探讨孕11-13⁺⁶周孕妇子宫动脉血流及左心室参数与子痫前期的相关性及其预测价值。

选取2020年1月至2022年9月于哈尔滨医科大学附属第四医院首次产检的孕11~13⁺⁶周孕妇，收集孕妇临床资料，包括年龄、收缩压、舒张压、平均动脉压（MAP）等参数，应用超声检测子宫动脉搏动指数（PI）、阻力指数（RI）、收缩期/舒张期血流速度（S/D）、左心室二尖瓣环舒张早期平均峰值速度（e'）、二尖瓣舒张早期峰值流速/二尖瓣环舒张早期平均峰值速度（E/e'）等参数，随访获得子痫前期组108例，随机选取同期符合标准正常孕妇110例作为对照组，采用t检验或U检验比较2组间各参数的差异。通过Logistic回归法筛选出子痫前期的独立影响因素并构建预测子痫前期的诺曼模型，通过受试者操作特征（ROC）曲线对预测模型的准确性进行评估，绘制校准曲线分析预测模型的校准度。

与对照组比较，子痫前期组孕妇年龄[（30.07±5.03）岁vs（29.35±6.49）岁]、收缩压[（111.75±5.20）mmHg vs（109.62±8.19）mmHg]、舒张压[（70.06±6.37）mmHg vs（68.62±6.35）mmHg]、MAP[（82.30±7.54）mmHg vs（81.06±7.27）mmHg]、子宫动脉PI[（1.85±0.64）vs（1.64±0.57）]、RI[（0.71±0.12）vs（0.69±0.11）]、S/D[（4.33±1.64）vs（4.25±1.70）]和左心室E/e'[（8.32±0.91）vs（7.54±0.84）]比较均高，左心室e'小于对照组[（9.81±1.74）cm/s vs（10.63±1.82）cm/s]，差异均具有统计学意义（t=0.923、2.309、1.601、1.167、2.441、1.240、0.937、6.301、3.256；P=0.034、0.008、0.010、0.014、0.005、0.013、0.025、0.001、0.002）。Logistic回归法筛选得出孕妇MAP[比值比（OR）=1.08，P=0.002]、子宫动脉PI（OR=2.54，P=0.004）、RI（OR=1.56，P=0.012）、左心室e'（OR=0.71，P=0.004）、E/e'（OR=1.68，P=0.013）是子痫前期的独立影响因素。诺曼模型预测子痫前期的ROC曲线下面积为0.81（95%CI：0.75~0.87），敏感度为73.14%，特异度为77.82%，预测模型校准度良好，对子痫前期的预测具有较好的准确性。

孕11~13⁺⁶周孕妇的MAP、子宫动脉PI、RI以及左心室e'、E/e'对子痫前期的预测具有一定的临床参考价值；基于早孕期孕妇MAP、子宫动脉PI、RI以及左心室e'、E/e'构建的诺曼模型预测子痫前期具有较好的准确性，对子痫前期患者的早期管理具有重要意义，可在一定程度上提高临床诊断效能。

To assess the predictive value of uterine artery and left ventricular parameters for pre-eclampsia in women at 11-13⁺⁶ weeks of pregancy.

Pregnant women at 11-13⁺⁶ weeks of gestation who had their first prenatal examination at the Fourth Affiliated Hospital of Harbin Medical University from January 2020 to September 2022 were selected, and their clinical data were collected, including age, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and other parameters.Ultrasound was applied to detect the uterine artery pulsatility index (PI), resistance index (RI), systolic/diastolic velocity ratio (S/D), left ventricular mean early diastolic mitral annular velocity (e'), mitral early diastolic peak velocity/mean early diastolic mitral annular velocity (E/e'), and other parameters. Pregnancy outcomes were recorded, based on which 108 cases of pre-eclampsia were identified, and 110 normal pregnant women were randomly selected as a control group. The t test or U test was used to compare the differences in the above parameters between the two groups. The independent influencing factors of pre-eclampsia were screened out by Logistic regression analysis, and a prediction model was constructed based on these factors. The accuracy of the prediction model was evaluated by receiver operating characteristic curve analysis, and the calibration curve was drawn to analyze the calibration degree of the prediction model.

Age [(30.07±5.03) vs (29.35±6.49)], systolic blood pressure [(111.75±5.20) mmHg vs (109.62±8.19) mmHg], diastolic blood pressure [(70.06±6.37) mmHg vs (68.62±6.35) mmHg], MAP [(82.30±7.54) mmHg vs (81.06±7.27) mmHg], uterine artery PI [(1.85±0.64) vs (1.64±0.57)], RI [(0.71±0.12) vs (0.69±0.11)], S/D [(4.33±1.64) vs (4.25±1.70)], and left ventricular E/e' [(8.32±0.91) vs (7.54±0.84)] of pregnant women in the pre-eclampsia group were significantly greater than those of the control group (t=0.923, 2.309, 1.601, 1.167, 2.441, 1.240, 0.937, and 6.301; P=0.034, 0.008, 0.010, 0.014, 0.005, 0.013, 0.025, and 0.001, respectively), while the e' [(9.81±1.74) vs (10.63±1.82)] of the left ventricle was smaller than that of the control group (t=3.256, P=0.002). Logistic regression analysis identified that MAP, uterine artery PI and RI, and left ventricular e' and E/e' were independent influencing factors of pre-eclampsia (odds ratio=1.08, 2.54, 1.56, 0.71, and 1.68; P=0.002, 0.004, 0.012, 0.004, and 0.013, respectively). The area under the curve of the nomogram model based on the above independent influencing factors for predicting pre-eclampsia was 0.81 (95% confidence interval: 0.75-0.87), with a sensitivity of 73.14% and specificity of 77.82%. The prediction model was well calibrated and had a high predictive accuracy for pre-eclampsia.

MAP, uterine artery PI and RI, and left ventricular e' and E/e' of pregnant women at 11-13⁺⁶ weeks of pregnancy have appreciated value for the prediction of pre-eclampsia. The nomogram model constructed based on MAP, uterine artery PI and RI, and left ventricular e' and E/e' of pregnant women in early pregnancy has good accuracy in predicting pre-eclampsia, is of great significance for the early management of patients with pre-eclampsia, and can improve the efficiency of clinical diagnosis.