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目的 :探讨孕11~13+6周时,采用超声多普勒监测孕妇子宫动脉血流以评估超声检测对预测子痫间前期的可行性。方法:选择1 500例在我院行正规产前检查的单胎妊娠孕妇,于孕11~13+6周时采用超声多普勒检测双侧子宫动脉血流,并记录双侧子宫动脉血流搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、有无舒张早期切迹等。随访所有研究对象的妊娠过程及母胎结局等情况。结果:11 500例孕妇中11例于中孕期终止妊娠,72例发生妊娠期高血压疾病,214例发生其他不良妊娠结局,另1 203例正常妊娠(正常组)。2将72例发生妊娠期高血压疾病的孕妇分为早发型子痫间前期(16例)、迟发型子痫间前期(26例)、妊娠期高血压(30例)3组,各组的子宫动脉血流PI和RI值均高于正常组(P<0.05),且其中早发型子痫间前期组的这2项指标数值增高最明显。3受试者工作特征曲线显示,当子宫动脉血流PI的界限值取1.89时,其预测早发型子痫间前期的灵敏度和特异度分别为82.4%和68.1%;而子宫动脉血流PI联合舒张早期切迹预测早发型子痫间前期的灵敏度和特异度则为83.1%和73.2%。结论 :孕11~13+6周时子宫动脉PI升高并出现舒张早期切迹,是筛查子痫间前期(尤其是早发型)的有效指标。
OBJECTIVE: To explore the feasibility of using ultrasound Doppler to monitor uterine arterial blood flow in pregnant women from 11 to 13 + 6 weeks of gestation to evaluate the feasibility of ultrasound in predicting the pre-eclampsia. Methods: A total of 1 500 pregnant women with normal prenatal examination in our hospital were enrolled. Uterine artery blood flow was measured by using Doppler during 11 ~ 13 + 6 weeks of pregnancy. Bilateral uterine arterial blood flow Pulsatility index (PI), resistance index (RI), presence or absence of early notch and so on. All patients were followed up for pregnancy and the outcome of the fetus. Results: Of 11 500 pregnant women, 11 died of pregnancy in the second trimester, 72 had hypertensive disorder of pregnancy, 214 had other unfavorable pregnancy outcomes, and another 1 203 had normal pregnancy (normal group). 2 72 pregnant women with gestational hypertension were divided into three groups: early preeclampsia (16 cases), late preeclampsia (26 cases), gestational hypertension (30 cases) The PI and RI values of uterine arterial blood flow were higher than those of normal group (P <0.05), and the value of these two indexes in preeclampsia group was the most obvious. 3 The working curve of the subjects showed that the sensitivity and specificity of predicting the preeclampsia of early-onset preeclampsia were 82.4% and 68.1%, respectively, when the cut-off value of uterine artery flow PI was 1.89; while the uterine artery flow PI The sensitivity and specificity of early diastolic notch predicting early preeclampsia were 83.1% and 73.2%. Conclusion: Uterine artery PI is increased and early diastolic notch is found in 11 ~ 13 + 6 weeks of gestation, which is an effective index for screening preeclampsia (especially early-onset).