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早发型重度子痫前期孕妇胎儿主肺动脉多普勒流速曲线参数的变化及意义

Changes and significance of Doppler flow velocity curve parameters of the main pulmonary artery in fetuses of pregnant women with early-onset severe preeclampsia

    摘要
  • 摘要:
    目的 探讨早发型重度子痫前期孕妇胎儿主肺动脉多普勒流速曲线参数的变化及其对胎儿肺成熟度的预测价值。
    方法 选取30例早发型重度子痫前期孕妇设为研究组，并根据新生儿结局的不同将其进一步分为呼吸窘迫综合征(RDS)组17例和非RDS组13例，另选取同期产检的80名正常妊娠孕妇设为正常对照组。比较各组孕妇胎儿主肺动脉多普勒流速曲线参数，并分析各参数对新生儿RDS的预测价值。
    结果 研究组孕妇胎儿收缩期加速时间(AT)、收缩期射血时间(ET)短于对照组，收缩期加速时间与射血时间比值(AT/ET)低于对照组，差异有统计学意义(P < 0.05); RDS组孕妇胎儿AT、ET短于非RDS组，差异有统计学意义(P < 0.05), 但2组AT/ET差异无统计学意义(P>0.05)。二元Logistic回归分析结果显示，三者联合预测新生儿RDS的方程为logit(P)=AT+(-0.560/1.048)×ET+(-2.464/1.048)×AT/ET。受试者工作特征曲线分析结果显示, AT、ET、AT/ET单独及联合预测新生儿RDS的曲线下面积分别为0.837、0.877、0.712及0.929，敏感度分别为94.1%、94.1%、47.1%及94.1%, 特异度分别为58.1%、75.3%、84.9%及78.5%。
    结论 早发型重度子痫前期孕妇胎儿主肺动脉多普勒流速曲线参数AT、ET、AT/ET数值均降低，应用多普勒超声监测胎儿的主肺动脉流速曲线能够有效评估其肺成熟度。

     

    Abstract:
    Objective To investigate the changes in Doppler flow velocity curve parameters of the main pulmonary artery in fetuses of pregnant women with early-onset severe preeclampsia and their predictive value for fetal lung maturity.
    Methods Thirty pregnant women with early-onset severe preeclampsia were selected as study group and further divided into respiratory distress syndrome (RDS) group (n=17) and non-RDS group (n=13) based on neonatal outcomes. Additionally, 80 pregnant women with normal pregnancies undergoing antenatal examination during the same period were selected as normal control group. Doppler flow velocity curve parameters of the mainpulmonary artery in fetuses of pregnant women in each group were compared, and the predictive value of these parameters for neonatal RDS was analyzed.
    Results The systolic acceleration time (AT) and systolic ejection time (ET) of fetuses in the study group were shorter than those in the control group, and the ratio of AT to ET (AT/ET) was lower than that in the control group (P < 0.05). The AT and ET of fetuses in the RDS group were shorter than those in the non-RDS group (P < 0.05), but there was no statistically significant difference in AT/ET between the two groups (P>0.05). Binary Logistic regression analysis revealed that the combined predictive equation for neonatal RDS using these three parameters was logit(P)=AT+(-0.560/1.048)×ET+(-2.464/1.048)×AT/ET. Receiver operating characteristic curve analysis showed that the areas under the curve for AT, ET, AT/ET alone and their combination for predicting neonatal RDS were 0.837, 0.877, 0.712, and 0.929, respectively, with sensitivities of 94.1%, 94.1%, 47.1%, and 94.1%, and specificities of 58.1%, 75.3%, 84.9%, and 78.5%, respectively.
    Conclusion The Doppler flow velocity curve parameters including AT, ET, and AT/ET of the main pulmonary artery in fetuses of pregnant women with early-onset severe preeclampsia are decreased. Doppler ultrasonography can effectively evaluate fetal lung maturity by monitoring the flow velocity curve of the main pulmonary artery.

     

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