超声多参数评估妊娠期高血压疾病对胎儿心脏功能的影响

Multiparameter ultrasonic evaluation of the effects of hypertensive disorders of pregnancy on fetal cardiac function

摘要:

目的 探讨超声多参数评估妊娠期高血压疾病（HDP）对胎儿心脏功能的影响。方法 选取2019年2月—2021年1月本溪市中心医院收治的131例HDP患者，其中75例为妊娠期高血压（妊娠期高血压组），56例为子痫前期（子痫前期组）。另选取同期该院行超声检查的72例正常单胎妊娠孕妇作为对照组。对所有受试者进行胎儿超声心动图检查，获取血流动力学和心功能参数。结果 各组受试者年龄、受检时孕周比较，差异无统计学意义（P >0.05）。妊娠期高血压组和子痫前期组收缩压、舒张压、24 h尿蛋白定量高于对照组（P <0.05），子痫前期组高于妊娠期高血压组（P <0.05）。妊娠期高血压组和子痫前期组UA、DV、PV的PI和RI指数均高于对照组（P <0.05），AoI的PI和RI指数低于对照组（P <0.05）；子痫前期组UA、DV、PV的PI和RI指数高于妊娠期高血压组（P <0.05），AoI的PI和RI指数低于妊娠期高血压组（P <0.05）。妊娠期高血压组和子痫前期组左心室和右心室IVCT、IVRT长于对照组（P <0.05），MPI高于对照组（P <0.05），二尖瓣和三尖瓣E、E/A低于对照组（P <0.05），子痫前期组左心室和右心室IVCT、IVRT长于妊娠期高血压组（P <0.05），MPI高于妊娠期高血压组（P <0.05），二尖瓣和三尖瓣E、E/A低于妊娠期高血压组（P <0.05）。HDP患者UA、DV、PV的PI和RI与收缩压呈正相关（r =0.762、0.801、0.792、0.740、0.759和0.763，均P <0.05），左心室IVCT、右心室IVCT、左心室IVRT、右心室IVRT、左心室MPI、右心室MPI与收缩压呈正相关（r =0.749、0.748、0.752、0.749、0.839和0.802，均P <0.05）。AoI的PI和RI指数与收缩压呈负相关（r =-0.841和-0.802，均P <0.05），二尖瓣E、二尖瓣E/A、三尖瓣E、三尖瓣E/A与收缩压呈负相关（r =-0.785、-0.802、-0.773和-0.815，均P <0.05），其他指标与收缩压、舒张压和24 h尿蛋白定量无相关（P >0.05）。结论 HDP可影响胎儿心功能，且随着病情进展，对心功能损害越大。超声多参数可准确检测胎儿心功能且改变血流动力学，为临床评估HDP胎儿心功能提供重要信息。

Abstract:

Objective To evaluate the effects of hypertensive disorders of pregnancy (HDP) on fetal cardiac function using multiple parameters measured via ultrasound.Methods A total of 131 patients with HDP admitted to our hospital from February 2019 to January 2021 were selected, including 75 patients with gestational hypertension (gestational hypertension group), 56 patients with preeclampsia (preeclampsia group), and 72 healthy women with singleton pregnancy as control group. Fetal echocardiography was performed on all subjects to obtain hemodynamic and cardiac function parameters.Results The age and gestational age when undergoing examinations of the pregnant women were not different among the groups (P > 0.05). The systolic blood pressure, diastolic blood pressure, and the level of 24-hour urine protein were higher in the gestational hypertension group and preeclampsia group than in the control group, and were even greater in the preeclampsia group compared with the gestational hypertension group (P < 0.05). The resistance index (RI) and pulse index (PI) of fetal umbilical artery (UA), pulmonary vein (PV) and ductus venosus (DV) were higher, while those of aortic isthmus (AOI) were lower in the gestational hypertension group and preeclampsia group compared with the control group (P < 0.05). In comparison to the gestational hypertension group, RI and PI of UA, PV and DV were higher yet those of AOI were lower in the preeclampsia group (P < 0.05). Across the groups, the isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT) were shortest in the control group and longest in the preeclampsia group (P < 0.05), while myocardial performance index (MPI) was lowest in the control group and highest in the preeclampsia group (P < 0.05). Besides, the E-wave and the ratio between E-wave and A-wave (E/A ratio) of the mitral and tricuspid valves were lowest in the preeclampsia group and highest in the control group (P < 0.05). Correlation analysis showed that PI and RI of UA, DV and PV (r = 0.762, 0.801, 0.792, 0.740, 0.759 and 0.763, all P < 0.05), as well as IVCT, IVRT and MPI of left and right ventricles (r = 0.749, 0.748, 0.752, 0.749, 0.839 and 0.802, all P < 0.05) were all positively correlated with systolic blood pressure. On the contrary, the PI and RI of AOI (r = -0.841 and -0.802, both P < 0.05), as well as E-wave and E/A ratio of mitral and tricuspid valves (r = -0.785, -0.802, -0.773 and -0.815, all P < 0.05) were negatively correlated with systolic blood pressure. Other parameters were not correlated with systolic blood pressure, diastolic blood pressure or the level of 24-hour urine protein (P >0.05).Conclusions HDP can affect fetal cardiac function, and the damage to cardiac function becomes severer with the progression of the disease. Multiple parameters measured via ultrasound can accurately detect fetal cardiac function and hemodynamic changes, and therefore provide important information for clinical evaluation of fetal cardiac function in pregnant women with HDP.