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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (11) : 1109 -1114. doi: 10.3877/cma.j.issn.1674-0785.2022.11.013

临床研究

子宫动脉搏动指数、外周血胎儿血红蛋白及胎盘生长因子水平与早发型子痫前期再次妊娠结局的关系
宋海红1, 黎娉1, 陈鲜霞1,†()   
  1. 1. 810000　西宁，青海省人民医院超声科
  • 收稿日期:2021-10-15 出版日期:2022-11-15
  • 通信作者: 陈鲜霞

Relationship of uterine arterial pulsatility index, peripheral blood fetal hemoglobin, and placental growth factor level with outcome of early-onset preeclampsia re-pregnancy

Haihong Song1, Ping Li1, Xianxia Chen1,†()   

  1. 1. Department of Ultrasound, Qinghai Provincial People's Hospital, Xining 810000, China
  • Received:2021-10-15 Published:2022-11-15
  • Corresponding author: Xianxia Chen
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宋海红, 黎娉, 陈鲜霞. 子宫动脉搏动指数、外周血胎儿血红蛋白及胎盘生长因子水平与早发型子痫前期再次妊娠结局的关系[J/OL]. 中华临床医师杂志(电子版), 2022, 16(11): 1109-1114.

Haihong Song, Ping Li, Xianxia Chen. Relationship of uterine arterial pulsatility index, peripheral blood fetal hemoglobin, and placental growth factor level with outcome of early-onset preeclampsia re-pregnancy[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(11): 1109-1114.

目的

探讨子宫动脉搏动指数（PI）值、外周血胎儿血红蛋白（HbF）及胎盘生长因子（PIGF）与早发型子痫前期（E-PE）再次妊娠产妇妊娠结局的关系。

方法

回顾性收集2017年1月至2019年12月在青海省人民医院完成分娩及随访的81例E-PE再次妊娠产妇的临床资料。患者年龄（29.23±2.06）岁（25~35岁），均在孕13周接受小剂量阿司匹林干预。于治疗前1 d检测超声子宫动脉PI、外周血HbF及PIGF水平；记录妊娠结局并根据妊娠结局分为妊娠不良组和正常组；分析超声子宫动脉PI、外周血HbF及PIGF水平与不良妊娠结局的关系。

结果

81例产妇，发生不良妊娠结局19例（23.46%）。经单因素与多项Logistic回归分析结果显示，2-ME下降（OR=1.062，95%CI：1.019~1.107）、PIGF水平异常下降（OR=95.972，95%CI：11.617~792.873）、超声子宫动脉PI升高（OR=1.342，95%CI：1.160~1.552）、外周血HbF水平升高（OR=1.210，95%CI：1.087~1.347）是E-PE再次妊娠产妇不良妊娠结局的影响因素（均P＜0.05），且以PIGF、超声子宫动脉PI、外周血HbF表达异常的影响较显著，可能是独立危险因素。绘制受试者工作特征（ROC）曲线发现，超声子宫动脉PI、外周血HbF、PIGF预测E-PE再次妊娠产妇不良妊娠结局风险的曲线下面积（AUC）分别为0.852（95%CI：0.753~0.951）、0.916（95%CI：0.852~0.980）、0.805（95%CI：0.696~0.915），有一定预测价值。

结论

E-PE再次妊娠产妇若有子宫动脉PI显著升高、外周血HbF高表达、PIGF低表达的情况，可能提示不良妊娠结局风险。

关键词: 妊娠, 早发型子痫前期再次妊娠, 子宫动脉搏动指数, 外周胎儿血红蛋白, 胎盘生长因子, 妊娠结局
Objective

To explore the relationship of ultrasound uterine arterial pulsatility index (PI), peripheral blood fetal hemoglobin (HbF), and placental growth factor (PIGF) with outcome of early-onset preeclampsia (E-PE) re-pregnancy.

Methods

The clinical data of 81 E-PE pregnant women who had a delivery and were followed at Qinghai Provincial People's Hospital from January 2017 to December 2019 were retrospective analyzed. The patients were (29.23±2.06) years old (25-35 years) and received low-dose aspirin intervention at 13 weeks of gestation. The PI value of the uterine artery as well as the levels of HbF and PIGF in peripheral blood was measured 1 day before treatment. The pregnancy outcome was recorded and the patients were divided into either a poor pregnancy group or a normal group according to the pregnancy outcome. The relationship of PI value of the uterine artery and peripheral blood HbF and PIGF levels with adverse pregnancy outcome was analyzed.

