切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2024, Vol. 21 ›› Issue (07) : 726 -732. doi: 10.3877/cma.j.issn.1672-6448.2024.07.014

妇产科超声影像学

早孕期低危妊娠和高危妊娠胎盘微血流成像特征及预后分析
李钱梅1, 何冠南2, 赵婧2, 陈曦2, 唐玉英2, 马丽琼2, 梁蓉2, 袁桃2, 李明星3,†()   
  1. 1. 646000　四川泸州，西南医科大学附属医院超声医学科；610000　成都，四川省妇幼保健院（四川省妇女儿童医院）超声科
    2. 610000　成都，四川省妇幼保健院（四川省妇女儿童医院）超声科
    3. 646000　四川泸州，西南医科大学附属医院超声医学科
  • 收稿日期:2023-11-02 出版日期:2024-07-01
  • 通信作者: 李明星
  • 基金资助:
    四川省医学（青年创新）科研课题(S22077); 四川省妇幼保健院院内科技创新基金(CXPJ2022-06); 成都市医学科研课题(2023365); 成都市卫健委医学科研课题(2022221)

Placental microvascular flow imaging characteristics and prognosis of early low-risk and high-risk pregnancies

Qianmei Li1, Guannan He2, Jing Zhao2, Xi Chen2, Yuying Tang2, Liqiong Ma2, Rong Liang2, Tao Yuan2, Mingxing Li3,†()   

  1. 1. Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Department of Ultrasound, Sichuan Maternal and Child Health Hospital (Sichuan Women and Children's Hospital), Chengdu 61000, China
    2. Department of Ultrasound, Sichuan Maternal and Child Health Hospital (Sichuan Women and Children's Hospital), Chengdu 61000, China
    3. Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
  • Received:2023-11-02 Published:2024-07-01
  • Corresponding author: Mingxing Li
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李钱梅, 何冠南, 赵婧, 陈曦, 唐玉英, 马丽琼, 梁蓉, 袁桃, 李明星. 早孕期低危妊娠和高危妊娠胎盘微血流成像特征及预后分析[J]. 中华医学超声杂志（电子版）, 2024, 21(07): 726-732.

Qianmei Li, Guannan He, Jing Zhao, Xi Chen, Yuying Tang, Liqiong Ma, Rong Liang, Tao Yuan, Mingxing Li. Placental microvascular flow imaging characteristics and prognosis of early low-risk and high-risk pregnancies[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 726-732.

目的

观察早孕期低危和高危妊娠胎盘微血流灌注成像（MV-Flow），并探讨早孕期低危及高危妊娠胎盘微血管指数（MVI）及其对不良妊娠结局的预测价值。

方法

选择2022年1月至12月在四川省妇幼保健院规律产检的孕11~13+6周的单胎妊娠孕妇。高危妊娠定义为一项高度风险因素或两项中度风险因素，低危妊娠定义为单胎妊娠母亲无合并症。分别对95例低危妊娠和44例高危妊娠孕妇进行早孕期胎盘MV-Flow，测量2组孕妇早孕期胎盘MVI、血流指数、血管指数、血管形成-血流指数（VFI）、胎盘体积、子宫动脉搏动指数，收集孕妇基本临床资料、新生儿分娩体质量及孕周、不良妊娠结局。分别采用χ2检验/Fisher’s精确检验、Wilcoxon秩和检验比较高危组与低危组上述变量的差异；采用组内相关系数（ICC）检验分析MVI值测量的一致性；采用多元线性回归分析孕妇基本参数与低危组中MVI值的相关性；采用Logistic回归评估各参数预测不良妊娠结局的效能。

结果

低危组MVI参考值为57.30（46.10，67.47），高危组MVI参考值为48.09（37.52，58.63），高危组胎盘MVI明显低于低危组（Z=-3.446，P<0.001）。高危组与低危组中发生不良妊娠结局(11 vs 9)、孕妇年龄[30（28，35）岁vs 29（27，31）岁]、使用阿司匹林（13 vs 6）方面比较，差异均有统计学意义（χ2=5.885，P=0.015；Z=2.385，P=0.017；χ2=13.751，P<0.001）。低危组中发现孕周与MVI呈弱线性相关性（r2=0.081，P<0.05），MVI值随着孕周增加而增大。孕次对早期胎盘MVI值有一定影响（B=4.022，t=3.190，P<0.05）。2组孕妇早期胎盘MVI对不良妊娠结局的预测均没有统计学意义（P均>0.05）。低危组中1例MVI（24.6）值低发生早期流产。

