Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):33-6. doi: 10.1016/j.ejogrb.2009.06.029. Epub 2009 Jul 23.
The aim of this study was to determine the correlation between ductus venosus (DV) Doppler velocimetry and fetal cardiac troponin T (cTnT).
Between March 2007 and March 2008, 89 high-risk pregnancies were prospectively studied. All patients delivered by cesarean section and the Doppler exams were performed on the same day. Multiple regression included the following variables: maternal age, parity, hypertension, diabetes, gestational age at delivery, umbilical artery (UA) S/D ratio, diagnosis of absent or reversed end-diastolic flow velocity (AREDV) in the UA, middle cerebral artery (MCA) pulsatility index (PI), and DV pulsatility index for veins (PIV). Immediately after delivery, UA blood samples were obtained for the measurement of pH and cTnT levels. Statistical analysis included the Kruskal-Wallis test and multiple regressions.
The results showed a cTnT concentration at birth >0.05 ng/ml in nine (81.8%) of AREDV cases, a proportion significantly higher than that observed in normal UA S/D ratio and UA S/D ratio >p95 with positive diastolic blood flow (7.7 and 23.1%, respectively, p<0.001). A positive correlation was found between abnormal DV-PIV and elevated cTnT levels in the UA. Multiple regression identified DV-PIV and a diagnosis of AREDV as independent factors associated with abnormal fetal cTnT levels (p<0.0001, F(2.86)=63.5, R=0.7722).
DV-PIV was significantly correlated with fetal cTnT concentrations at delivery. AREDV and abnormal DV flow represent severe cardiac compromise, with increased systemic venous pressure, and a rise in right ventricular afterload, demonstrated by myocardial damage and elevated fetal cTnT.
本研究旨在确定静脉导管（DV）多普勒速度与胎儿心肌肌钙蛋白 T（cTnT）之间的相关性。
2007 年 3 月至 2008 年 3 月，前瞻性研究了 89 例高危妊娠。所有患者均行剖宫产分娩，且在同一天进行多普勒检查。多元回归纳入以下变量：母亲年龄、产次、高血压、糖尿病、分娩时孕周、脐动脉（UA）S/D 比值、UA 舒张末期血流速度缺失或反流（AREDV）的诊断、大脑中动脉（MCA）搏动指数（PI）和静脉 DV 搏动指数（PIV）。分娩后立即采集 UA 血样，用于测量 pH 值和 cTnT 水平。统计分析包括 Kruskal-Wallis 检验和多元回归。
结果显示，9 例（81.8%）AREDV 患者出生时 cTnT 浓度>0.05ng/ml，这一比例明显高于正常 UA S/D 比值和 UA S/D 比值>p95 伴正向舒张期血流的患者（分别为 7.7%和 23.1%，p<0.001）。异常 DV-PIV 与 UA 中升高的 cTnT 水平之间存在正相关。多元回归确定了 DV-PIV 和 AREDV 诊断为与胎儿 cTnT 水平异常相关的独立因素（p<0.0001，F（2.86）=63.5，R=0.7722）。
DV-PIV 与分娩时胎儿 cTnT 浓度显著相关。AREDV 和异常的 DV 血流代表严重的心脏功能障碍，伴有全身静脉压升高和右心室后负荷增加，表现为心肌损伤和胎儿 cTnT 升高。
