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孕早期对胎盘同侧子宫动脉进行多普勒测速可提高预测早发型子痫前期的能力。

First trimester Doppler velocimetry of the uterine artery ipsilateral to the placenta improves ability to predict early-onset preeclampsia.

作者信息

Song Wen-Ling, Zhao Yan-Hui, Shi Shu-Jing, Liu Xian-Ying, Zheng Gui-Ying, Morosky Christopher, Jiao Yang, Wang Xiao-Jing

机构信息

Prenatal Diagnosis Center, the Second Hospital, Jilin University, Changchun, Jilin.

Heping Hospital affiliated to Changzhi Medical College, Changzhi, China.

出版信息

Medicine (Baltimore). 2019 Apr;98(16):e15193. doi: 10.1097/MD.0000000000015193.

Abstract

This study sought to investigate the effects of placental laterality on the measurements of uterine artery (UtA) Doppler velocimetry and their application in predicting early-onset preeclampsia (PE).We conducted a prospective cohort study on all women with singleton, uncomplicated pregnancies scheduled for first-trimester nuchal translucency at our institution. Pulsatility index (PI) for both UtAs was measured by Doppler velocimetry, and placental laterality was determined. Additionally, pregnancy outcome data were abstracted from the medical records. Receiver operating characteristic curves (ROCs) were plotted.Of the 304 patients enrolled, 247 met the inclusion criteria. Among these patients, 240 had uncomplicated delivery, while 7 had early delivery at <34 weeks due to PE. For the uncomplicated pregnancies, PI measurements of the UtA ipsilateral to the placenta were similar (left versus right UtA: 1.06 ± 0.38 vs. 1.04 ± 0.40; P = .745). However, PI measurements of the UtA contralateral to the placenta differed significantly (left versus right UtA: 1.45 ± 0.51 vs. 1.3 ± 0.47; P = .027). In predicting early-onset PE, the ideal cut-off value for the placental side PI was 1.91, with sensitivity 100% and specificity 96.3%. For nonplacental side PI, the ideal cut-off value for PI was 1.975, with sensitivity 57.1% and specificity 79.2%. Using the mean of the left and right UtA PI, the ideal cut-off value was 1.63, with sensitivity 100% and specificity 74.2%.ROC analysis confirmed that PI measurements of the UtA on the placental side were significantly lower than those on the contralateral side, PI measurements of the UtA ipsilateral to the placenta were similar.

摘要

本研究旨在探讨胎盘位置对子宫动脉(UtA)多普勒测速测量结果的影响及其在预测早发型子痫前期(PE)中的应用。我们对在本机构进行孕早期颈项透明带检查的所有单胎、无并发症妊娠妇女进行了一项前瞻性队列研究。通过多普勒测速测量双侧UtA的搏动指数(PI),并确定胎盘位置。此外,从医疗记录中提取妊娠结局数据。绘制了受试者工作特征曲线(ROC)。在纳入的304例患者中,247例符合纳入标准。在这些患者中,240例分娩顺利,7例因PE在<34周时早产。对于无并发症的妊娠,胎盘同侧UtA的PI测量值相似(左UtA与右UtA:1.06±0.38 vs. 1.04±0.40;P = 0.745)。然而,胎盘对侧UtA的PI测量值差异显著(左UtA与右UtA:1.45±0.51 vs. 1.3±0.47;P = 0.027)。在预测早发型PE时,胎盘侧PI的理想截断值为1.91,敏感性为100%,特异性为96.3%。对于非胎盘侧PI,PI的理想截断值为1.975,敏感性为57.1%,特异性为79.2%。使用左右UtA PI的平均值,理想截断值为1.63,敏感性为100%,特异性为74.2%。ROC分析证实,胎盘侧UtA的PI测量值显著低于对侧,胎盘同侧UtA的PI测量值相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bac1/6494271/a29bf1b642dc/medi-98-e15193-g002.jpg

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