重度子痫前期子宫动脉、脐动脉血流动力学与血清Hcy、D-D水平的关系探讨

2019年7月 中国民康医学 Jul，2019 第 31 卷 半月刊 第 14 期摇 摇 摇 摇 摇 Medical Journal of Chinese People's Health Vol.31 Semimonthly No.14

揖论 著铱

重度子痫前期子宫动脉、脐动脉血流动力学与 血清Hcy、D-D水平的关系探讨

于 娟（许昌市妇幼保健院产科，河南 许昌 461000）【摘要】 目的：探讨重度子痫前期子宫动脉、脐动脉血流动力学与血清同型半胱氨酸（Hcy）、D-二聚体（D-D）水平的关系。方法：选取75例子痫前期患者为研究对象，其中35例为重度子痫前期，为重度组，40例为轻度子痫前期，为轻度组，另选取同期正常妊娠孕妇40例为对照组，以超声检测三组的子宫动脉、脐动脉血流动力学指标，并抽取其外周静脉血，检测血清同型半胱氨酸（Hcy）、D-二聚体（D-D）水平，分析子宫动脉、脐动脉血流动力学与血清Hcy、D-D水平的关系。结果：三组的子宫动脉、脐动脉的搏动指数（PI）、阻力指数（RI）、血流速度峰谷比（S/D）差异显著，且重度组大于其他两组，轻度组大于对照组，差异均有统计学意义（P<0.05）；三组的血清Hcy、D-D水平差异显著，且重度组明显高于其他两组，轻度组高于对照组，差异均有统计学意义（P<0.05）；经Pearson相关性分析，子痫前期患者的子宫动脉PI、RI、S/D值与Hcy、D-D水平呈正相关（rHcy=0.326、0.501、0.422，P<0.05；rD-D=0.340、0.385、0.487，P<0.05），脐动脉PI、RI、S/D值与Hcy、D-D水平呈正相关（rHcy=0.685、0.401、0.325，P<0.05；rD-D=0.368、0.421、0.402，P<0.05）。结论：子宫动脉、脐动脉血流动力学指标可为子痫前期的病情诊断提供指导，血清Hcy、D-D参与重度子痫前期的病理生理过程，且子宫动脉、脐动脉PI、RI、S/D值与Hcy、D-D水平呈正相关。【关键词】子痫前期；子宫动脉；脐动脉；同型半胱氨酸；D-二聚体doi: 10. 3969 / j. issn. 1672-0369. 2019. 14. 001

中图分类号: R714 文献标识码: A 文章编号: 1672-0369（2019）14-0001-03Study on relationships among hemodynamics of uterine artery, umbilical artery and serum Hcy and D-D levels in patients with severe preeclampsiaYU Juan(Department of Obstetrics of Xuchang Women and Children’s Hospital, Xuchang 461000 Henan, China)

【Abstract】 Objective: To investigate relationships among hemodynamics of uterine artery, umbilical artery and serum homocysteine (Hcy) and D-dimer (D-D) levels in patients with severe preeclampsia. Methods: 75 cases with preeclampsia admitted from February 2017 to February 2018 were selected. Among them, 35 cases with severe preeclampsia were set as severe group, while 40 cases with mild preeclampsia were used as mild group. Another 40 normal pregnant women in the same period were selected as control group. The ultrasound was used to detect the hemodynamic indexes of the uterine and umbilical arteries. Further, the peripheral venous blood was taken to detect the levels of serum Hcy and D-D. Then, the relationships among the hemodynamic indexes of uterine artery, umbilical artery and serum Hcy and D-D levels were analyzed. Results: There were significant differences in the pulse index (PI), resistance index (RI) and peak to valley ratio of blood flow velocity (S/D) of the uterine and umbilical arteries among the 3 groups (P<0.05). Of which, those of the severe group were larger than those of the mild group and the control group (P<0.05), those of the mild group were larger than those of the control group (P<0.05), and the differences were statistically significant (P<0.05). There were significant differences in the serum Hcy and D-D levels among the 3 groups (P<0.05). Of which, those of the severe group were larger than those of the mild group and the control group (P<0.05), those of the mild group were larger than those of the control group (P<0.05), and the differences were statistically significant (P<0.05). The Pearson correlation analysis showed that the PI, RI, S/D of the uterine artery were positively correlated with the Hcy and D-D levels in the preeclampsia patients (rHcy=0.326, 0.501, 0.422, P<0.05; rD-D= 0.340, 0.385, 0.487, P<0.05). The PI, RI, S/D of the umbilical artery were also positively correlated with the Hcy and D-D levels (rHcy=0.685, 0.401, 0.325, P<0.05; rD-D=0.368, 0.421, 0.402, P<0.05). Conclusions: The hemodynamic indexes of the uterine artery and umbilical artery can provide guidance for the diagnosis of preeclampsia. The serum Hcy and D-D are involved in the pathophysiological process of severe preeclampsia. Moreover, the PI, RI and S/D values of the uterine artery and umbilical artery are positively correlated with the Hcy and D-D levels.【Key words】 Preeclampsia; Uterine artery; Umbilical artery; Homocysteine; D-dimer

