子痫前期孕妇胎盘血流灌注指标预测胎盘早剥的价值及血流灌注指标与胎盘病理评分的相关性

Value of placental blood perfusion index in predicting placental abruption in pre-eclampsia pregnant women and correlation between blood perfusion index and placental pathological score

摘要:

目的 探讨子痫前期（PE）孕妇胎盘血流灌注指标预测胎盘早剥的价值及血流灌注指标与胎盘病理评分的相关性。方法 选取2019年5月—2022年8月南通市妇幼保健院收治的121例PE孕妇，其中轻度PE84例，重度PE37例。检测所有PE孕妇胎盘血流灌注三维能量多普勒超声指标，包括血管化指数（VI）、血流指数（FI）及血管化血流指数（VFI）。所有PE孕妇自入院起随访至胎儿娩出。比较轻度PE与重度PE胎盘VI、FI、VFI情况，多因素逐步Logistic回归分析PE胎盘早剥发生情况及影响PE发生胎盘早剥的因素，绘制受试者工作特征（ROC）曲线，分析胎盘VI、FI、VFI早期预测PE发生胎盘早剥的价值，比较不同病情胎盘早剥胎盘VI、FI、VFI情况，分析PE胎盘病理评分与胎盘VI、FI、VFI的相关性。结果 重度PEVI、FI及VFI低于轻度PE组（P <0.05）。121例PE孕妇中共有20例发生胎盘早剥。多因素Logistic逐步回归分析显示：血红蛋白［O^R=3.916（95% CI：1.611，9.516）］、产次≥ 3次［O^R=4.473（95% CI：1.840，10.870）］、VI［O^R=3.935（95% CI：1.619，9.564）］、FI［O^R=4.141（95% CI：1.704，10.065）］、VFI［O^R=4.276（95% CI：1.759，10.392）］是影响PE发生胎盘早剥的危险因素（P <0.05）。ROC曲线分析结果显示，VI、FI、VFI及三者联合预测PE发生胎盘早剥的敏感性分别为70.00%（95% CI：0.457，0.872）、75.00%（95% CI：0.506，0.904）、80.00%（95% CI：0.557，0.934）、70.00%（95% CI：0.457，0.872），特异性分别为75.25%（95% CI：0.655，0.831）、76.24%（95% CI：0.665，0.839）、79.21%（95% CI：0.698，0.864）、90.01%（95% CI：0.821，0.949），AUC分别为0.734（95% CI：0.639，0.828）、0.711（95% CI：0.599，0.822）、0.756（95% CI：0.651，0.860）、0.886（95% CI：0.817，0.956）。Ⅱ级胎盘早剥组VI、FI、VFI低于0级、I级胎盘早剥组（P <0.05），Ⅰ级胎盘早剥组VI、FI、VFI低于0级胎盘早剥组（P <0.05）。Pearson相关性分析显示，PE胎盘病理评分与胎盘VI、FI及VFI呈负相关（r =-0.612、-0.609和-0.638，均P <0.05）。结论 PE胎盘血流灌注指标VI、FI、VFI与胎盘早剥及其病情相关。VI、FI、VFI及三者联合预测PE发生胎盘早剥的效能良好。PE胎盘VI、FI、VFI与胎盘病理改变相关。

Abstract:

Objective To investigate the value of placental blood perfusion index in predicting placental abruption in pre-eclampsia pregnant women and the correlation between blood perfusion index and placental pathological score.Methods One hundred and twenty-one PE patients admitted to the hospital from May 2019 to August 2022 were selected, including 84 patients with mild PE and 37 patients with severe PE. The clinical data of placental tissue blood perfusion indexes such as vascularization index (VI), blood flow index (FI), and vascularization flow index (VFI) in all PE patients were collected. All PE patients were followed up from the start of hospitalization to delivery of the fetus. The VI, FI, and VFI of placental tissue of patients with mild PE and severe PE were compared. The occurrence of placental abruption in PE patients and the factors affecting the occurrence of placental abruption in PE patients were analyzed. The value of placental tissue VI, FI, and VFI levels in early prediction of placental abruption in PE patients was analyzed. The VI, FI, and VFI of placental tissue in patients with placental abruption in different conditions were compared. The correlation between the placental histopathological score of PE patients and the levels of VI, FI, and VFI in placental tissue was analyzed.Results The levels of VI, FI, and VFI in patients with severe PE were lower than those in the group with mild PE (P < 0.05). A total of 20 of the 121 PE patients had placental abruption. Logistic multivariate regression analysis showed: hemoglobin [O^R = 3.916, (95% CI: 1.611, 9.516) ], parity ≥ 3 times [O^R= 4.473, (95% CI: 1.840, 10.870) ], VI levels [O^R = 3.935, (95% CI: 1.619, 9.564) ], FI levels [O^R = 4.141, (95% CI: 1.704, 10.065) ], and VFI levels [O^R= 4.276, (95% CI: 1.759, 10.392) ] were risk factors affecting the occurrence of placental abruption in PE patients (P < 0.05). The ROC curve results showed that the sensitivity of VI, FI, VFI, and their combination in predicting the occurrence of placental abruption in PE patients was 70.00% (95% CI: 0.457, 0.872), 75.00% (95% CI: 0.506, 0.904), 80.00% (95% CI: 0.557, 0.934), and 70.00% (95% CI: 0.457, 0.872), respectively; the specificity was 75.25% (95% CI: 0.655, 0.831), 76.24 % (95% CI: 0.665, 0.839), 79.21% (95% CI: 0.698, 0.864), and 90.01% (95% CI: 0.821, 0.949) , respectively; AUC were 0.734 (95% CI: 0.639, 0.828), 0.711 (95% CI: 0.599, 0.822), 0.756 (95% CI: 0.651, 0.860), and 0.886 (95% CI: 0.817, 0.956), respectively. The levels of VI, FI, and VFI in grade Ⅱ placental abruption group were lower than those in grade 0 and grade I placental abruption group (P < 0.05), while the levels of VI, FI and VFI in grade I placental abruption group were lower than those in grade 0 placental abruption group (P < 0.05). Pearson correlation analysis showed that placental pathological score was negatively correlated with placental VI level (r = -0.612), FI level (r = -0.609) and VFI level (r = -0.638) in PE patients (P < 0.05).Conclusion The blood perfusion indexes VI, FI, and VFI of the placental tissue of PE patients are related to placental abruption and its condition. The combination of VI, FI, and VFI has a good effect on predicting the occurrence of placental abruption in PE patients. The placental tissue VI, FI, and VFI of PE patients are related to the pathological changes of the placenta.