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预测妊娠期高血压疾病患者妊娠结局的价值

Value of hemodynamic parameters of fetal ductus venosus measured via ultrasound combined with serum PLGF in predicting pregnancy outcome of patients with hypertensive disorders of pregnancy

摘要:

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）预测妊娠期高血压疾病（HDP）患者妊娠结局的价值。方法 回顾性分析2022年4月—2023年4月在承德市中心医院产检诊断为HDP的80例患者的临床资料，将其作为研究组。另取同期该院健康产检孕妇100例作为对照组。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。根据HDP患者妊娠结局分为不良结局组（18例）、结局良好组（62例）。比较两组基线资料、胎儿静脉导管血流动力学参数、PLGF水平，绘制受试者工作特征（ROC）曲线分析胎儿静脉导管血流动力学参数及血清PLGF水平预测HDP患者不良妊娠结局的价值，采用多因素逐步Logistic回归模型分析HDP患者不良妊娠结局的危险因素。结果 研究组胎儿静脉导管血流动力学参数（PI、RI、S/D、静脉导管分流率）均高于对照组（P <0.05），血清PLGF水平低于对照组（P <0.05）。研究组不良妊娠结局发生率高于对照组（P <0.05）。不良结局组年龄≥ 35岁占比、孕前BMI、PI、RI、S/D、静脉导管分流率均高于良好结局组（P <0.05），血清PLGF水平低于良好结局组（P <0.05）。ROC曲线分析结果显示，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HDP患者不良妊娠结局。孕前BMI、PI、RI、S/D、静脉导管分流率、血清PLGF水平及其联合预测HDP患者不良妊娠结局的敏感性分别为77.8%（95% CI：0.713，0.854）、83.3%（95% CI：0.682，0.951）、83.3%（95% CI：0.813，0.927）、94.4%（95% CI：0.847，0.952）、94.4%（95% CI：0.907，0.983）、72.2%（95% CI：0.682，0.841）、94.4%（95% CI：0.921，0.965），特异性分别为85.5%（95% CI：0.690，0.873）、54.8%（95% CI：0.522，0.764）、91.2%（95% CI：0.871，0.925）、75.8%（95% CI：0.723，0.862）、91.8%（95% CI：0.857，0.931）、93.6%（95% CI：0.748，0.964）、95.2%（95% CI：0.917，0.980）。多因素逐步Logistic回归分析结果显示，年龄［O^R=1.357（95% CI：1.033，1.783）］、孕前BMI ［O^R=1.536（95% CI：1.118，2.110）］、PI ［O^R=1.797（95% CI：1.122，2.878）］、RI ［O^R=1.751（95% CI：1.121，2.735）］、S/D ［O^R=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 ［O^R=2.132（95% CI：1.176，3.865）］均为HDP患者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水平下降均与HDP发生、发展关系密切，以上指标可有效预测妊娠结局，且联合检测价值更高。

Abstract:

Objective To investigate the value of hemodynamic parameters of fetal ductus venosus measured via ultrasound combined with serum placental growth factor (PLGF) in predicting pregnancy outcome of patients with hypertensive disorders of pregnancy (HDP).Methods The clinical data of 80 patients diagnosed with HDP during prenatal examination in our hospital from April 2022 to April 2023 were retrospectively analyzed, and they were set as the case group. Another 100 healthy pregnant women undergoing prenatal examination during the same period were selected as the control group. The hemodynamic parameters [pulse index (PI), resistance index (RI), ratio of systolic to diastolic peak flow velocity (S/D), ductus venosus shunt rate], the serum level of PLGF and the incidence of adverse pregnancy outcomes were compared between the two groups. According to the pregnancy outcomes, HDP patients were divided into adverse outcome group (n = 18) and good outcome group (n = 62). The baseline data, hemodynamic parameters of fetal ductus venosus and PLGF levels of the two groups were compared, and the value of hemodynamic parameters of fetal ductus venosus and serum levels of PLGF in predicting adverse pregnancy outcomes of HDP patients was analyzed by the receiver operating characteristic (ROC) curve. Multivariable Logistic regression analysis was used to determine the risk factors for adverse pregnancy outcomes among HDP patients.Results The hemodynamic parameters of fetal ductus venosus including PI, RI, S/D and the ductus venosus shunt rate in the case group were higher than those in the control group (P < 0.05), and the serum level of PLGF in the case group was lower than that in the control group (P < 0.05). The incidence of adverse pregnancy outcomes in the case group was higher than that in the control group (P < 0.05). The proportion of patients with age ≥ 35 years old, pre-pregnancy body mass index (BMI), PI, RI, S/D, and the ductus venosus shunt rate in the adverse outcome group were higher than those in the good outcome group (P < 0.05). The ROC curve analysis revealed that both hemodynamic parameters of fetal ductus venosus and the serum level of PLGF could be used to predict the adverse pregnancy outcome of HDP patients. The sensitivities of pre-pregnancy BMI, PI, RI, S/D, the ductus venosus shunt rate, the serum level of PLGF and their combined detection for predicting adverse pregnancy outcomes of HDP patients were 77.8% (95% CI: 0.713, 0.854), 83.3% (95% CI: 0.682, 0.951), 83.3% (95% CI: 0.813, 0.927), 94.4% (95% CI: 0.847, 0.952), 94.4% (95% CI: 0.907, 0.983), 72.2% (95% CI: 0.682, 0.841), and 94.4% (95% CI: 0.921, 0.965), with the specificities being 85.5% (95% CI: 0.690, 0.873), 54.8% (95% CI: 0.522, 0.764), 91.2% (95% CI: 0.871, 0.925), 75.8% (95% CI: 0.723, 0.862), 91.8% (95% CI: 0.857, 0.931), 93.6% (95% CI: 0.748, 0.964), and 95.2% (95% CI: 0.917, 0.980). Multivariable Logistic regression analysis demonstrated that age [O^R = 1.357 (95% CI: 1.033, 1.783) ], pre-pregnancy BMI [O^R = 1.536 (95% CI: 1.118, 2.110) ], PI [O^R = 1.797 (95% CI: 1.122, 2.878) ], RI [O^R = 1.751 (95% CI: 1.121, 2.735) ], S/D [O^R = 1.886 (95% CI: 1.075, 3.309) ], ductus venosus shunt rate [O^R = 1.967 (95% CI: 1.142, 3.388) ] and PLGF [O^R = 2.132 (95% CI: 1.176, 3.865) ] were factors contributing to the adverse pregnancy outcome in HDP patients (P < 0.05).Conclusions Abnormally high values of hemodynamic parameters of fetal ductus venosus and decreased serum level of PLGF are closely related to the occurrence and development of HDP. These indicators effectively predict the pregnancy outcome, and their combined detection yields higher sensitivity and specificity.