早孕期低危妊娠和高危妊娠胎盘微血流成像特征及预后分析  

Placental microvascular flow imaging characteristics and prognosis of early low-risk and high-risk pregnancies

作　　者：李钱梅 何冠南[2] 赵婧[2] 陈曦[2] 唐玉英 马丽琼 梁蓉[2] 袁桃[2] 李明星 Qianmei Li;Guannan He;Jing Zhao;Xi Chen;Yuying Tang;Liqiong Ma;Rong Liang;Tao Yuan;Mingxing Li(Department of Ultrasound,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Ultrasound,Sichuan Maternal and Child Health Hospital(Sichuan Women and Children's Hospital),Chengdu 61000,China)

机构地区：[1]西南医科大学附属医院超声医学科,四川泸州646000 [2]四川省妇幼保健院(四川省妇女儿童医院)超声科,成都610000

出　　处：《中华医学超声杂志（电子版）》2024年第7期726-732,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：四川省医学(青年创新)科研课题(S22077);四川省妇幼保健院院内科技创新基金(CXPJ2022-06);成都市医学科研课题(2023365);成都市卫健委医学科研课题(2022221)。

摘　　要：目的观察早孕期低危和高危妊娠胎盘微血流灌注成像(MV-Flow),并探讨早孕期低危及高危妊娠胎盘微血管指数(MVI)及其对不良妊娠结局的预测价值。方法选择2022年1月至12月在四川省妇幼保健院规律产检的孕11~13+6周的单胎妊娠孕妇。高危妊娠定义为一项高度风险因素或两项中度风险因素,低危妊娠定义为单胎妊娠母亲无合并症。分别对95例低危妊娠和44例高危妊娠孕妇进行早孕期胎盘MV-Flow,测量2组孕妇早孕期胎盘MVI、血流指数、血管指数、血管形成-血流指数(VFI)、胎盘体积、子宫动脉搏动指数,收集孕妇基本临床资料、新生儿分娩体质量及孕周、不良妊娠结局。分别采用χ^(2)检验/Fisher’s精确检验、Wilcoxon秩和检验比较高危组与低危组上述变量的差异;采用组内相关系数(ICC)检验分析MVI值测量的一致性;采用多元线性回归分析孕妇基本参数与低危组中MVI值的相关性;采用Logistic回归评估各参数预测不良妊娠结局的效能。结果低危组MVI参考值为57.30(46.10,67.47),高危组MVI参考值为48.09(37.52,58.63),高危组胎盘MVI明显低于低危组(Z=-3.446,P<0.001)。高危组与低危组中发生不良妊娠结局(11 vs 9)、孕妇年龄[30(28,35)岁vs 29(27,31)岁]、使用阿司匹林(13 vs 6)方面比较,差异均有统计学意义(χ^(2)=5.885,P=0.015;Z=2.385,P=0.017;χ^(2)=13.751,P<0.001)。低危组中发现孕周与MVI呈弱线性相关性(r2=0.081,P<0.05),MVI值随着孕周增加而增大。孕次对早期胎盘MVI值有一定影响(B=4.022,t=3.190,P<0.05)。2组孕妇早期胎盘MVI对不良妊娠结局的预测均没有统计学意义(P均>0.05)。低危组中1例MVI(24.6)值低发生早期流产。结论MV-Flow技术可以定量显示早孕期胎盘微血流灌注。检查孕周、孕次与早孕期胎盘微血流灌注有一定的相关性,早孕期高危妊娠胎盘MVI较低危妊娠明显减低,但尚未发现早孕期胎盘MVI异常会导致不良妊娠结�Objective To perform placental microflow perfusion imaging(MV-Flow)in early low-risk and high-risk pregnancies,and explore the characteristics of placental microvascular index(MVI)in low-risk and high-risk pregnancies and its predictive value for adverse pregnancy outcome.Methods Pregnant women with singleton pregnancies at 11 to 13+6 weeks of gestation who underwent regular prenatal check-ups at Sichuan Maternal and Child Health Hospital from January to December 2022 were selected.A high-risk pregnancy was defined as the presence of one high-risk factor or two moderate-risk factors,and a low-risk pregnancy was defined as a singleton pregnancy in a mother with no comorbidities.Placental MV-FIow was performed in early pregnancy on 95 cases of low-risk pregnancies and 44 cases of high-risk pregnancies.Placental MVI,vascularization index,flow index,vascularization-flow,placental volume,and uterine artery pulse index of the two groups of pregnant women in early pregnancy were measured,and the basic clinical data of the pregnant women,newborn birth weight and gestational age,and adverse pregnancy were collected.Theχ^(2) test/Fisher's exact test and Wilcoxon rank sum test were used to compare the differences in the above variables between the high-risk group and low-risk group.The intraclass correlation coefficient test was used to analyze the consistency of MVI measurements.Multiple linear regression was used to analyze the correlation between the basic parameters of pregnant women and MVI values in the low-risk group,and logistic regression was used to evaluate the effectiveness of each parameter in predicting adverse pregnancy outcome.Results The MVI reference value of the low-risk pregnancy group was 57.30(46.10-67.47),and the corresponding value of the high-risk pregnancy group was 48.09(37.52-58.63).The placental MVI of the high-risk group was significantly lower than that of the low-risk group(Z=-3.446,P<0.001).There were statistically significant differences in adverse pregnancy outcomes(11 vs 9),maternal age[

关 键 词：早孕期 高危妊娠 胎盘 微血流成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]