子宫动脉多普勒血流速度检测在低危人群子痫前期预测中的应用。
The utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population.
机构信息
Department of Obstetrics, University of Cincinnati, Cincinnati, Ohio, USA.
出版信息
Obstet Gynecol. 2012 Oct;120(4):815-22. doi: 10.1097/AOG.0b013e31826af7fb.
OBJECTIVE
The underlying pathophysiology of preeclampsia is thought to be abnormal trophoblast invasion of the spiral arteries leading to maldevelopment of uteroplacental perfusion. We estimated whether uterine artery Doppler measurements made in the early second trimester would predict the subsequent development of preeclampsia.
METHODS
Uterine artery Doppler measurements before 21 weeks of gestation (median 16.6 weeks) were correlated with subsequent development of preeclampsia in a cohort of 2,188 low-risk nulliparous women in a randomized control trial of antioxidant supplementation for prevention of preeclampsia. Preeclampsia developed in 165 (7.5%) women.
RESULTS
Development of preeclampsia overall was associated with increased resistance index, pulsatility index, a pulsatility index or resistance index multiple of the median at or above the 75th percentile but not the presence of a notch or a bilateral notch before 21 weeks of gestation. The sensitivity was 43% (95% confidence interval [CI] 35-51) and specificity 67% (95% CI 65-69) for prediction of preeclampsia overall. The presence of a notch or bilateral notch, resistance index, and pulsatility index multiple of the median was significantly associated with early onset (before 34 weeks of gestation) compared with late onset or no preeclampsia (odds ratio [OR] 6.9, 95% CI 2.3-20.9; sensitivity 78%, 95% CI 52-94; specificity 66%, 95% CI 64-68). The presence of a notch or resistance index multiple of the median at or above the 75th percentile increased the odds of developing severe compared with mild or no preeclampsia (OR 2.2, 95% CI 1.4-3.7; sensitivity 53%, 95% CI 40-65; specificity 66%, 95% CI 64-68).
CONCLUSION
Our data show poor sensitivity of second-trimester Doppler ultrasound measurements for prediction of preeclampsia overall in a well-characterized, low-risk, nulliparous population. The technique has utility in identifying poor trophoblast invasion of spiral arteries of a magnitude that severely compromises uteroplacental blood flow and gives early-onset disease.
LEVEL OF EVIDENCE
II.
目的
子痫前期的潜在病理生理学被认为是滋养细胞异常侵入螺旋动脉，导致胎盘灌注不良。我们评估了妊娠中期 2 周前的子宫动脉多普勒测量是否可以预测随后子痫前期的发生。
方法
在一项抗氧化剂补充预防子痫前期的随机对照试验中，对 2188 名低危初产妇的队列进行了妊娠中期 2 周前（中位 16.6 周）的子宫动脉多普勒测量，并与随后子痫前期的发生相关联。165 名（7.5%）妇女发生子痫前期。
结果
总体而言，子痫前期的发生与阻力指数、搏动指数增加、在 21 周前达到或高于第 75 百分位的中位数的搏动指数或阻力指数倍数、 notch 或双侧 notch 的存在有关。敏感性为 43%（95%CI 35-51），特异性为 67%（95%CI 65-69），可预测总体子痫前期。 notch 或双侧 notch、阻力指数和搏动指数倍数与早发（34 周前）相比与晚发或无子痫前期显著相关（比值比[OR] 6.9，95%CI 2.3-20.9；敏感性 78%，95%CI 52-94；特异性 66%，95%CI 64-68）。 notch 或高于第 75 百分位的中位数倍数的阻力指数的存在增加了与轻度或无子痫前期相比发生严重子痫前期的可能性（比值比[OR] 2.2，95%CI 1.4-3.7；敏感性 53%，95%CI 40-65；特异性 66%，95%CI 64-68）。
结论
我们的数据显示，在特征明确、低危、初产妇人群中，妊娠中期多普勒超声测量对总体子痫前期的预测敏感性较差。该技术可用于识别严重损害胎盘血流的螺旋动脉滋养细胞侵入程度，并可早期发现疾病。
证据水平
II。
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