作者简介：于娟（1981.04-），女，山西省文水县人，汉族，本科，主治医师，邮箱：wenxiangysd@163.com

子痫前期是妊娠期的特有疾病，指妊娠20周以后出现血压升高、蛋白尿的情况，并伴有头晕、恶心、呕吐、上腹部不适感，而重度子痫前期可发展为子痫，导致抽搐发作及昏迷，威胁母胎的生命安全[1-2]。目前子痫前期的病因及病理机制尚未明确阐述，而血管内皮损伤是其重要病理特征，血管内皮功能损伤可进一步造成血管痉挛及血栓的形成，导致血流动力学异常[3]。研究证实[4]，子痫前期患者多伴有同型半胱氨酸（Hcy）、

D-二聚体（D-D）的升高，二者是反映血管内皮功能及凝血的重要指标，本文通过探讨重度子前期患者 2019年7月 中国民康医学 Jul，2019 第 31 卷 半月刊 第 14 期摇 摇 摇 摇 摇 Medical Journal of Chinese People's Health Vol.31 Semimonthly No.14

子宫动脉、脐动脉血流动力学与血清Hcy、D-D水平的关系，以了解子痫前期的病理机制，旨在为疾病的研究、诊疗提供理论依据。1 资料与方法1.1 临床资料 选取许昌市妇幼保健院2017年2月至2018年2月收治的子痫前期患者75例为研究对象。纳入标准：妊娠≥20周，且为单胎妊娠；子痫前期患者均有血压升高、蛋白尿，且符合《妇产科学》中对子痫前期的诊断及分度标准[5]：轻度子痫前期：

妊娠20周收缩压≥140 mmHg和（或）舒张压≥ 90 mmHg（1 mmHg=0.133 kPa），伴蛋白尿≥0.3 g/24 h或随机尿蛋白≥（+），不伴或伴有上腹部不适及头痛等症状。重度子痫前期：血压持续升高，收缩压≥160 mmHg和（或）舒张压≥110 mmHg；蛋白尿≥2.0 g/24 h或随机蛋白尿≥（++）；血清肌酐≥1.2 mg/dL；血小板＜10 000/mL；微血管性溶血（乳酸脱氢酶）升高；血清转氨酶水平升高（门冬氨酸转氨酶或丙氨酸氨基转移酶）；持续头痛或其他大脑或视觉障碍；持续上腹部疼痛。出现以上任一情况即可诊断为重度子痫前期；受检者对于本研究内容均知情并签署知情同意书。排除标准：妊娠前伴有糖尿病及高血压患者；合并有其他妊娠期疾病者；既往有吸烟、饮酒史者。其中35例重度子痫前期患者为重度组，40例轻度子痫前期患者为轻度组。重度组：年龄22~37岁，平均（30.5±5.5）岁；孕周21~38周，平均（28.2±3.0）周；收缩压162~189 mmHg，平均（172.3±7.2）mmHg；舒张压108~132 mmHg，平均（118.5±6.5）mmHg。轻度组：年龄21~38岁，平均（30.3±5.2）岁；孕周21~37周，平均（28.0±3.2）周；收缩压140~159 mmHg，平均（150.3±7.8）mmHg；舒张压85~108 mmHg，平均（96.3±6.8）mmHg。另选取同期正常健康妊娠孕妇40例，为对照组，孕妇年龄20~36岁，平均（30.0±5.2）岁，孕周20~39周，平均（27.8±3.5）周。三组的年龄、孕周比较差异无统计学意义（P>0.05），有可比性。1.2 方法 （1）超声检查：美国GE Voluson E8 彩色多普勒超声诊断仪（上海欧启电子科技有限公司），