Department of Obstetrics & Gynecology, Ziekenhuis Oost Limburg, Genk, Belgium.
Ultrasound Obstet Gynecol. 2010 Jul;36(1):69-75. doi: 10.1002/uog.7591.
To test the hypothesis that Doppler characteristics of maternal renal interlobar veins (RIV) are different between pregnancies affected by early-onset pre-eclampsia (EP) and those affected by late-onset pre-eclampsia (LP).
A gestational age of 34 weeks was considered to differentiate EP from LP. All women had a renal duplex scan according to a standard protocol, with known intraobserver correlation coefficient (0.88). Maximum (Vmax) and minimum (Vmin) RIV velocities were measured on two occasions (between 28 and 32 and between 34 and 37 weeks) in 18 women with uncomplicated pregnancy (UP). In women with EP (n = 32) or LP (n = 41), these variables were measured once, within 3 days following hospital admission. Delta velocity (DeltaV) was calculated as Vmax - Vmin and the RIV impedance index (RIVI) was calculated as DeltaV/Vmax. Data on neonatal outcome and maternal renal function were obtained for UP and those with EP and LP, and group-specific means +/- SD were calculated and compared.
Compared with UP, the RIVI of both left and right kidneys was higher in those with EP (0.49 +/- 0.13 vs. 0.36 +/- 0.04, P = 0.0001, and 0.46 +/- 0.15 vs. 0.33 +/- 0.04, P = 0.0008) and in those with LP (0.41 +/- 0.07 vs. 0.37 +/- 0.06, P = 0.04, and 0.38 +/- 0.12 vs. 0.30 +/- 0.05, P = 0.009). RIVI was higher in pregnancies with EP than in those with LP (P < or = 0.01), and this difference was associated with lower median birth-weight percentiles (22.5 (interquartile range (IQR), 15-35) vs. 40.0 (IQR, 12-55), P = 0.01), higher maternal serum uric acid concentrations (419 +/- 84 vs. 374 +/- 85 micromol/L, P = 0.03) and higher proteinuria (4131 +/- 3885 vs. 1190 +/- 1133 mg/24 h, P < 0.0001).
Maternal vascular maladaption in pre-eclampsia is associated with abnormal Doppler findings in the venous compartment. RIVI is higher in EP than in LP pregnancies and this is associated with lower birth-weight percentiles and higher proteinuria.
验证如下假说，即早发型子痫前期（EP）和晚发型子痫前期（LP）患者的母体肾叶间静脉（RIV）多普勒特征不同。
以 34 孕周区分 EP 和 LP。所有女性均按标准方案进行肾双功超声检查，组内观察者相关系数为 0.88。18 例单纯妊娠（UP）女性在 28-32 周和 34-37 周时两次测量 RIV 的最大速度（Vmax）和最小速度（Vmin）。32 例 EP 患者和 41 例 LP 患者入院后 3 天内各测量一次上述参数。计算最大速度与最小速度的差值（DeltaV），RIV 阻抗指数（RIVI）=DeltaV/Vmax。记录 UP 组及 EP 和 LP 患者的新生儿结局和母体肾功能数据，计算组内平均值（+/-标准差）并进行比较。
与 UP 相比，EP 患者双侧 RIVI 均升高（左肾：0.49 +/- 0.13 比 0.36 +/- 0.04，P = 0.0001；右肾：0.46 +/- 0.15 比 0.33 +/- 0.04，P = 0.0008），LP 患者也升高（左肾：0.41 +/- 0.07 比 0.37 +/- 0.06，P = 0.04；右肾：0.38 +/- 0.12 比 0.30 +/- 0.05，P = 0.009）。EP 患者的 RIVI 高于 LP 患者（P <= 0.01），且这种差异与较低的中位数出生体重百分位数相关（22.5（四分位间距（IQR），15-35）比 40.0（IQR，12-55），P = 0.01），较高的母体血尿酸浓度（419 +/- 84 比 374 +/- 85 umol/L，P = 0.03）和较高的蛋白尿水平（4131 +/- 3885 比 1190 +/- 1133 mg/24 h，P < 0.0001）。
子痫前期的母体血管适应性不良与静脉系统多普勒异常有关。EP 患者的 RIVI 高于 LP 患者，且与较低的出生体重百分位数和较高的蛋白尿水平相关。
