Takahashi Kayo, Ohkuchi Akihide, Hirashima Chikako, Matsubara Shigeki, Suzuki Mitsuaki
Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
J Obstet Gynaecol Res. 2012 Nov;38(11):1275-85. doi: 10.1111/j.1447-0756.2012.01864.x. Epub 2012 May 8.
Our aim was to determine the reference values of indices of impedance to flow in uterine arteries at 16-23 weeks, and to evaluate the effects of these indices for predicting early-onset pre-eclampsia (EO-PE), which was defined as PE with onset at <32 weeks.
During 2004 to 2008, 1536 women with a singleton pregnancy were recruited into a prospective cohort study at 16-23 weeks. The mean notch depth index (mNDI), mean pulsatility index (mPI) and mean resistance index (mRI) were calculated.
Early-onset pre-eclampsia occurred in 16 (1.0%). The 80th, 90th, 95th and 97.5th percentiles of the mNDI at 16-23 weeks were determined. Normal reference ranges of the mPI and mRI were constructed, and individual standard deviation scores (SDS) of the mPI and mRI were calculated. The area under the receiver-operating characteristics curves (AROC) of the mNDI, mPI, mRI and bilateral notching (BN) for predicting EO-PE were 0.807, 0.809, 0.782 and 0.798, respectively. For predicting EO-PE, a mNDI of the 90th percentile, mPI-SDS of 1.383, mRI-SDS of 0.975 and BN yielded sensitivities (specificities) of 0.688 (0.886), 0.750 (0.889), 0.813 (0.809) and 0.750 (0.845) with positive likelihood ratios and 95% confidence intervals of 6.0 (4.2-8.6), 6.8 (4.9-9.3), 4.3 (3.3-5.5) and 4.9 (3.6-6.6), respectively.
We established the reference values for mNDI, mRI and mPI at 16-23 weeks. The positive likelihood ratios of mNDI and mPI for predicting EO-PE showed moderate screening performances, indicating mNDI or mPI in the second trimester could assist to find high risk women with the subsequent onset of EO-PE.
我们的目的是确定16 - 23周时子宫动脉血流阻抗指数的参考值，并评估这些指数对预测早发型子痫前期（EO - PE，定义为发病孕周<32周的子痫前期）的作用。
在2004年至2008年期间，1536名单胎妊娠女性在16 - 23周时被纳入一项前瞻性队列研究。计算平均切迹深度指数（mNDI）、平均搏动指数（mPI）和平均阻力指数（mRI）。
早发型子痫前期发生在16例（1.0%）。确定了16 - 23周时mNDI的第80、90、95和97.5百分位数。构建了mPI和mRI的正常参考范围，并计算了mPI和mRI的个体标准差分数（SDS）。mNDI、mPI、mRI和双侧切迹（BN）预测EO - PE的受试者工作特征曲线下面积（AROC）分别为0.807、0.809、0.782和0.798。对于预测EO - PE，第90百分位数的mNDI、mPI - SDS为1.383、mRI - SDS为0.975和BN的敏感性（特异性）分别为0.688（0.886）、0.750（0.889）、0.813（0.809）和0.750（0.845），阳性似然比及95%置信区间分别为6.0（4.2 - 8.6）、6.8（4.9 - 9.3）、4.3（3.3 - 5.5）和4.9（3.6 - 6.6）。
我们建立了16 - 23周时mNDI、mRI和mPI的参考值。mNDI和mPI预测EO - PE的阳性似然比显示出中等的筛查性能，表明孕中期的mNDI或mPI有助于发现随后发生EO - PE的高危女性。
