Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Physiology, Hasselt University, Hasselt, Belgium.
Ultrasound Obstet Gynecol. 2015 Apr;45(4):421-6. doi: 10.1002/uog.13427. Epub 2015 Mar 9.
To compare functional characteristics of maternal thoraco-abdominal arteries and veins in proteinuric and non-proteinuric hypertension in pregnancy.
This retrospective study included women with singleton pregnancies during the third trimester, which were either uncomplicated or complicated with different clinical types of hypertension: non-proteinuric gestational hypertension (GH), early-onset pre-eclampsia (PE) diagnosed < 34 weeks or late-onset PE diagnosed ≥ 34 weeks. Demographic maternal and neonatal data were recorded, together with maternal serum and urine analytes. All women underwent standardized automated blood-pressure measurement, together with non-invasive impedance cardiography (ICG), for measurement of cardiac output (CO), aortic flow velocity index (VI) and aortic flow acceleration index (ACI). A standardized combined Doppler-electrocardiography assessment of maternal venous hemodynamics was performed to measure renal interlobar vein impedance index (RIVI), hepatic vein impedance index (HVI) and venous pulse transit time (VPTT) in liver and kidneys. Finally, resistance index (RI), pulsatility index (PI) and arterial pulse transit time (APTT) were measured in the uterine arcuate arteries. Mann-Whitney U-tests and Fisher's exact tests were used for intergroup comparisons, and linear dependence between variables was assessed using Pearson's correlation coefficient (r).
A total of 150 pregnancies were evaluated: 22 with uncomplicated pregnancy, 41 GH, 31 early PE and 56 late PE. Aortic VI and ACI were lower in GH, early PE and late PE than in uncomplicated pregnancy. Both early PE and late PE differed from GH by having shorter APTT in the uterine arcuate arteries and higher RIVI. Hemodynamic abnormalities were most pronounced in early PE, during which uterine arcuate artery RI was higher and VPTT in kidneys was shorter than in late PE. There was a significant correlation between degree of proteinuria and RIVI for the left (r = 0.381) and right (r = 0.347) kidney in late PE, but this was not true for early PE.
There is a gradient of worsening arterial and venous hemodynamic abnormalities from GH to late PE and then to early PE. Venous hemodynamic abnormalities are present only in PE, with a linear correlation between proteinuria and RIVI in late PE. The role of the maternal venous compartment in the pathophysiology and etiology of PE-related symptoms may be much more important than considered at present.
比较蛋白尿和非蛋白尿妊娠高血压中母体胸腹部动脉和静脉的功能特征。
本回顾性研究纳入了妊娠晚期单胎妊娠的妇女，这些妇女的病情既不复杂也不复杂，伴有不同临床类型的高血压：非蛋白尿妊娠期高血压（GH）、早发型子痫前期（PE）<34 周或晚发型 PE ≥34 周。记录了产妇和新生儿的人口统计学数据，以及产妇血清和尿液分析物。所有女性均接受标准化自动血压测量和非侵入性阻抗心动图（ICG），以测量心输出量（CO）、主动脉血流速度指数（VI）和主动脉血流加速指数（ACI）。对母体静脉血液动力学进行标准化的联合多普勒-心电图评估，以测量肾叶间静脉阻抗指数（RIVI）、肝静脉阻抗指数（HVI）和肝脏和肾脏中的静脉脉搏传导时间（VPTT）。最后，测量子宫弓形动脉的阻力指数（RI）、搏动指数（PI）和动脉脉搏传导时间（APTT）。使用曼-惠特尼 U 检验和 Fisher 确切检验进行组间比较，使用 Pearson 相关系数（r）评估变量之间的线性依赖性。
共评估了 150 例妊娠：22 例为单纯妊娠，41 例为 GH，31 例为早发性 PE，56 例为晚发性 PE。与单纯妊娠相比，GH、早发性 PE 和晚发性 PE 的主动脉 VI 和 ACI 较低。早发性 PE 和晚发性 PE 与 GH 不同，子宫弓形动脉的 APTT 更短，RIVI 更高。早发性 PE 的血液动力学异常最为明显，其中子宫弓形动脉 RI 较高，肾脏 VPTT 较短。晚发性 PE 左（r=0.381）和右（r=0.347）肾的蛋白尿程度与 RIVI 呈显著相关，但早发性 PE 并非如此。
从 GH 到晚发性 PE，再到早发性 PE，动脉和静脉血液动力学异常逐渐加重。静脉血液动力学异常仅存在于 PE 中，晚发性 PE 中蛋白尿与 RIVI 呈线性相关。母体静脉腔在 PE 相关症状的病理生理学和病因学中的作用可能比目前认为的更为重要。