结论

MV-Flow技术可以定量显示早孕期胎盘微血流灌注。检查孕周、孕次与早孕期胎盘微血流灌注有一定的相关性，早孕期高危妊娠胎盘MVI较低危妊娠明显减低，但尚未发现早孕期胎盘MVI异常会导致不良妊娠结局。

关键词: 早孕期, 高危妊娠, 胎盘, 微血流成像
Objective

To perform placental microflow perfusion imaging (MV-Flow) in early low-risk and high-risk pregnancies, and explore the characteristics of placental microvascular index (MVI) in low-risk and high-risk pregnancies and its predictive value for adverse pregnancy outcome.

Methods

Pregnant women with singleton pregnancies at 11 to 13+6 weeks of gestation who underwent regular prenatal check-ups at Sichuan Maternal and Child Health Hospital from January to December 2022 were selected. A high-risk pregnancy was defined as the presence of one high-risk factor or two moderate-risk factors, and a low-risk pregnancy was defined as a singleton pregnancy in a mother with no comorbidities. Placental MV-FIow was performed in early pregnancy on 95 cases of low-risk pregnancies and 44 cases of high-risk pregnancies. Placental MVI, vascularization index, flow index, vascularization-flow, placental volume, and uterine artery pulse index of the two groups of pregnant women in early pregnancy were measured, and the basic clinical data of the pregnant women, newborn birth weight and gestational age, and adverse pregnancy were collected. The χ2 test/Fisher's exact test and Wilcoxon rank sum test were used to compare the differences in the above variables between the high-risk group and low-risk group. The intraclass correlation coefficient test was used to analyze the consistency of MVI measurements. Multiple linear regression was used to analyze the correlation between the basic parameters of pregnant women and MVI values in the low-risk group, and logistic regression was used to evaluate the effectiveness of each parameter in predicting adverse pregnancy outcome.

Results

The MVI reference value of the low-risk pregnancy group was 57.30 (46.10-67.47), and the corresponding value of the high-risk pregnancy group was 48.09 (37.52-58.63). The placental MVI of the high-risk group was significantly lower than that of the low-risk group (Z=-3.446, P<0.001). There were statistically significant differences in adverse pregnancy outcomes (11 vs 9), maternal age [30 (28, 35) years vs 29 (27, 31) years], and aspirin was used (13 vs 6) between the high-risk group and the low-risk group (χ2=5.885, P=0.015; Z=2.385, P=0.017; χ2=13.751, P<0.001). In the low-risk group, there was a weak linear correlation between gestational age and MVI (r2=0.081, P<0.05), and the MVI value increased with increasing gestational age. Gravidity had a certain impact on early placental MVI value (B=4.022, t=3.190, P<0.05). There was no significant difference in the prediction of adverse pregnancy outcomes by early placental MVI in the two groups of pregnant women (P>0.05 for both). One case in the low-risk group had an early miscarriage with a low MVI value (24.6).

Conclusion

MV-Flow technology can quantitatively display placental microperfusion in early low-risk and high-risk pregnancies. There is a certain correlation between gestational age and gravidity and placental microblood perfusion in early pregnancy. Placental MVI in early high-risk pregnancies is significantly lower than that in low-risk pregnancies. However, it has not been found that abnormal placental MVI in early pregnancy will lead to adverse pregnancy.

