糖尿病母亲胎儿心血管循环重塑：胎儿计算模型分析。

Remodeling of the cardiovascular circulation in fetuses of mothers with diabetes: A fetal computational model analysis.

机构信息

Division of Pediatric Cardiology, Bronx Lebanon Hospital Center, Bronx, NY, USA.

Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain; BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, CIBER-ER, University of Barcelona, Spain.

出版信息

Placenta. 2018 Mar;63:1-6. doi: 10.1016/j.placenta.2017.12.020. Epub 2018 Jan 4.

DOI:10.1016/j.placenta.2017.12.020

PMID:29486850

Abstract

AIMS

Myocardial structural and functional abnormalities are known to occur in fetuses of mothers with diabetes mellitus (FMDM). The main aim of this investigation was to explore the cardiovascular circulatory patterns in FMDM using a validated lumped computational model of the cardiovascular system.

METHODS

This was a multi-institutional study involving FMDM compared to fetuses of maternal controls (FC). Fetal echocardiographic Doppler data from left and right ventricular outflow tracts, aortic isthmus, middle cerebral and umbilical arteries were fitted into a validated fetal circulation computational model to estimate patient-specific placental and vascular properties. Non-parametric comparisons were made between resistances, compliances and flows in the brain and placenta in FMDM and FC.

RESULTS

Data from 23 FMDM and 31 FC were fitted into the model. In FMDM, compared to FC, placental relative resistance was lower (0.59 ± 0.50 versus 0.91 ± 0.41; p < .05) with higher brain relative resistance (2.36 ± 1.65 versus 1.60 ± 0.85; p < .05). Middle cerebral artery flow was lower in FMDM than FC (0.12 ± 0.14 vs. 0.27 ± 0.21 ml/min; p 0.04) with a lower cerebral-placental flow ratio. Combined stroke volume was lower in FMDM (3.65 ± 2.05 ml) than FC (4.97 ± 2.45 ml) (p 0.04).

CONCLUSIONS

Blood flow is redistributed in FMDM to the placenta, away from the brain. This alteration may play a role in the postnatal health of these fetuses.

摘要

目的

已知患有糖尿病的母亲（FMDM）的胎儿存在心肌结构和功能异常。本研究的主要目的是使用已验证的心血管系统集中计算模型来探索 FMDM 的心血管循环模式。

方法

这是一项多机构研究，比较了 FMDM 与母亲对照（FC）的胎儿。从左、右心室流出道、主动脉峡部、大脑中动脉和脐动脉获得胎儿超声心动图多普勒数据，并拟合到已验证的胎儿循环计算模型中，以估算患者特异性胎盘和血管特性。在 FMDM 和 FC 中，对大脑和胎盘的阻力、顺应性和流量进行了非参数比较。

结果

将 23 例 FMDM 和 31 例 FC 的数据拟合到模型中。与 FC 相比，FMDM 的胎盘相对阻力较低（0.59±0.50 与 0.91±0.41；p<.05），大脑相对阻力较高（2.36±1.65 与 1.60±0.85；p<.05）。与 FC 相比，FMDM 的大脑中动脉流量较低（0.12±0.14 与 0.27±0.21 ml/min；p=0.04），且大脑-胎盘血流比值较低。FMDM 的综合心排量较低（3.65±2.05 ml），FC 较高（4.97±2.45 ml）（p=0.04）。