Eastwood K A, Patterson C, Hunter A J, McCance D R, Young I S, Holmes V A
Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom; Royal Jubilee Maternity Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast BT12 6BA, United Kingdom.
Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, United Kingdom.
Placenta. 2017 Mar;51:89-97. doi: 10.1016/j.placenta.2017.01.005. Epub 2017 Jan 5.
Pre-eclampsia remains a leading cause of maternal and fetal morbidity and mortality. This systematic review aims to evaluate the ability of placental vascularisation indices (PVIs) derived from 3D power Doppler whole placental volume scanning to predict early, late and any-onset pre-eclampsia (PE). The following databases were searched: MEDLINE, EMBASE and Web of Science. Studies selected for inclusion measured PVIs: Vascularisation Index (%) (VI) and/or Flow Index (FI) and/or Vascularisation Flow Index (VFI) derived from 3D power Doppler whole placental volume scanning via Virtual Organ Computer-aided Analysis (VOCAL) technique prior to diagnosis of PE. A total of 667 records were screened with five eligible studies included. A narrative review of all studies was undertaken and three studies with sufficient data were included in a meta-analysis. This review, the first of its kind to evaluate the predictive value of PVIs for PE, reports significantly lower first trimester PVIs across a range of studies in women who develop PE. Mean differences in vascularisation indices in PE and non-PE pregnancies were: VI -2.93% (95% CI -5.84,-0.01), FR -2.83 (95% CI -3.97,-1.69) and VFI -0.93 (95% CI -1.6,-0.25), respectively. While only two studies reported sensitivity and specificity data, VI and VFI most accurately predicted early onset PE, and VFI predicted PE in high risk women. Further research is required to validate these findings in different study populations and to examine the performance of PVIs within combined screening models for PE.
子痫前期仍然是孕产妇和胎儿发病及死亡的主要原因。本系统评价旨在评估通过三维能量多普勒全胎盘容积扫描得出的胎盘血管化指数（PVI）预测早发型、晚发型及任何类型子痫前期（PE）的能力。检索了以下数据库：MEDLINE、EMBASE和Web of Science。纳入的研究测量了PVI：血管化指数（%）（VI）和/或血流指数（FI）和/或血管化血流指数（VFI），这些指数是在PE诊断前通过虚拟器官计算机辅助分析（VOCAL）技术从三维能量多普勒全胎盘容积扫描中得出的。共筛选了667条记录，纳入了5项符合条件的研究。对所有研究进行了叙述性综述，3项数据充分的研究纳入了荟萃分析。本综述是评估PVI对PE预测价值的同类研究中的第一项，报告了在一系列研究中，发生PE的女性孕早期PVI显著更低。PE和非PE妊娠中血管化指数的平均差异分别为：VI -2.93%（95%CI -5.84，-0.01），FR -2.83（95%CI -3.97，-1.69）和VFI -0.93（95%CI -1.6，-0.25）。虽然只有两项研究报告了敏感性和特异性数据，但VI和VFI最准确地预测了早发型PE，VFI预测了高危女性的PE。需要进一步研究以在不同研究人群中验证这些发现，并检验PVI在PE联合筛查模型中的表现。
