妊娠高血压综合征患者分娩前后 血管内皮功能的高频超声研究

High-frequency ultrasound study of vascular endothelial function before and after delivery for patients with PIH

摘要:

目的 研究妊娠高血压综合征（PIH）患者分娩前后肱动脉内皮依赖性血管舒张功能变化。方法 高 频超声检测146 例PIH 患者（研究组）分娩前（孕28 ～ 40 周）、分娩后6 周右侧肱动脉血管内皮功能，对照组为 100 例健康生育期妇女。测量静息状态下右侧肱动脉内径（D1）、血流量（Q1）以及反应性充血后内径（D2）、 血流量（Q2）；计算内径变化率（△ D%）、血流量变化率（△ Q%）。结果 研究组分娩前、分娩后6 周肱动脉 △ D% 及△ Q% 与对照组比较，差异有统计学意义（P <0.05），研究组均低于对照组；研究组分娩前与分娩后 6 周肱动脉△ D% 及△ Q% 比较，差异无统计学意义（P >0.05）；分娩前、分娩后6 周妊娠期高血压组与轻度 子痫前期组肱动脉△ D% 及△ Q% 比较，差异无统计学意义（P >0.05），两组肱动脉△ D% 及△ Q% 与重度子 痫前期组比较，差异有统计学意义（P <0.05），均低于重度子痫前期组。结论 PIH 患者分娩前即存在内皮依 赖性血管舒张功能受损，并至少持续至分娩后6 周无改善和恢复；重度子痫前期患者分娩前后血管内皮功能 受损程度均重于妊娠期高血压及轻度子痫前期患者。

关键词:妊娠高血压综合征;内皮依赖性血管舒张功能;分娩

Abstract:

Objective To study the changes of endothelium-dependent vasodilatation in brachial artery before and after delivery in patients with pregnancy-induced hypertension (PIH). Methods High-frequency ultrasonography was used to detect the right brachial artery endothelial function in 146 PIH patients before delivery (28-40 weeks of gestation) and 6 weeks after delivery, the control group was 100 healthy women. The internal diameter and blood flow of right brachial artery at rest (D1 and Q1) and after reactive hyperemia (D2 and Q2) were measured; and the change rate of internal diameter ( △ D%) and the change rate of blood flow ( △ Q%) were calculated. Results The brachial artery △ D% and △ Q% of the PIH patients were lower than those of the control group before delivery and 6 weeks after delivery (P < 0.05). In the PIH patients, there was no significant difference in brachial artery △ D% or △ Q% before delivery and 6 weeks after delivery (P > 0.05). Before delivery and 6 weeks after delivery, there was no significant difference in brachial artery △ D% or △ Q% between the PIH group and the mild preeclampsia group (P > 0.05). The △ D% and △ Q% of brachial artery in the PIH and the mild preeclampsia groups were lower than those in the severe preeclampsia group (P < 0.05). Conclusions In PIH patients there is endothelium-dependent vasodilatation damage before delivery, and there is no improvement or recovery at least 6 weeks after delivery. And the vascular endothelial dysfunction in severe preeclampsia patients before and after delivery are more severe than gestational hypertension and mild preeclampsia patients.

Key words:pregnancy-induced hypertension; endothelium-dependent vasodilatation; delivery