Vonck Sharona, Staelens Anneleen Simone, Mesens Tinne, Tomsin Kathleen, Gyselaers Wilfried
Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium.
PLoS One. 2014 Dec 23;9(12):e115594. doi: 10.1371/journal.pone.0115594. eCollection 2014.
It is well known that hepatic hemodynamics is an important physiologic mechanism in the regulation of cardiac output (CO). It has been reported that maternal cardiac output relates to neonatal weight at birth.
In this study, we assessed the correlation between maternal hepatic vein Doppler flow parameters, cardiac output and neonatal birth weight.
Healthy women with uncomplicated second or third trimester pregnancy attending the outpatient antenatal clinic of Ziekenhuis Oost-Limburg in Genk (Belgium), had a standardized combined electrocardiogram-Doppler ultrasound with Impedance Cardiography, for measurement of Hepatic Vein Impedance Index (HVI = [maximum velocity - minimum velocity]/maximum velocity), venous pulse transit time (VPTT = time interval between corresponding ECG and Doppler wave characteristics) and cardiac output (heart rate x stroke volume). After delivery, a population-specific birth weight chart, established from a cohort of 27000 neonates born in the index hospital, was used to define customized birth weight percentiles (BW%). Correlations between HVI, VPTT, CO and BW% were calculated using Spearman's ρ, linear regression analysis and R2 goodness of fit in SPSS 22.0.
A total of 73 women were included. There was a negative correlation between HVI and VPTT (ρ = -0.719, p < 0.001). Both HVI and VPTT correlated with CO (ρ = -0.403, p < 0.001 and ρ = 0.332, p < 0.004 resp.) and with BW% (ρ = -0.341, p < 0.003 and ρ = 0.296, p < 0.011 resp.).
Our data illustrate that the known contribution of hepatic hemodynamics in the regulation of cardiac output is also true for women with uncomplicated pregnancies. Our study is the first to illustrate a potential link between maternal hepatic hemodynamics and neonatal birth weight. Whether this link is purely associative or whether hepatic vascular physiology has a direct impact on fetal growth is to be evaluated in more extensive clinical and experimental research.
众所周知，肝脏血流动力学是调节心输出量（CO）的重要生理机制。据报道，母亲的心输出量与新生儿出生体重有关。
在本研究中，我们评估了母亲肝静脉多普勒血流参数、心输出量与新生儿出生体重之间的相关性。
在比利时根克的东林堡医院门诊产前诊所就诊的妊娠中期或晚期无并发症的健康女性，接受了标准化的心电图 - 多普勒超声联合阻抗心动图检查，以测量肝静脉阻抗指数（HVI = [最大速度 - 最小速度]/最大速度）、静脉搏动传输时间（VPTT = 相应心电图和多普勒波特征之间的时间间隔）和心输出量（心率×每搏输出量）。分娩后，使用从该指数医院出生的27000名新生儿队列建立的特定人群出生体重图表，来定义定制的出生体重百分位数（BW%）。使用SPSS 22.0中的Spearman's ρ、线性回归分析和R2拟合优度计算HVI、VPTT、CO和BW%之间的相关性。
共纳入73名女性。HVI与VPTT之间存在负相关（ρ = -0.719，p < 0.001）。HVI和VPTT均与CO相关（分别为ρ = -0.403，p < 0.001和ρ = 0.332，p < 0.004），并与BW%相关（分别为ρ = -0.341，p < 0.003和ρ = 0.296，p < 0.011）。
我们的数据表明，肝脏血流动力学在调节心输出量方面的已知作用对于无并发症妊娠的女性同样适用。我们的研究首次阐明了母亲肝脏血流动力学与新生儿出生体重之间的潜在联系。这种联系是纯粹的关联性，还是肝脏血管生理学对胎儿生长有直接影响，有待在更广泛的临床和实验研究中进行评估。