Results

Among the 81 parturients, 19 (23.46%) had adverse pregnancy outcomes. The results of univariate and multivariate logistic regression analysis showed that the decrease of 2-methoxyestradiol (odds ratio [OR]=1.062, 95% confidence interval [CI]: 1.019-1.107), abnormal decrease of PIGF level (OR=95.972, 95%CI: 11.617-792.873), increase of PI value of the uterine artery (OR=1.342, 95%CI: 1.160-1.552), and increase of HbF in peripheral blood (OR=1.210, 95%CI: 1.087-1.347) were factors resulting in adverse pregnancy outcomes in pregnant women with E-PE (P＜0.05 for all). PIGF, PI value of the uterine artery, and abnormal expression of HbF in peripheral blood had significant effects, which might be independent risk factors. Receiver operating characteristic curve analysis showed that the area under the curve of PI value of the uterine artery, peripheral blood HbF, and PIGF in predicting the risk of adverse pregnancy outcome in E-PE pregnant women was 0.852 (95%CI: 0.753-0.951), 0.916 (95%CI: 0.852-0.980), and 0.805 (95%CI: 0.696-0.915), respectively, which had appreciated predictive value.

Conclusion

In patients with E-PE re-pregnancy, increased PI value of the uterine artery, high peripheral blood HbF expression, and low PIGF expression may indicate the risk of adverse pregnancy outcomes.

Key words: Pregnancy, Early preeclampsia re-pregnancy, Uterine arterial pulsatility index, Peripheral fetal hemoglobin, Placental growth factor, Pregnancy outcome
图1 早发型子痫前期（E-PE）再次妊娠产妇彩色多普勒超声子宫动脉搏动指数（PI）检查结果 1A：2.59；1B：1.71；1C：0.84；1D：0.84
表1 早发型子痫前期（E-PE）再次妊娠产妇不良妊娠结局影响因素的单因素分析（
xˉ
±s）
项目 不良妊娠结局组（n=19） 妊娠结局正常组（n=62） t值 P值
年龄（岁） 29.10±2.05 29.03±2.01 0.132 0.895
孕前BMI（kg/m2） 22.31±2.07 22.29±2.10 0.036 0.971
分娩时孕周（周） 39.18±0.59 39.20±0.57 0.133 0.895
总胆固醇（mmol/L） 5.28±1.57 5.30±1.54 0.049 0.961
2-ME（ng/L） 534.12±11.89 550.76±12.30 5.198 ＜0.001
超声子宫动脉PI 1.72±0.31 1.07±0.28 6.634 ＜0.001
外周血HbF（mg/L） 105.46±5.87 82.05±5.36 16.290 ＜0.001
PIGF（ng/L） 158.52±6.61 245.33±6.29 53.423 ＜0.001
表2 早发型子痫前期（E-PE）再次妊娠产妇不良妊娠结局影响因素多因素多项logistic回归分析结果
变量 B值 标准误 Wald χ2值 OR值（95%CI） P值
2-ME 0.060 0.021 8.104 1.062（1.019~1.107） 0.004
超声子宫动脉PI 4.564 1.077 17.946 95.972（11.617~792.873） ＜0.001
外周血HbF 0.294 0.074 15.711 1.342（1.160~1.552） ＜0.001
PIGF 0.191 0.055 12.128 1.210（1.087~1.347） ＜0.001
表3 治疗前1 d超声子宫动脉PI、外周血HbF及PIGF水平预测E-PE再次妊娠产妇不良妊娠结局的价值分析
项目 AUC 95%CI P值 最佳截断值 灵敏度 特异度 约登指数
超声子宫动脉PI 0.852 0.753~0.951 ＜0.001 0.965 0.951 0.500 0.451
外周血HbF 0.916 0.852~0.980 ＜0.001 94.495 mg/L 0.947 0.569 0.516
PIGF 0.805 0.696~0.915 ＜0.001 172.060 ng/L 0.984 0.840 0.824
图2 治疗前1 d 超声子宫动脉PI、外周血HbF、PIGF水平预测E-PE再次妊娠产妇不良妊娠结局风险的受试者工作特征曲线注：PI为动脉搏动指数；HbF为外周血胎儿血红蛋白；PIGF为胎盘生长因子；E-PE为早发型子痫前期
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