Key words: Early pregnancy, High-risk pregnancies, Placenta, Microvascular flowing imaging
图1 能量直方图计算全胎盘体积及胎盘血管指数图注：VI为血管指数，FI为血流指数，VFI为血管形成-血流指数，Volume为胎盘体积
图2 早孕期胎盘微血管指数的测量，手动绘制感兴趣区域（ROI）胎盘长轴最大面
表1 2组孕妇基本临床信息比较
项目 低危组（n=95） 高危组（n=44） 统计值 P值
年龄[岁，M（QR）] 29（27，31） 30（28，35） Z=-2.385 0.017
体质量指数[kg/m2，M（QR）] 20.50（19.20，23.50） 22.10（19.81，23.91） Z=-1.619 0.105
检查孕周[周，M（QR）] 12.6（12.4，13.1） 12.6（12.4，13.1） Z=-0.135 0.893
孕次[例（%）]     χ2=3.402 0.182
1次 36（37.9） 24（54.6）    
2次 30（31.6） 10（22.7）    
≥3次 29（30.5） 10（22.7）    
产次[例（%）]     χ2=3.788 0.052
0次 55（57.9） 33（75.0）    
≥1次 40（42.1） 11（25.0）    
是否使用阿司匹林或低分子量肝素[例（%）]     χ2=13.751 <0.001
否 89（93.7） 31（70.5）    
是 6（6.3） 13（29.5）    
分娩孕周[周，M（QR）] 39.2（38.6，39.6） 39.0（38.1，39.6） Z=-1.424 0.154
新生儿体质量[g，M（QR）] 3200.0（2997.5，3530.0） 3127.5（2765.0，3452.5） Z=-1.300 0.194
不良结局[例（%）] 9（9.5） 11（25.0） χ2=5.885 0.015
子痫前期 2（2.1） 4（9.0） - 0.080
高血压 0（0） 3（6.8） - 0.030
胎儿生长受限 1（1.0） 0（0） - 1.000
早产 3（3.2） 4（9.0） - 0.207
流产 3（3.2） 0（0） - 0.551
图3 检测孕周与胎盘微血管指数线性相关图
表2 低危妊娠孕妇早孕期胎盘微血管指数与孕妇临床资料的关系
项目 未标准化系数 标准化系数 t值 P值 B值的95%CI 共线性统计
B值 SE值 β值 下限 上限 容差 VIF
年龄 -0.180 0.498 -0.038 -0.361 0.719 -1.170 0.810 0.813 1.230
检查孕周 10.677 3.198 0.328 3.338 0.001 4.322 17.032 0.943 1.061
孕次 4.022 1.261 0.338 3.190 0.002 1.517 6.528 0.813 1.229
体质量指数 -0.452 0.497 -0.089 -0.909 0.366 -1.440 0.536 0.946 1.057
胎盘位置 -1.489 2.713 -0.053 -0.549 0.585 -6.880 3.902 0.964 1.038
图4 高危组和低危组早孕期胎盘微血管指数柱形图注：**P<0.001
表3 2组妊娠孕妇超声监测指标的差异[M（QR）]
项目 低危组（n=95） 高危组（n=44） Z值 P值
MVI（%） 57.30（46.10，67.47） 48.09（37.52，58.63） -3.446 <0.001
UtA-PI 1.67（1.31，2.02） 1.73（1.52，2.16） -1.678 0.093
血管指数（%） 13.05（8.30，18.55） 9.51（6.73，13.27） -2.896 0.004
血流指数 95.06（86.60，103.63） 93.78（87.29，101.13） -0.224 0.823
VFI 12.20（7.30，18.82） 9.72（5.89，13.06） -2.572 0.010
胎盘体积（cm3） 58.20（45.60，67.90） 60.54（48.50，70.06） -0.811 0.418
表4 早孕期胎盘微血流超声指标对不良妊娠的诊断效能
项目 高危组 低危组
OR值 SE值 P值 OR值 SE值 P值
MVI 1.042 0.039 0.297 0.940 0.037 0.095
UtA-PI 1.162 0.954 0.875 2.038 0.738 0.335
VFI 0.808 0.111 0.056 1.084 0.057 0.154
年龄 1.124 0.112 0.294 0.984 0.137 0.905
体质量指数 1.027 0.104 0.796 0.816 0.149 0.173
血压 1.099 0.053 0.076 1.066 0.047 0.177
1
Staff AC, Fjeldstad HE, Fosheim IK, et al. Failure of physiological transformation and spiral artery atherosis: their roles in preeclampsia [J]. Am J Obstet Gynecol, 2022, 226(2S): S895-S906.
2
Brosens I, Pijnenborg R, Vercruysse L, et al. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation [J]. Am J Obstet Gynecol, 2011, 204(3): 193-201.
3
Turner JM, Robertson NT, Hartel G, et al. Impact of low-dose aspirin on adverse perinatal outcome: meta-analysis and meta-regression [J]. Ultrasound Obstet Gynecol, 2020, 55(2): 157-169.
4
Chen X, Wei X, Zhao S, et al. Characterization of placental microvascular architecture by MV-Flow imaging in normal and fetal growth-restricted pregnancies [J]. J Ultrasound Med, 2021, 40(8): 1533-1542.
5
Hernandez-Andrade E, Huntley ES, Bartal MF, et al. Doppler evaluation of normal and abnormal placenta [J]. Ultrasound Obstet Gynecol, 2022, 60(1): 28-41.
