P=0.043).Adverse pregnancy outcomes were noticed in 59 pre-eclampsia cases.The AUC of fetal right heart Mod-MPI and 目的观察子痫前期胎儿右心改良心肌做功指数(Mod-MPI)及静脉导管(DV)频谱参数改变及其预测不良妊娠结局的价值。方法前瞻性纳入81例子痫前期孕妇,将其分为重度子痫前期(SPE)组(n=39)及轻度子痫前期(MPE)组(n=42);另以85名健康孕妇为对照组。获取胎儿右心功能参数,包括右心室等容舒张时间(IRT)、等容收缩时间(ICT)、射血时间(ET)、总耗时(TST)及Mod-MPI数据、三尖瓣舒张早期与晚期峰值流速比值(TV-E/A)、DV频谱各波形(S、V、D、A波)血流速度,并计算搏动指数(PI)及DV各波形血流速度比率(S/V,S/D,S/A,V/D,V/A,D/A);以胎儿宫内窘迫、早产、新生儿窒息或伴低体质量为不良妊娠结局,分析子痫前期胎儿右心Mod-MPI、TV-E/A与DV参数的相关性,以受试者工作特征(ROC)曲线及曲线下面积(AUC)评估右心Mod-MPI及DV PI预测不良妊娠结局的效能。结果相比对照组及MPE组,SPE组胎儿右心IRT、ICT及Mod-MPI增高而ET减低(P均<0.05);3组间右心TST及TV-E/A差异无统计学意义(P均>0.05)。对照组、MPE组及SPE组胎儿DV A波速度及V/D渐次降低而PI渐次升高(P均<0.05)。子痫前期胎儿右心Mod-MPI与DV PI呈中度正相关(r=0.637,P=0.016),TV-E/A与DV V/D呈弱负相关(r=-0.355,P=0.043)。59例妊娠结局不良;以子痫前期胎儿右心Mod-MPI及DV PI预测不良妊娠结局的AUC分别为0.897及0.848,差异无统计学意义(Z=0.460,P=0.400)。结论子痫前期胎儿右心Mod-MPI及DV频谱参数值改变均对妊娠结局不良有较高预测价值。

关 键 词：PRE-ECLAMPSIA fetal heart ventricular function ultrasonography prenatal prospective studies 

分 类 号：R714.244[医药卫生—妇产科学] R445.1[医药卫生—临床医学]