超微血流成像联合脉冲多普勒预测妊娠期高血压疾病患者妊娠结局的临床价值  

Clinical value of superb microvascular imaging combined with pulse Doppler in predicting pregnancy outcomes in patients with hypertensive disorders of pregnancy

作　　者：黄仙[1] 黄蓉霞[2] 张静[2] 雷俊华[1] HUANG Xian;HUANG Rongxia;ZHANG Jing;LEI Junhua(Department of Ultrasound Medicine,Kunming Maternal and Child Health Care Hospital,Kunming 650031,China;Department of Obstetrics and Gynecology,Kunming Maternal and Child Health Care Hospital,Kunming 650031,China)

机构地区：[1]昆明市妇幼保健院超声医学科,云南昆明650031 [2]昆明市妇幼保健院妇产科,云南昆明650031

出　　处：《临床超声医学杂志》2025年第3期221-226,共6页Journal of Clinical Ultrasound in Medicine

基　　金：昆明市卫生健康委员会科研基金[2022-SW(后备)-93]。

摘　　要：目的应用超微血流成像(SMI)联合脉冲多普勒评估妊娠期高血压疾病(HDCP)患者胎盘血流灌注水平,探讨其预测不良妊娠结局的临床价值。方法选取我院收治的103例HDCP患者(HDCP组)和105例同期正常孕妇(对照组),其中HDCP组患者包括单纯妊娠期高血压患者57例、轻度子痫前期患者32例和重度子痫前期患者14例,应用脉冲多普勒获取子宫动脉和脐动脉阻力指数(RI)、搏动指数(PI)、收缩期与舒张期峰值流速比值(S/D),SMI获取胎盘血管指数(VI),比较HDCP组与对照组上述参数及不良妊娠结局发生率,以及不同程度HDCP患者子宫动脉和脐动脉PI、S/D、RI及胎盘VI的差异。绘制受试者工作特征(ROC)曲线分析各参数单独及联合应用预测HDCP患者不良妊娠结局的诊断效能。结果HDCP组子宫动脉和脐动脉PI、S/D、RI均高于对照组,胎盘VI低于对照组,差异均有统计学意义(均P<0.001)。单纯妊娠期高血压、轻度子痫前期、重度子痫前期患者子宫动脉和脐动脉PI、S/D、RI均依次升高,胎盘VI依次降低,差异均有统计学意义(均P<0.05)。HDCP组早产、剖宫产、新生儿窒息、胎儿生长受限、胎儿窘迫等不良妊娠结局的发生率均高于对照组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,胎盘VI预测HDCP患者不良妊娠结局的曲线下面积为0.762;子宫动脉PI、S/D、RI及其联合胎盘VI预测HDCP患者不良妊娠结局的曲线下面积分别为0.654、0.576、0.671、0.884;脐动脉PI、S/D、RI及其联合胎盘VI预测HDCP患者不良妊娠结局的曲线下面积分别为0.700、0.712、0.779、0.930。结论SMI联合脉冲多普勒可准确评估HDCP患者胎盘血流灌注水平,且其对不良妊娠结局具有较好的预测价值。Objective To evaluate the placental blood flow perfusion in patients with hypertensive disorders of pregnancy(HDCP)by superb microvascular imaging(SMI)combined with pulse Doppler,and to investigate the clinical value in predicting adverse pregnancy outcomes.Methods A total of 103 HDCP patients(HDCP group)and 105 normal pregnant women(control group)in our hospital were enrolled,the HDCP group including 57 cases of gestational hypertension,32 cases of mild preeclampsia,and 14 cases of severe preeclampsia.Pulse Doppler was used to obtain the resistance index(RI),pulsatility index(PI),systolic-to-diastolic ratio(S/D)of the uterine and umbilical arteries.SMI was used to obtain placental vascularization index(VI).The differences of above parameters and the incidence of adverse pregnancy outcomes were compared between the two groups,and the differences in uterine and umbilical artery PI,S/D,RI,and placental VI were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic performance of individual and combined parameters in predicting adverse pregnancy outcomes in HDCP patients.Results The PI,S/D,and RI of the uterine and umbilical arteries in the HDCP group were significantly higher than those in the control group,while the placental VI was significantly lower(all P<0.001).In the subgroups of gestational hypertension,mild preeclampsia,and severe preeclampsia,the PI,S/D,and RI of the uterine and umbilical arteries progressively increased,while the placental VI progressively decreased,with significant differences(all P<0.05).The incidence of adverse pregnancy outcomes,including preterm delivery,cesarean section,neonatal asphyxia,fetal growth restriction,and fetal distress were significantly higher in the HDCP group than those in the control group(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of placental VI in predicting adverse pregnancy outcomes was 0.762.The AUC of uterine artery PI,S/D,RI,and combined with VI in predicting adverse pregnancy outcomes were 0.654,

关 键 词：超微血流成像 脉冲多普勒 妊娠期高血压疾病 胎盘血流灌注 妊娠结局 

分 类 号：R445.1[医药卫生—影像医学与核医学]