6
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 [J]. Obstet Gynecol, 2020, 135(6): e237-e260.
7
Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention [J]. Int J Gynaecol Obstet, 2019, 145 Suppl 1(Suppl 1): 1-33.
8
中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020) [J]. 中华妇产科杂志, 2020, 55(4): 227-238.
9
中华医学会围产医学分会胎儿医学学组, 中华医学会妇产科学分会产科学组. 胎儿生长受限专家共识(2019版) [J]. 中华围产医学杂志, 2019, 22(6): 361-380.
10
中华医学会妇产科学分会产科学组. 早产的临床诊断与治疗推荐指南(草案) [J]. 中华妇产科杂志, 2007, 42(7): 498-500.
11
孙红双, 任芸芸. 基于超声成像技术评价胎盘功能的研究新进展 [J]. 中国医学影像学杂志, 2022, 30(4): 406-411.
12
Phipps EA, Thadhani R, Benzing T, et al. Pre-eclampsia: pathogenesis, novel diagnostics and therapies [J]. Nat Rev Nephrol, 2019, 15(5): 275-289.
13
Hecht JL, Zsengeller ZK, Spiel M, et al. Revisiting decidual vasculopathy [J]. Placenta, 2016, 42: 37-43.
14
吴淑芬, 杨舒萍, 沈浩霖, 等. 早孕期全胎盘血管指数对高风险孕妇发生子痫前期的预测价值 [J]. 中国超声医学杂志, 2023, 39(1): 53-55.
15
Takeuchi S, Rothrauff BB, Kanto R, et al. Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament [J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(1): 93-101.
16
刘菲菲, 朱家安. 超微血管成像技术在肌肉骨骼系统中的应用 [J/OL]. 中华医学超声杂志(电子版), 2022, 19(5): 470-473.
17
牛梓涵, 张培培, 武玺宁, 等. 超声微血管成像评价胎盘灌注与胎儿生长发育关系的初步研究 [J]. 中华超声影像学杂志, 2021, 30(8): 691-696.
18
Odibo AO, Kayisli U, Lu Y, et al. Longitudinal assessment of spiral artery and intravillous arteriole blood flow and adverse pregnancy outcome [J]. Ultrasound Obstet Gynecol, 2022, 59(3): 350-357.
19
Burton GJ, Jauniaux E. The human placenta: new perspectives on its formation and function during early pregnancy [J]. Proc Biol Sci, 2023, 290(1997): 20230191.
20
Roberts V, Morgan TK, Bednarek P, et al. Early first trimester uteroplacental flow and the progressive disintegration of spiral artery plugs: new insights from contrast-enhanced ultrasound and tissue histopathology [J]. Hum Reprod, 2017, 32(12): 2382-2393.
21
Hafner E, Metzenbauer M, Stümpflen I, et al. First trimester placental and myometrial blood perfusion measured by 3D power Doppler in normal and unfavourable outcome pregnancies [J]. Placenta, 2010, 31(9): 756-763.
22
Khong TY, Adema ED, Erwich JJ. On an anatomical basis for the increase in birth weight in second and subsequent born children [J]. Placenta, 2003, 24(4): 348-353.
23
Duley L, Meher S, Hunter KE, et al. Antiplatelet agents for preventing pre-eclampsia and its complications [J]. Cochrane Database Syst Rev, 2019, 2019(10): D4659.
24
Burton GJ, Woods AW, Jauniaux E, et al. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy [J]. Placenta, 2009, 30(6): 473-482.
25
McLaughlin K, Zhang J, Lye SJ, et al. Phenotypes of pregnant women who subsequently develop hypertension in pregnancy [J]. J Am Heart Assoc, 2018, 7(14): e9595.
26
Allen RE, Morlando M, Thilaganathan B, et al. Predictive accuracy of second-trimester uterine artery Doppler indices for stillbirth: a systematic review and meta-analysis [J]. Ultrasound Obstet Gynecol, 2016, 47(1): 22-27.
27
何雪威, 谷美玉, 吴亭亭. 超声子宫动脉及子宫内膜血流参数对不明原因复发性流产患者妊娠结局的影响 [J/OL]. 中华医学超声杂志(电子版), 2023, 20(11): 1158-1163.

