-
帆状胎盘是指脐带附着在胎膜,血管经胎膜作扇形分布并进入胎盘。既往研究[1]表明:帆状胎盘对母体并不会产生影响,但是对胎儿的影响相对较大。如脐带附着点在胎盘下缘近宫颈部位或胎膜下血管跨越宫颈内口,则会增加胎儿宫内窘迫、死亡及失血发生率[2-4]。目前,临床上对于帆状胎盘发病机制尚未阐明,多与妊娠初期胎盘低置有关,且随着孕期发展胎盘向血供丰富的子宫上端生长,容易演变为帆状胎盘。因此,加强单胎妊娠及合并帆状胎盘病人产前诊断对改善病人预后具有重要的意义[5]。国外研究[6]表明:帆状胎盘与胎儿脐动脉(UA) 及大脑中动脉(MCA)血流动力学存在紧密的联系,能作为临床诊断的辅助手段,可有效地预测妊娠结局。因此,本研究探讨UA联合MCA血流动力学在单胎妊娠合并帆状胎盘中的诊断效能。
-
观察组UA血流动力学中S/D、RI及PI水平均高于对照组,差异均有统计学意义(P<0.01)(见表 1)。
分组 n S/D RI PI 观察组 50 3.53±0.71 0.87±0.14 1.93±0.21 对照组 50 2.35±0.49 0.38±0.11 0.83±0.14 t — 9.67* 19.46 30.82 P — <0.01 <0.01 <0.01 *示t′值 表 1 2组UA血流动力学水平比较(x±s)
-
观察组MCA血流动力学中RI、PI水平均低于对照组,差异均有统计学意义(P<0.01)(见表 2)。
分组 n RI PI 观察组 50 0.56±0.13 1.35±0.16 对照组 50 0.84±0.17 1.74±0.19 t — 9.25 11.10 P — <0.01 <0.01 表 2 2组MCA血流动力学水平比较(x±s)
-
ROC曲线结果表明:UA联合MCA血流动力学在单胎妊娠合并帆状胎盘中的诊断效能AUC高于单一UA和MCA血流动力学(P<0.01),灵敏度分别为93.51%、79.43%和84.17%,特异度分别为61.42%、67.81%和65.67%(见表 3、图 2)。
检测变量 AUC SE P 95%CI 灵敏度/% 特异度/% UA血流动力学 0.746 0.061 <0.01 0.713~0.858 79.43 67.81 MCA血流动力学 0.812 0.074 <0.01 0.794~0.871 84.17 65.67 联合检查 0.894 0.083 <0.01 0.845~0.932 93.51 61.42 表 3 UA、MCA血流动力学在单胎妊娠合并帆状胎盘中的诊断效能
胎儿脐动脉联合大脑中动脉血流动力学在单胎妊娠合并帆状胎盘中的诊断效能评价
Evaluation of the diagnostic efficacy of the fetal umbilical artery combined with middle cerebral artery hemodynamics in single pregnancy complicated with vela placenta
-
摘要:
目的探讨胎儿脐动脉(UA)联合大脑中动脉(MCA)血流动力学在单胎妊娠合并帆状胎盘中的诊断效能。 方法选择2017年11月至2020年11月单胎妊娠者50例,设为对照组;选择同期治疗的单胎妊娠合并帆状胎盘者50例,设为观察组。2组均采用彩色多普勒超声技术检测者UA[包括脐动脉收缩期峰值流速/舒张末期流速(S/D)值、阻力指数(RI)及搏动指数(PI)]、MCA血流动力学[阻力指数(RI)及搏动指数(PI)]指标;绘制ROC曲线,分析UA、MCA血流动力学在单胎妊娠合并帆状胎盘中的诊断效能(灵敏度、特异度)。 结果观察组UA血流动力学中S/D、RI及PI水平均高于对照组(P < 0.01);观察组MCA血流动力学中RI、PI水平均低于对照组(P < 0.01);ROC曲线结果表明:UA联合MCA血流动力学在单胎妊娠合并帆状胎盘中的诊断效能高于单一UA和MCA血流动力学(P < 0.01),灵敏度分别为93.51%、79.43%和84.17%,特异度分别为61.42%、67.81%和65.67%。 结论UA血流动力学中S/D、RI及PI在单胎妊娠合并帆状胎盘病人中呈高表达,而MCA血流动力学呈低表达,加强胎儿UA及MCA联合测定能获得较高的诊断效能,可指导临床治疗。 Abstract:ObjectiveTo investigate the diagnostic efficacy of fetal umbilical artery(UA) combined with middle cerebral artery(MCA) hemodynamics in single pregnancy complicated with vela placenta. MethodsFifty cases of single pregnancy women from November 2017 to November 2020 were set as the control group, and 50 pregnancy women with single pregnancy complicated with vela placenta were set as the observation group.The UA[including peak systolic velocity/end-diastolic velocity(S/D), resistance index(RI) and pulsation