【】目的? 探讨超声测量胎儿静脉导管血流动力学参数联合血清胎盘生长因子(PLGF)预测妊高症妊娠结局的价值。方法? 回顾性分析2022年4月至2023年4月在我院产检后诊断为妊高症的80例患者的临床资料,将其设为病例组,另选同期产检正常的100名孕妇作为对照组,比较两组胎儿静脉导管血流动力学参数[搏动指数(PI)、阻力指数(RI)、血流速度峰谷比(S/D)、静脉导管分流率]、血清PLGF水平及不良妊娠结局发生率。依据妊高症组的妊娠结局分为不良结局组(n=18)、结局良好组(n=62),比较两组基线资料、胎儿静脉导管血流动力学参数、PLGF水平,通过ROC分析胎儿静脉导管血流动力学参数及血清PLGF水平预测妊高症不良妊娠结局的价值。采用多因素Logistic回归分析妊高症不良妊娠结局的危险因素。结果? 病例组胎儿静脉导管血流动力学参数均高于对照组,血清PLGF水平低于对照组(P＜0.05)；病例组不良妊娠结局发生率高于对照组(P＜0.05)；不良结局组孕前体质量指数(BMI)、PI、RI、S/D、静脉导管分流率及年龄≥35岁人数占比均高于结局良好组(P＜0.05)；经ROC分析证实,胎儿静脉导管血流动力学参数及血清PLGF水平均可用于预测妊高症不良妊娠结局,曲线下面积分别为0.888、0.717、0.913、0.911、0.984、0.709,胎儿静脉导管血流动力学参数联合血清PLGF曲线下面积为0.957,均有P＜0.05；多因素Logistic回归分析证实,年龄[OR=1.357(95%CI:1.033~1.783)]、孕前BMI[OR=1.536(95%CI:1.118~2.110)]、PI[OR=1.797(95%CI:1.122~2.878)]、RI[OR=1.751(95%CI:1.121~2.735)]、S/D[OR=1.886(95%CI:1.075~3.309)]、静脉导管分流率[OR=1.967(95%CI:1.142~3.388)]、PLGF[OR=2.132(95%CI:1.176~3.865)]均为妊高症不良妊娠结局的危险因素(P＜0.05)。结论? 胎儿静脉导管血流动力学参数异常高表达、血清PLGF水平下降均于妊高症的发生与发展密切相关,以上指标可有效预测妊娠结局,且联合检测可获得更高敏感度及特异性。
【】Objective? To investigate the value of ultrasound measurement of fetal venous catheter hemodynamic parameters combined with serum placental growth factor (PLGF) in predicting pregnancy outcome of pregnancy-induced hypertension (PIH).Method? The clinical data of 80 patients diagnosed with pregnancy-induced hypertension after prenatal examination in our hospital from April 2022 to April 2023 were retrospectively analyzed, and they were set as case group, and 100 pregnant women with normal prenatal examination during the same period were selected as control group. The hemodynamic parameters (pulse index (PI), resistance index (RI), peak-to-valley ratio (S/D) of blood flow velocity, venous catheter flow rate), serum PLGF level and the incidence of adverse pregnancy outcomes were compared between the two groups. According to the pregnancy outcomes of pregnan-induced hypertension group, the two groups were divided into adverse outcome group (n=18) and good outcome group (n=62). Baseline data, fetal venous catheter hemodynamic parameters and PLGF levels of the two groups were compared, and the value of fetal venous catheter hemodynamic parameters and serum PLGF levels in predicting adverse pregnancy outcomes of pregnan-induced hypertension was analyzed by ROC. Multivariate Logistic regression was used to analyze the risk factors of pregnancy-induced hypertension.Result? The hemodynamic parameters of fetal venous catheter in case group were higher than those in control group, and the serum PLGF level was lower than that in control group (P < 0.05). The incidence of adverse pregnancy outcome in case group was higher than that in control group (P < 0.05). Prepregnancy body mass index (BMI) , PI, RI, S/D, venous catheter flow rate and the proportion of patients aged ≥35 years in the adverse outcome group were higher than those in the good outcome group (P < 0.05). ROC analysis confirmed that both fetal venous catheter hemodynamic parameters and serum PLGF level could be used to predict the adverse pregnancy outcome of pregnacy-induced hypertension, and the areas under the curve were 0.888, 0.717, 0.913, 0.911, 0.984, 0.709, respectively. The area under the curve of fetal venous catheter hemodynamic parameters combined with serum PLGF was 0.957 (P < 0.05). Multivariate Logistic regression analysis confirmed that age [OR=1.357 (95%CI: 1.033~1.783)], pre-pregnancy BMI[OR=1.536 (95%CI: 1.118~2.110)], PI[OR=1.797 (95%CI: 1.122~2.878)], RI[OR=1.751 (95%CI: 1.121~2.735)], S/D[OR=1.886 (95%CI: 1.075~3.309)], venous catheter flow rate [OR=1.967 (95%CI: 1.967) 1.142~3.388)] and PLGF[OR=2.132 (95%CI: 1.176~3.865)] are risk factors for pregnancy-induced hypertension (P < 0.05).Conclusion? Abnormally high expression of fetal venous catheter hemodynamic parameters and decreased serum PLGF level are closely related to the occurrence and development of pregnancy-induced hypertension. These indicators can effectively predict pregnancy outcome, and combined detection can obtain higher sensitivity and specificity.