URL    
28
Flenady V, Wojcieszek AM, Ellwood D, et al. Classification of causes and associated conditions for stillbirths and neonatal deaths [J]. Semin Fetal Neonatal Med, 2017, 22(3): 176-185.
29
Hosseinirad H, Yadegari P, Falahieh FM, et al. The impact of congenital uterine abnormalities on pregnancy and fertility: a literature review [J]. JBRA Assist Reprod, 2021, 25(4): 608-616.
[1] 罗润兰, 蒋文莉, 张艳, 罗渝昆. 超声高清微血流成像技术在鉴别乳腺良恶性结节中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(12): 1242-1247.
[2] 张涛, 赵胜, 杨小红, 包艳娟, 戢秀勤, 高艳多, 张晓燕. 早孕期胎儿腹壁缺损的超声诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(11): 1139-1144.
[3] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[4] 唐龙观, 邬绿莹, 王海红, 陈婉丝, 杨盛英. MTHFR基因多态性与胎盘细胞凋亡的相关性研究[J]. 中华细胞与干细胞杂志(电子版), 2023, 13(05): 272-276.
[5] 卫星, 孙路明. 辅助生殖技术与胎儿生长障碍[J]. 中华产科急救电子杂志, 2024, 13(02): 88-92.
[6] 李婷, 滕银成. 体外受精-胚胎移植与前置胎盘[J]. 中华产科急救电子杂志, 2024, 13(02): 84-87.
[7] 印贤琴, 刘宇茵, 毛丽丽, 孙雯, 陈敦金. 前次剖宫产时机对再次妊娠合并前置胎盘患者临床结局的影响[J]. 中华产科急救电子杂志, 2023, 12(04): 244-248.
[8] 郭志荣, 马京梅. 胎盘植入性疾病的风险评估和治疗策略[J]. 中华产科急救电子杂志, 2023, 12(03): 151-154.
[9] 张丽姿, 陈敦金. 胎盘植入性疾病的不良结局及远期影响[J]. 中华产科急救电子杂志, 2023, 12(03): 155-158.
[10] 古士锋, 张丽姿, 梁景英, 杜丽丽, 孙雯, 陈敦金. 2011－2021年我国胎盘植入性疾病研究热点：基于CiteSpace可视化分析[J]. 中华产科急救电子杂志, 2023, 12(03): 159-166.
[11] 岳永飞, 朱利平, 王晓艳. 磁共振成像技术在预测胎盘植入性疾病患者剖宫产术中出血量的研究[J]. 中华产科急救电子杂志, 2023, 12(03): 167-172.
[12] 王永, 李霞林, 杨蓉, 潘康妮, 余琳, 王伟伟, 孙雯, 陈敦金. 胎盘植入合并严重产后出血输血方案的研究[J]. 中华产科急救电子杂志, 2023, 12(03): 173-179.
[13] 吴文诗, 魏宋荃, 李桂民, 郑晓芳, 孙雯, 陈敦金, 余琳. 胎盘植入性疾病患者行子宫部分切除术后再次妊娠的临床研究[J]. 中华产科急救电子杂志, 2023, 12(03): 180-186.
[14] 刘光华, 欧阳强, 俞炬明, 范国平, 欧敬民, 邱明科, 林霏开, 孙会贞, 张惠, 汪希鹏, 金敏菲. 双侧髂内动脉球囊阻断序贯子宫动脉栓塞辅助下剖宫产的临床应用[J]. 中华介入放射学电子杂志, 2024, 12(01): 33-38.
[15] 栾泽东, 杨楠, 綦洪敏, 庞文艳, 王晓燕, 邹艳丽, 刘亚琴, 王好玲, 张锦婷. 超声五切面在早孕期诊断胎儿严重心脏畸形中的临床价值[J]. 中华诊断学电子杂志, 2023, 11(03): 190-197.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号