index(PI) of umbilical artery], MCA hemodynamics(RI and PI) in two groups were measured using color Doppler ultrasound.The ROC curve was drawn to analyze the diagnostic efficacy(sensitivity and specificity) of UA and MCA hemodynamics in single pregnancy complicated with vela placenta. ResultsThe levels of S/D, RI and PI in UA hemodynamics in observation group were higher than those in control group(P < 0.01).The levels of RI and PI in MCA hemodynamics in observation group were lower than those in control group(P < 0.01).The results of ROC curve showed that the diagnostic efficacy of UA combined with MCA hemodynamics in single pregnancy complicated with vela placenta was higher than that of UA or MCA hemodynamics alone(P < 0.01).The sensitivities of single UA or MCA and the combination of UA and MCA were 79.43%, 84.17% and 93.51%, respectively.The specificities of single UA or MCA and two combination of UA and MCA were 67.81%, 65.67% and 61.42%, respectively. ConclusionsIn UA hemodynamics, the expression levels of S/D, RI and PI in patients with single pregnancy complicated with vela placenta are high, while the level of MCA hemodynamics is low.Strengthening the combined determination of fetal UA and MCA can obtain the high diagnostic efficacy, which can guide the clinical treatment. -
Key words:
- vela placenta /
- single pregnancy /
- fetal umbilical artery /
- middle cerebral artery /
- hemodynamics /
- diagnostic efficacy
-
表 1 2组UA血流动力学水平比较(x±s)
分组 n S/D RI PI 观察组 50 3.53±0.71 0.87±0.14 1.93±0.21 对照组 50 2.35±0.49 0.38±0.11 0.83±0.14 t — 9.67* 19.46 30.82 P — <0.01 <0.01 <0.01 *示t′值 表 2 2组MCA血流动力学水平比较(x±s)
分组 n RI PI 观察组 50 0.56±0.13 1.35±0.16 对照组 50 0.84±0.17 1.74±0.19 t — 9.25 11.10 P — <0.01 <0.01 表 3 UA、MCA血流动力学在单胎妊娠合并帆状胎盘中的诊断效能
检测变量 AUC SE P 95%CI 灵敏度/% 特异度/% UA血流动力学 0.746 0.061 <0.01 0.713~0.858 79.43 67.81 MCA血流动力学 0.812 0.074 <0.01 0.794~0.871 84.17 65.67 联合检查 0.894 0.083 <0.01 0.845~0.932 93.51 61.42 -
[1] 熊常君, 陈秋玲, 邓卉, 等. 孕妇UtA与胎儿UmA和MCA测量在胎儿宫内窘迫诊断中的价值[J]. 现代生物医学进展, 2020, 20(4): 152. [2] 郝晓英, 高冰, 任郁, 等. 子宫动脉, 胎儿脐动脉和大脑中动脉血流频谱对妊娠高血压的价值[J]. 医学影像学杂志, 2020, 30(8): 140. [3] 施国荣, 方丽丽, 沈红英, 等. 彩色多普勒超声与脐动脉血流动力学指标在胎盘植入诊断中的应用[J]. 海南医学, 2019, 30(16): 2124. doi: 10.3969/j.issn.1003-6350.2019.16.025 [4] NGLA M, HA LINDÉN, OLOF S. Association of maternal eating disorders with pregnancy and neonatal outcomes[J]. JAMA Psychiatry, 2020, 77(3): 285. doi: 10.1001/jamapsychiatry.2019.3664 [5] 石莉, 吴栋才, 符小艳. 