基于3D-CPA诊断妊娠高血压孕妇胎儿宫内缺氧的研究

doi:10.7517/issn.1674-0475.210925

摘要/Abstract

摘要： 本文探讨妊高征孕妇胎儿宫内缺氧与三维能量多普勒技术(3D-CPA)技术检测的颅脑、胎盘参数改变的关系。选取确诊的100例妊娠高血压孕妇作为病例组、同期100例正常妊娠的孕妇作为对照组。采用3D-CPA检查两组胎儿颅脑、胎盘血流灌注参数,并检测两组胎儿分娩后的脐带血中氧化应激产物水平,分析3D-CPA参数与氧化应激产物的相关性。结果显示,病例组胎盘组织中的血管指数(VI)、血流指数(FI)、血管血流指数(VFI)测定值显著低于对照组(P<0.05);病例组胎儿颅脑的VI、FI、VFI测定值显著大于对照组(P<0.05);子痫前期组胎盘组织中的VI、FI、VFI测定值显著低于妊娠高血压疾病组(P<0.05);子痫前期组胎儿颅脑的VI、FI、VFI测定值显著大于妊娠高血压疾病组(P<0.05);病例组的脐血中丙二醛(MDA)、8-异前列腺素(8-iso)、氧化低密度脂蛋白(ox-LDL)、热休克蛋白-70(HSP-70)水平显著高于对照组(P<0.05);妊高征患者胎盘组织中的VI、VFI与脐血中MDA、ox-LDL、8-iso、HSP-70水平呈显著负相关关系(P<0.05),FI值与ox-LDL、8-iso、HSP-70水平呈显著负相关关系(P<0.05)。妊高征组胎儿颅脑的VI与脐血中MDA、8-iso、HSP-70呈显著正相关关系(P<0.05),VFI与脐血中8-iso、HSP-70水平呈显著正相关关系(P<0.05)。因此,3D-CPA检查可发现妊高征孕妇胎儿胎盘血流参数水平降低,颅脑血流参数代偿性增加,并且与宫内缺氧有关。

关键词: 妊娠高血压疾病, 胎儿, 宫内缺氧, 三维能量多普勒技术, 氧化应激

Abstract: This article explored the relationship between intrauterine hypoxia in pregnant women with pregnancy-induced hypertension and the changes in brain and placental parameters detected by three-dimensional power Doppler (3D-CPA). One hundred confirmed pregnant women with hypertension during pregnancy were selected as the case group, and 100 pregnant women with normal pregnancy in the same period were selected as the control group. 3D-CPA was used to examine the fetal brain and placental blood perfusion parameters of the two groups, and the two groups of fetal delivery were detected after the level of oxidative stress products in cord blood, the correlation between 3D-CPA parameters and oxidative stress products was analyzed. The blood vessel index (VI), blood flow index (FI), and vascular blood flow index (VFI) measured values in the placenta tissue of the case group were lower than those of the control group (P<0.05). VI, FI, VFI measured value in the fetal brain of the case 280 group was greater than that of the control group (P<0.05). The measured values of VI, FI, and VFI in the placental tissue of the preeclampsia group were lower than those of the hypertensive disorder group during pregnancy (P<0.05). The measured values of FI, VFI and VI in the fetal brain of the preeclampsia group were greater than those of the hypertensive disease group during pregnancy (P<0.05). The cord blood of the case group contained malondialdehyde (MDA), 8-isoprostaglandin (8-iso), Oxidized low-density lipoprotein (ox-LDL) and heat shock protein-70 (HSP-70) were significantly higher than those of the control group (P<0.05). The VI and VFI in the placenta tissue of patients with pregnancy-induced hypertension were significantly negatively correlated with the levels of MDA, ox-LDL, 8-iso, and HSP-70 in the patient’s cord blood (P<0.05), and FI was significantly negatively correlated with ox-LDL, 8-ISO and HSP-70 (P<0.05). The VI of the fetal brain in the pregnancy-induced hypertension group was significantly positively correlated with MDA, 8-iso, and HSP-70 in the umbilical cord blood of the patients (P<0.05), and VFI was significantly positively correlated with 8-iso and HSP-70. 3D-CPA examination can find that the level of fetal placental blood flow parameters of pregnant women with pregnancy-induced hypertension is reduced, and the craniocerebral blood flow parameters are compensatedly increased, and it is related to intrauterine hypoxia.

