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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (07) : 660 -666. doi: 10.3877/cma.j.issn.1672-6448.2022.07.012

妇产科超声影像学

剪切波弹性成像技术评估子痫前期胎盘弹性的临床价值
壮健1, 潘昌杰2,†(), 李晓琴1, 于梦霞1, 张超1, 朱韦文1   
  1. 1. 213164　江苏常州，南京医科大学附属常州第二人民医院超声科
    2. 213164　江苏常州，南京医科大学附属常州第二人民医院放射科
  • 收稿日期:2021-04-24 出版日期:2022-07-01
  • 通信作者: 潘昌杰

Clinical value of shear wave elastography in evaluating placental elasticity in patients with preeclampsia

Jian Zhuang1, Changjie Pan2,†(), Xiaoqin Li1, Mengxia Yu1, Chao Zhang1, Weiwen Zhu1   

  1. 1. Department of Ultrasound, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213164, China
    2. Department of Radiology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213164, China
  • Received:2021-04-24 Published:2022-07-01
  • Corresponding author: Changjie Pan
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引用本文：

壮健, 潘昌杰, 李晓琴, 于梦霞, 张超, 朱韦文. 剪切波弹性成像技术评估子痫前期胎盘弹性的临床价值[J]. 中华医学超声杂志（电子版）, 2022, 19(07): 660-666.

Jian Zhuang, Changjie Pan, Xiaoqin Li, Mengxia Yu, Chao Zhang, Weiwen Zhu. Clinical value of shear wave elastography in evaluating placental elasticity in patients with preeclampsia[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(07): 660-666.

目的

评价剪切波弹性成像技术对子痫前期的诊断价值。

方法

前瞻性纳入2019年10月至2020年12月在常州第二人民医院超声科检查的晚孕期孕妇177名。根据临床诊断将孕妇分为健康组152名和子痫前期组25例。采用单因素分析比较2组间一般临床资料、二维超声、彩色多普勒超声参数及胎盘（母体面和胎儿面）杨氏模量值（Emean、Emax、Emin）间的差异。采用Spearman相关分析胎盘杨氏模量值与胎儿脐血流参数间的相关性，并建立受试者工作特征曲线，评价胎盘杨氏模量值诊断子痫前期的诊断效能。

结果

健康组与子痫前期组孕妇的羊水指数、胎盘厚度以及脐动脉血流收缩/舒张期速度比（S/D）、阻力指数（RI）、搏动指数（PI）比较，差异均无统计学意义（P均＞0.05）。除胎盘母体面Emin以外，子痫前期组孕妇胎盘母体面Emean、Emax及胎儿面Emean、Emax、Emin均高于健康组［（5.87±0.41）kPa vs（5.30±0.53）kPa；8.67（8.30，9.66）kPa vs 8.01（7.56，8.50）kPa；（5.15±0.34）kPa vs（4.65±0.52）kPa；（8.07±0.70）kPa vs（7.11±0.85）kPa；（3.28±0.44）kPa vs（3.01±0.54）kPa］，差异具有统计学意义（t=-6.215、Z=-4.566、t=-6.298、t=-5.376、t=-2.430，P＜0.001、＜0.001、＜0.001、＜0.001、=0.016）。健康组和子痫前期组孕妇胎盘自身的母体面Emean、Emax、Emin均高于胎儿面，差异具有统计学意义（t=11.319、Z=-8.461、t=12.118、t=6.266、Z=-3.807、t=5.416，P均＜0.001）。相关性分析显示2组中各杨氏模量值与脐动脉血流的S/D、RI、PI值均无显著相关性（P均＞0.05）。当截断值为5.85 kPa时，胎盘母体面的Emean值诊断子痫前期的效能最佳，其敏感度、特异度、准确性分别为68.0%、85.5%、83.1%。

结论

子痫前期孕妇胎盘的杨氏模量值高于健康孕妇。剪切波弹性成像技术可通过评价胎盘硬度辅助子痫前期的诊断。

关键词: 剪切波弹性成像, 子痫前期, 胎盘, 超声
Objective

To evaluate the diagnostic value of shear wave elastography in preeclampsia.

Methods

One hundred and seventy-seven pregnant women in the third trimester were prospectively enrolled at the Department of Ultrasound of Changzhou No. 2 People's Hospital from October 2019 to December 2020. Pregnant women were divided into a healthy group (n=152) and a preeclampsia group (n=25) according to clinical diagnosis. The differences in general data, two-dimensional ultrasound and color Doppler ultrasound parameters, and placental Young's modulus (Emean, Emax, and Emin) were compared. The correlation between placental Young's modulus values and fetal umbilical blood flow parameters was analyzed by Spearman correlation, and receiver operating characteristic curve analysis was performed to evaluate the diagnostic efficacy of placental Young's modulus in the diagnosis of preeclampsia.

