多模态超声评估妊娠期糖尿病患者胎盘功能的价值  

Value of multimodal ultrasound in evaluating placental function for patients with gestational diabetes mellitus

作　　者：蔡红霞 张文[1] 周文娟 秦爱平 CAI Hong-xia;ZHANG Wen;ZHOU Wen-juan;QIN Ai-ping(Department of Ultrasound,Affiliated Hospital of Yangzhou University,Yangzhou 226000,Jiangsu,China;Department of Ultrasound,Affiliated Yancheng Maternal Child Health Hospital of Yangzhou University,Yancheng 224000,Jiangsu,China)

机构地区：[1]扬州大学附属医院超声科,江苏扬州226000 [2]扬州大学附属盐城妇幼保健院超声科,江苏盐城224000

出　　处：《生物医学工程与临床》2024年第6期787-793,共7页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨晚孕期频谱多普勒超声、三维能量多普勒超声(3D-PDU)及剪切波弹性成像(SWE)评估妊娠期糖尿病(GDM)患者胎盘功能的价值。方法选择GDM患者58例为GDM组,年龄24~38岁,平均年龄30.7岁;孕龄28~40周,平均孕龄34.7周;孕前身体质量指数(BMI)18.3~33.7 kg/m^(2),平均BMI 23.6 kg/m^(2);空腹、口服葡萄糖后1 h、2 h血糖分别为3.97~6.58、7.45~13.17、4.62~12.82 mmol/L,平均血糖分别为5.20、9.94、8.34 mmol/L。正常孕妇70例为对照组,年龄21~42岁,平均年龄29.6岁;孕龄28~41周,平均孕龄35.1周;孕前BMI 16.2~32.0 kg/m^(2),平均BMI 22.8 kg/m^(2)。常规超声检查胎儿双顶径、头围、腹围、股骨长、胎龄、胎儿体质量、胎盘厚度、羊水量。应用频谱多普勒超声获得胎儿脐动脉(UA)、大脑中动脉(MCA)及孕妇子宫动脉(UtA)的血流参数[收缩期/舒张末期峰值速度比(S/D)、搏动指数(PI)、阻力指数(RI)],计算脑-胎盘比(CPR);通过3D-PDU获得胎盘能量指数[血管血流指数(VFI)、血流指数(FI)、血管指数(VI)];应用SWE测得胎盘中央及边缘的平均弹性模量(E)。比较两组数据,绘制受试者工作特性(ROC)曲线对各参数进行评价。结果GDM组与对照组检查时胎儿双顶径、头围、腹围、股骨长、胎龄、胎儿体质量、胎盘厚度、羊水量比较,差异均无统计学意义(P>0.05)。两组孕妇产次、分娩方式和新生儿出生体质量、Apgar 1 min和5 min评分比较,差异均无统计学意义(P>0.05)。与对照组比较,GDM组不良妊娠结局的发生率升高(25.9%vs 11.4%),UtA血流参数升高(S/D:1.94±0.30 vs 1.82±0.18;PI:0.73±0.16 vs 0.65±0.11;RI:0.48±0.06 vs 0.45±0.05),GDM组胎盘能量指数降低(VI:11.76±2.92 vs 15.81±2.98;FI:33.44±2.80 vs 34.79±2.50;VFI:3.94±1.05 vs 5.53±1.20),GDM组胎盘中央及边缘E升高(5.94±0.89 vs 4.81±0.65;6.12±1.01 vs 4.88±0.71),差异均有统计学意义(P<0.05);两组UA、MCA血流参数(S/D、PI、RI)及CPR比较,差异无统计学意Objective To explore the value of spectral Doppler ultrasound,three-dimensional power Doppler ultrasound(3DPDU)and shear wave elastography(SWE)in evaluating placental function for patients with gestational diabetes mellitus(GDM)during late pregnancy.Methods A total of 58 pregnant women with GDM were enrolled as GDM group,which aged 24-38 years old with mean age of 30.7 years old;gestational age was 28-40 weeks with mean gestational age of 34.7 weeks;prepregnancy body mass index(BMI)was 18.3-33.7 kg/m^(2) with mean BMI of 23.6 kg/m^(2);fasting blood glucose,1 hour and 2 hours after oral glucose were 3.97-6.58,7.45-13.17 and 4.62-12.82 mmol/L,respectively,with mean blood glucose of 5.20,9.94 and 8.34 mmol/L,respectively.A total of 70 normal pregnant women were set as control group,which aged 21-42 years old with mean age of 29.6 years old;gestational age was 28-41 weeks with mean gestational age of 35.1 weeks;pre-pregnancy BMI was 16.2-32.0 kg/m^(2) with mean BMI of 22.8 kg/m^(2).The fetal biparietal diameter,head circumference,abdominal circumference,femur length,gestational age,fetal body mass,placental thickness and amniotic fluid volume were examined by conventional ultrasound.The blood flow parameters[peak systolic/end-diastolic velocity ratio(S/D),pulsatility index(PI),resistance index(RI)]of fetal umbilical artery(UA),middle cerebral artery(MCA)and uterine artery(UtA)in pregnant women were obtained by spectral Doppler,and the cerebroplacental ratio(CPR)was calculated.The placental energy index[vascularization flow index(VFI),blood flow index(FI)and vascularization index(VI)]were obtained by 3D-PDU.The mean elastic modulus(E)of central and margin of placenta was measured by SWE.The data between 2 groups were compared,and the receiver operating characteristic(ROC)curve was drawn to evaluate the parameters.Results There were no significant differences in fetal biparietal diameter,head circumference,abdominal circumference,femur length,gestational age,fetal body mass,placental thickness and amniotic fluid volume

关 键 词：剪切波弹性成像 三维能量多普勒超声 胎盘功能 妊娠期糖尿病 频谱多普勒超声 

分 类 号：R714.256[医药卫生—妇产科学] R445.1[医药卫生—临床医学]