胎儿脐动脉与大脑中动脉血流频谱预测晚孕期胎儿窘迫的临床价值比较[J]. 蚌埠医学院学报, 2020, 45(11): 69. [6] CIOBANU A, WRIGHT A, SYNGELAKI A, et al. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio[J]. Ultrasound Obstet Gynecol, 2019, 53(4): 465. doi: 10.1002/uog.20157 [7] SZELÉNYI Z, GYÖRI D, BOLDIZSÁR S, et al. Pregnancy and stillbirth losses in dairy cows with singleton and twin pregnancies[J]. Acta Vet Hung, 2019, 67(1): 115. doi: 10.1556/004.2019.013 [8] 尹晓燕, 卞晓星, 刘爱民. 胎儿超声血流动力学及脐血血气分析联合检测对新生儿窒息的诊断意义[J]. 重庆医学, 2019, 48(9): 16. [9] 任秀娥, 王卓, 郑晓芳, 等. 高危妊娠晚期胎儿脐动脉, 大脑中动脉血流多普勒参数变化与不良妊娠结局的关系[J]. 影像科学与光化学, 2020, 38(3): 76. [10] 邢少宁, 符爱贞. 彩超胎儿脐动脉及大脑中动脉血流频谱检测及对胎儿窘迫的诊断价值分析[J]. 中国妇幼保健, 2019, 34(8): 1891. [11] YANG M, ZHENG Y, LI M, et al. Clinical features of velamentous umbilical cord insertion and vasa previa: A retrospective analysis based on 501 cases[J]. Medicine, 2020, 99(51): e23166. doi: 10.1097/MD.0000000000023166 [12] 邢静, 王一清, 沈刚, 等. 彩色多普勒超声在羊水过少的胎儿脐动脉与大脑中动脉的血流动力学变化及胎儿结局分析中的应用价值[J]. 中国医师进修杂志, 2019, 42(12): 1089. doi: 10.3760/cma.j.issn.1673-4904.2019.12.008 [13] 熊常君, 陈秋玲, 邓卉, 等. 孕妇UtA与胎儿UmA和MCA测量在胎儿宫内窘迫诊断中的价值[J]. 现代生物医学进展, 2020, 20(4): 152. [14] JIN B, HUANG Q, JI M, et al. Perinatal outcomes in dichorionic diamniotic twins with multifetal pregnancy reduction versus expectant management: A systematic review and meta-analysis[J]. Medicine, 2020, 99(25): e20730. doi: 10.1097/MD.0000000000020730 [15] 李建敏, 李娜, 周玲, 等. 超声脐动脉血流联合血清β-HCG, 胎心监护预测胎儿宫内窘迫的价值[J]. 中国医师杂志, 2020, 22(2): 295. doi: 10.3760/cma.j.issn.1008-1372.2020.02.035 [16] 马强, 蔺莉, 梁雪静, 等. 彩色多普勒超声在妊娠期高血压孕妇子宫动脉血流动力学参数监测中的意义及对母婴结局影响[J]. 中国生育健康杂志, 2019, 30(6): 524. doi: 10.3969/j.issn.1671-878X.2019.06.006 [17] 尤利益, 朱紫宛, 陈登. 时间-空间关联成像技术定量分析在胎儿心脏畸形筛查中的价值[J]. 医学研究杂志, 2019, 48(2): 157. [18] HOFFMAN MK, GOUDAR SS, KODKANY BS, et al. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy(ASPIRIN): a randomised, double-blind, placebo-controlled trial[J]. Lancet, 2020, 395(10220): 285. doi: 10.1016/S0140-6736(19)32973-3 [19] 石莉, 吴栋才, 符小艳. 胎儿脐动脉与大脑中动脉血流频谱预测晚孕期胎儿窘迫的临床价值比较[J]. 蚌埠医学院学报, 2020, 45(11): 1515. [20] 邵晴荷, 杨洁, 周玉珊, 等. 妊娠期糖尿病患者血清CysC, Hcy以及胎儿脐动脉血流动力学指标对胎儿妊娠结局的影响[J]. 广东医学, 2019, 40(20): 2867. [21] 丁清华, 朱勇苗, 李小青, 等. 妊娠中晚期重度子痫前期妇女胎盘-胎儿的三维能量多普勒超声研究[J]. 海南医学, 2019, 30(22): 2957 doi: 10.3969/j.issn.1003-6350.2019.22.030