Results

There was no difference in amniotic fluid index, placental thickness, systolic/diastolic velocity ratio (S/D), resistance index (RI), or pulsatility index (PI) between the two groups (P＞0.05). Except for the Emin of the maternal side of the placenta, Emean and Emax of the maternal side of the placenta and Emean, Emax, and Emin of the fetal side of the placenta in the preeclampsia group were significantly higher than those in the healthy group [(5.87±0.41) kPa vs (5.30±0.53) kPa, t=-6.215, P＜0.001; 8.67 (8.30, 9.66) kPa vs 8.01 (7.56, 8.50) kPa, Z=-4.566, P＜0.001; (5.15±0.34) kPa vs (4.65±0.52) kPa, t=-6.298, P＜0.001; (8.07±0.70) kPa vs (7.11±0.85) kPa, t=-5.376, P＜0.001; (3.28±0.44) kPa vs (3.01±0.54) kPa, t=-2.430, P=0.016]. Emean, Emax, and Emin of the maternal side of the placenta itself were significantly higher than those of the fetal side of the placenta in both groups (t=11.319, Z=-8.461, t=12.118, t=6.266, Z=-3.807, and t=5.416, respectively; P＜0.001). Correlation analysis showed no significant correlation between Young's modulus values and S/D, RI, or PI values in the umbilical artery in the two groups (P＞0.05). When the cut-off value was 5.85 kPa, the diagnostic performance of Emean of the maternal side of the placenta was the best; the sensitivity, specificity, and accuracy were 68.0%, 85.5%, and 83.1%, respectively.

Conclusion

Young's modulus values of the placenta in pregnant women with preeclampsia are higher than those of healthy pregnant women. Shear wave elastography can assist in the diagnosis of preeclampsia by measuring placental stiffness.

Key words: Shear wave elastography, Preeclampsia, Placenta, Ultrasound
表1 健康组与子痫前期组孕妇的二维及彩色多普勒超声各测值的比较
组别 例数 脐动脉（
x¯
±s）		 羊水指数［cm，M（QR）］ 胎盘厚度［cm，M（QR）］
S/D RI PI
健康组 152 2.06±0.30 0.51±0.07 0.71±0.14 12.6（11.1，15.1） 3.2（2.9，3.7）
子痫前期组 25 2.16±0.29 0.53±0.06 0.75±0.13 12.4（11.1，14.3） 3.2（3.1，3.5）
统计值 t=-1.565 t=-1.451 t=-1.607 Z=-0.463 Z=-0.316
P值 0.127 0.149 0.117 0.643 0.752
表2 健康组与子痫前期组孕妇胎盘母体面及胎儿面杨氏模量值比较（kPa）
组别 例数 母体面 胎儿面
Emean（
x¯
±s）		 Emax［M（QR）］ Emin（
x¯
±s）		 Emean（
x¯
±s）		 Emax（
x¯
±s）		 Emin（
x¯
±s）
健康组 152 5.30±0.53 8.01（7.56，8.50） 3.67±0.53 4.65±0.52 7.11±0.85 3.01±0.54
子痫前期组 25 5.87±0.41 8.67（8.30，9.66） 3.97±0.34 5.15±0.34 8.07±0.70 3.28±0.44
统计值 t=-6.215 Z=-4.566 t=-2.745 t=-6.298 t=-5.376 t=-2.430
P值 ＜0.001 ＜0.001 0.070 ＜0.001 ＜0.001 0.016
图1 健康组与子痫前期组孕妇胎盘自身的母体面及胎儿面杨氏模量值比较。图a~f分别为健康组Emean、Emax、Emin和子痫前期组Emean、Emax、Emin，胎盘母体面与胎儿面比较，差异均具有统计学意义（t=11.319、Z=-8.461、t=12.118、t=6.266、Z=-3.807、t=5.416，P均＜0.001） 注：Emean、Emax、Emin为杨氏模量的平均值、最大值、最小值；“***”为P＜0.001，“****”为P＜0.0001
图2 妊娠28周健康孕妇胎盘母体面及胎儿面杨氏模量值
图3 妊娠28周子痫前期孕妇胎盘母体面及胎儿面杨氏模量值
图4 健康组（图a）和子痫前期组（图b）孕妇胎盘杨氏模量值与脐血流参数的相关性热图 注：红色系表示参数间呈正相关，紫色系表示参数间呈负相关，格中的数字表示相关系数；Emean、Emax、Emin为杨氏模量的平均值、最大值、最小值；S/D为收缩/舒张期速度比；RI为阻力指数；PI为搏动指数
图5 胎盘各杨氏模量值诊断子痫前期的受试者操作特征曲线
表3 胎盘各杨氏模量值诊断子痫前期的诊断效能
杨氏模量值 曲线下面积 95%CI 截断值（kPa） 敏感度（%） 特异度（%） 准确性（%） 阳性预测值（%） 阴性预测值（%）
Emean母体面 0.81 0.75~0.87 5.85 68.00 85.50 83.10 43.60 94.20
Emean胎儿面 0.79 0.72~0.85 5.02 72.00 77.60 76.80 34.60 94.40
Emax母体面 0.79 0.72~0.84 7.92 96.00 48.70 55.40 23.50 98.70
Emax胎儿面 0.79 0.72~0.85 7.19 96.00 53.30 59.30 25.30 98.80
Emin母体面 0.70 0.63~0.77 3.74 80.00 61.80 64.40 25.60 94.90
Emin胎儿面 0.65 0.57~0.72 2.83 88.00 44.70 50.80 20.80 95.80
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