Key words: pregnancy-induced hypertension, fetus, intrauterine hypoxia, three-dimensional energy Doppler technique, oxidative stress

徐雁, 于海晶, 夏宏林, 黄艳. 基于3D-CPA诊断妊娠高血压孕妇胎儿宫内缺氧的研究[J]. 影像科学与光化学, 2022, 40(2): 280-285.

XU Yan, YU Haijing, XIA Honglin, HUANG Yan. Study on Diagnosis of Fetal Intrauterine Hypoxia in Pregnant Women with Hypertension During Pregnancy Based on 3D-CPA[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(2): 280-285.

参考文献

[1] 马超, 汪韬, 肖杨. 妊娠期高血压孕妇脐血流不同参数对宫内胎儿缺氧、胎儿生长受限的预测价值[J]. 临床误诊误治, 2020, 301(9):98-102.
[2] 潘菊花, 任叶青. 高龄产妇胎儿宫内缺氧脐动脉血流超声参数与过氧化损伤的关系研究[J]. 中国妇幼保健, 2019, 34(10):2232-2234.
[3] 马斌. 三维能量多普勒超声在妊娠期高血压疾病胎盘血流灌注监测中的价值[J]. 中国妇幼保健, 2018, 33(4):918-921.
[4] 王淑贞. 实用妇产科学[M]. 北京:人民卫生出版社, 1987:102-103.
[5] Apgar V. A proposal for a new method of evaluation of the newborn infant[J]. Anesthesia & Analgesia, 1975, 32(4):260-267.
[6] Kulida L V, Malysheva M V, Peretyatko L P, et al. Morphopathology of myocardial hypoxic-ischemic injuries in newborns at 22-27 weeks' gestation[J]. Arkhiv Patologii, 2021, 83(4):29.
[7] Wallace J G, Bellissimo C J, Yeo E, et al. Obesity during pregnancy results in maternal intestinal inflammation, placental hypoxia, and alters fetal glucose metabolism at mid-gestation[J]. Scientific Reports, 2019, 9(1):17621.
[8] Klycheva O I, Khuraseva A B. Methods of pharmacological correction of intrauterine growth restriction syndrome[J]. I P Pavlov Russian Medical Biological Herald, 2020, 28(2):213-222.
[9] 刘和时, 朱永胜. 血管多普勒超声预测不良妊娠结局[J]. 中国医学影像技术, 2021, 37(1):147-150.
[10] Nasyrov R A, Sidorova N A, Melnikova V F, et al. Morphological and immunohistochemical features of placental damage in cases of perinatal death:Institutional experience with emphasis on viral etiology[J]. Annals of Clinical and Laboratory Science, 2020, 50(6):754-760.
[11] 韦雯雯, 李晓兰, 于震, 等. 多普勒超声技术在妊娠期高血压孕妇妊娠结局中的应用[J]. 安徽医科大学学报, 2020, 55(9):1466-1468.
[12] Bezhenar V F, Ivanova L A, Korshunov M Y. Determining the cause of perinatal loss:Is it always possible?[J]. Journal of Obstetrics and Women S Diseases, 2020, 69(3):5-12.
[13] 陈春霖, 黄水平, 兰枝. 胎儿脐动脉和大脑中动脉参数比值对胎儿宫内缺氧的诊断价值分析[J]. 中南医学科学杂志, 2019, 47(1):61-63.
[14] 张大娟, 梁喜, 张屹辉. 多普勒频谱分析胎儿宫内缺氧[J]. 中国超声医学杂志, 2020, 36(3):246-249.
[15] 张凌, 王凤, 何芳, 等. 胎儿频谱多普勒联合胎儿生物物理学评分对胎儿宫内缺氧的诊断价值[J]. 海南医学, 2019, 30(5):78-80.