胎儿和宫内生长受限儿童的主动脉中膜厚度。
Aortic intima media thickness in fetuses and children with intrauterine growth restriction.
机构信息
From Gynecological Science and Human Reproduction, Section of Maternal Fetal Medicine, University of Padua School of Medicine, Padua, Italy; Pharmacology and Physiology, the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey; and Pediatrics, University of Padua School of Medicine, Padua, Italy.
出版信息
Obstet Gynecol. 2009 Nov;114(5):1109-1114. doi: 10.1097/AOG.0b013e3181bb23d3.
OBJECTIVE
To measure aortic intima media thickness and diameter by ultrasonography in fetuses with intrauterine growth restriction (IUGR) and in appropriate for gestational age (AGA) fetuses and in the same children after a mean follow-up of 18 months.
METHODS
This was a prospective study performed between January 2006 and August 2008. Fetuses were classified as having IUGR if the estimated fetal weight was below the 10th percentile and umbilical artery pulsatility index was greater than 2 standard deviations; they were classified as AGA if the estimated fetal weight was between the 10th and 90th percentiles. Abdominal aortic intima media thickness and diameter were measured in each fetus with IUGR and in each AGA fetus at a mean gestational age of 32 weeks. The same measurements were taken in the children after a mean follow-up of 18 months.
RESULTS
Thirty-eight fetuses with IUGR and 32 AGA fetuses were enrolled in the study. Aortic intima media thickness median values were significantly higher in IUGR than in AGA both in utero (1.9 mm compared with 1.15 mm; P<.001) and after birth (2.4 mm compared with 1.03 mm; P<.001) and were significantly correlated (P=.018, r=0.48). At 32 weeks of gestation, aortic intima media thickness in fetuses with IUGR was inversely correlated with estimated fetal weight (P<.003; r=-0.58). Median diameter of the abdominal aorta and blood-flow velocity at 32 weeks of gestation were significantly higher in fetuses with IUGR compared with AGA fetuses (median diameter 4.5 mm compared with 3.6 mm, P<.001, blood-flow velocity 42.5 cm/s compared with 23.3 cm/s, P<.001). At follow-up, in 25 children who had had IUGR and 25 children who had been AGA, there was no significant difference in median diameter of the abdominal aorta (6.8 mm compared with 7.5 mm, P=.21).
CONCLUSION
Aortic wall thickening in fetuses and children with IUGR shows differences with respect to those who were AGA. This may reflect a correlation between impaired growth in utero, Doppler abnormalities, low birth weight, and early signs of vascular dysfunction.
LEVEL OF EVIDENCE
II.
目的
通过超声测量宫内生长受限（IUGR）胎儿和适于胎龄（AGA）胎儿的主动脉内膜中层厚度和直径，并在平均 18 个月的随访后测量同一儿童的主动脉内膜中层厚度和直径。
方法
这是一项 2006 年 1 月至 2008 年 8 月期间进行的前瞻性研究。如果胎儿估计体重低于第 10 百分位数且脐动脉搏动指数大于 2 个标准差，则将胎儿分类为 IUGR；如果胎儿估计体重在第 10 百分位数至第 90 百分位数之间，则将胎儿分类为 AGA。在平均妊娠 32 周时，对每个 IUGR 胎儿和每个 AGA 胎儿进行腹主动脉内膜中层厚度和直径测量。在平均随访 18 个月后，对儿童进行相同的测量。
结果
本研究纳入了 38 例 IUGR 胎儿和 32 例 AGA 胎儿。IUGR 胎儿的主动脉内膜中层厚度中位数明显高于 AGA 胎儿，无论是在宫内（1.9mm 比 1.15mm；P<.001）还是出生后（2.4mm 比 1.03mm；P<.001），并且两者呈显著相关（P=.018，r=0.48）。在妊娠 32 周时，IUGR 胎儿的主动脉内膜中层厚度与估计胎儿体重呈负相关（P<.003；r=-0.58）。IUGR 胎儿的腹主动脉直径和血流速度在妊娠 32 周时明显高于 AGA 胎儿（直径中位数 4.5mm 比 3.6mm，P<.001，血流速度 42.5cm/s 比 23.3cm/s，P<.001）。在随访中，在 25 例曾患有 IUGR 的儿童和 25 例 AGA 儿童中，腹主动脉直径中位数无显著差异（6.8mm 比 7.5mm，P=.21）。
结论
IUGR 胎儿和儿童的主动脉壁增厚与 AGA 儿童不同。这可能反映了宫内生长受限、多普勒异常、低出生体重和早期血管功能障碍之间的相关性。
证据水平
II 级。
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