2020 年第 11 期 第 15 卷

大脑中动脉与静脉导管血流指数联合随机尿蛋白/肌酐比值预测妊娠高血压孕妇胎儿宫内缺氧的价值

The value of middle cerebral artery and ductus venosus blood flow index combined with random urine albumin/creatinine ratio on predicting fetus intrauterine hypoxia in pregnant woman with gestational hypertension

作者：孟菲杨柳杨娜赵亚宁贾健

英文作者：Meng Fei Yang Liu Yang Na Zhao Yaning Jia Jian

单位：陕西中医药大学第二附属医院产科，陕西省咸阳市，712000

英文单位：Department of Obstetrical the Second Affiliated Hospital of Shaanxi University of Chinese Medicine Shaanxi Province Xianyang 712000 China

关键词：妊娠高血压；超声；胎儿宫内缺氧；尿蛋白；肌酐

英文关键词：Gestationalhypertension;Ultrasound;Fetusintrauterinehypoxia;Urinealbumin;

• 摘要：

• 目的 探讨大脑中动脉（MCA）和静脉导管血流指数联合随机尿蛋白/肌酐比值（ACR）预测妊娠高血压孕妇胎儿宫内缺氧的价值。方法 收集2018年1—12月陕西中医药大学第二附属医院收治的145例妊娠高血压患者的临床资料，根据胎儿宫内缺氧诊断标准分为宫内缺氧组（29例）和非缺氧组（116例）。2组均使用彩色多普勒超声诊断仪测定胎儿MCA的搏动指数、阻力指数、收缩期最大血流速度与舒张期血流速度比值（S/D）和静脉导管的静脉搏动指数、静脉峰值流速指数，并于超声检查当日检测孕妇尿蛋白与肌酐水平，计算ACR。比较2组多普勒超声MCA、静脉导管血流指数和ACR，分析MCA、静脉导管、ACR单独检测以及联合检测诊断胎儿宫内缺氧的敏感度、特异度和准确度。绘制受试者工作特征（ROC）曲线分析不同方法对妊娠高血压孕妇胎儿宫内缺氧的预测价值。结果 宫内缺氧组胎儿MCA的搏动指数、阻力指数、S/D低于非缺氧组，静脉导管的静脉搏动指数、静脉峰值流速指数和ACR高于非缺氧组，差异均有统计学意义（均P＜0.05）。联合检测预测胎儿宫内缺氧的敏感度、准确度分别为93.10%、83.45%，均高于MCA检测、静脉导管检测及ACR检测(均P<0.05)。MCA检测、静脉导管检测、ACR检测、联合检测的ROC曲线下面积分别为0.703(95%置信区间：0.579～0.828)、0.674(95%置信区间：0.558～0.790)、0.614(95%置信区间：0.472～0.756)、0.815(95%置信区间：0.747～0.922)，联合检测的ROC曲线下面积显著高于单一检测，差异均有统计学意义(均P<0.05）。结论 MCA、静脉导管血流指数联合ACR对妊娠高血压孕妇发生胎儿宫内缺氧具有较高的预测价值。

• Objective To investigate the value of middle cerebral artery(MCA), ductus venosus (DV) blood flow index combined with random urine albumin/creatinine ratio(ACR) on predicting fetus intrauterine hypoxia in pregnant women with gestational hypertension. Methods A total of 145 patients with gestational hypertension admitted to the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from January to December 2018 were divided into intrauterine hypoxia group(29 cases) and non-hypoxia group(116 cases), according to the diagnostic criteria of fetus intrauterine hypoxia. The fetal MCA pulsation index(PI), MCA resistance index(RI), MCA ratio of systolic maximum blood flow velocity to diastolic blood flow velocity(S/D), DV pulsatility index of venous(PIV), DV peak velocity index of vein(PVIV) were measured by color Doppler ultrasound, the levels of albumin and creatinine were measured and ACR was calculated. The Doppler ultrasound MCA, DV blood flow index and ACR were compared between the two groups, and the sensitivity, specificity and accuracy alone and jointly in the diagnosis of fetal intrauterine hypoxia were analyzed. The receiver operating characteristic(ROC) curve was drawn to analyze the predicting value of different detections in fetus intrauterine hypoxia in pregnant women with gestational hypertension. Results The MCA PI, MCA RI and MCA S/D of the intrauterine hypoxia group were lower than those in the non-hypoxia group; DV PIV, DV PVIV and ACR were higher than those in the non-hypoxia group(all P<0.05). The sensitivity and accuracy of the combined detection were 93.10% and 83.45%,which were higher than MCA, DV detection and ACR detection(all P<0.05). The areas under the ROC curve of MCA, DV, ACR and combined detection were 0.703［95% confidence interval(CI): 0.579-0.828］, 0.674(95%CI: 0.558-0.790), 0.614(95%CI: 0.472-0.756), 0.815(95%CI: 0.747-0.922), respectively. The area under the ROC curve of combined detection was significantly higher than that of single test(all P<0.05). ConclusionMCA, DV blood flow index combined with ACR may predict fetus intrauterine hypoxia in pregnant women with gestational hypertension.