Zimmermann P, Kujansuu E, Tuimala R
Department of Obstetrics and Gynecology, University Hospital, Tampere, Finland.
J Perinat Med. 1994;22(2):137-47. doi: 10.1515/jpme.1994.22.2.137.
In forty-three pregnancies complicated by insulin-dependent diabetes mellitus, 16 classified White B, 11 White C, 8 White D and 8 White R or F, the resistance-index (PR index) in the main part of the uterine artery and arcuate uterine arteries was measured by duplex-pulsed wave Doppler ultrasound. Recordings of 24 hours' blood glucose profile and glycosylated hemoglobin were parameters of glycemic control. Vascular resistance in the main uterine artery decreased with proceeding gestation as a non-diabetic pregnancy. The uterine artery supplying the placental had lower resistance than the opposite side, with a mean PR index of 0.559 (SD 0.117) and 0.622 (SD 0.133), respectively. The mean difference between both sides was 0.062 (SD 0.102) (p < 0.001). The uterine artery PR index was slightly higher in the presence of evident morphological vasculopathy, with a mean PR index of 0.591 (SD 0.104) in White D*/R/F diabetics and 0.545 (SD 0.063) in White B/C/D#, respectively (p = 0.148). Additionally more than half of the diabetics without manifest complications (B/C/D#) showed a persistent notch. Long- and short-term glycemic control was unrelated to vascular resistance in the uterine artery, with correlation coefficients of 0.027 (p = 0.746) and 0.051 (p = 0.537) for glucose and HbA1C, respectively. Doppler velocimetry could not predict diabetic specific fetal mobidity. Vascular resistance in the uterine arcuate arteries was significantly lower in the subplacental region, with a mean PR index of 0.367 (SD 0.056) compared to 0.427 (SD 0.064) in areas distant to the placenta (p < 0.0005). It was not related to vasculopathy elsewhere.
in patients with diabetic vasculopathy the uterine artery is also affected, but there is no relationship with long- or short-term parameters of glycemic control. Doppler flow velocimetry of the uterine artery is a poor predictor of diabetes-specific fetal morbidity; if normal ranges of non-diabetic pregnancies are used for reference. Because of significantly different vascular resistance in the two main uterine arteries, mean values of both-side measurements should be used for analysis, whenever possible.
在43例合并胰岛素依赖型糖尿病的妊娠中，16例为White B级，11例为White C级，8例为White D级，8例为White R或F级，采用双功脉冲波多普勒超声测量子宫动脉主干和子宫弓形动脉的阻力指数（PR指数）。24小时血糖谱和糖化血红蛋白记录是血糖控制的参数。子宫动脉主干的血管阻力随孕周增加而降低，与非糖尿病妊娠情况相同。供应胎盘的子宫动脉阻力低于对侧，平均PR指数分别为0.559（标准差0.117）和0.622（标准差0.133）。两侧的平均差异为0.062（标准差0.102）（p<0.001）。在存在明显形态学血管病变时，子宫动脉PR指数略高，White D*/R/F糖尿病患者的平均PR指数为0.591（标准差0.104），White B/C/D#患者分别为0.545（标准差0.063）（p = 0.148）。此外，超过一半无明显并发症（B/C/D#）的糖尿病患者出现持续切迹。血糖的长期和短期控制与子宫动脉血管阻力无关，血糖和糖化血红蛋白的相关系数分别为0.027（p = 0.746）和0.051（p = 0.537）。多普勒测速无法预测糖尿病特异性胎儿发病率。胎盘下区域子宫弓形动脉的血管阻力显著低于远离胎盘区域，平均PR指数分别为0.367（标准差0.056）和0.427（标准差0.064）（p<0.0005）。它与其他部位的血管病变无关。
糖尿病血管病变患者的子宫动脉也会受到影响，但与血糖控制的长期或短期参数无关。子宫动脉多普勒血流测速对糖尿病特异性胎儿发病率的预测能力较差；若以非糖尿病妊娠的正常范围作为参考。由于两条子宫动脉主干的血管阻力存在显著差异，只要有可能，应使用两侧测量的平均值进行分析。
