标题：妊娠糖尿病孕妇早孕期子宫螺旋动脉血流参数的临床应用价值

      作者：朱艳芳，杜燕飞，邱燕生，林青梅，谢仙华，邓素明    (佛山市南海区妇幼保健院超声科，广东 佛山 528200)

      卷次： 2018年29卷21期

      【摘要】 目的 探讨妊娠期糖尿病孕妇早孕期子宫螺旋动脉血流参数的临床应用价值。方法 采用前瞻性巢式病例对照研究方法，选取2016年4月至2017年12月间来佛山市南海区妇幼保健院检查孕11~13+6周彩色多普勒超声监测子宫胎盘床螺旋动脉血流参数值并在佛山市南海区妇幼保健院分娩的孕妇406例为研究对象,根据妊娠是否合并糖尿病分成妊娠糖尿病病例组106例及对照组300例，病例组分为不良妊娠结局组33例及无不良妊娠结局组73例。分析病例组与对照组、病例组不同妊娠结局组间子宫螺旋动脉血流参数间的差异。结果 病例组孕妇的子宫螺旋动脉的S、D值分别为(35.89±11.69) cm/s、(20.59±7.96) cm/s，均明显低于对照组的(43.44±15.28) cm/s、(26.36±10.06) cm/s，差异均有统计学意义(P<0.05)；病例组孕妇的RI、PI、S/D值分别为(0.41±0.10)、(0.55±0.16)、(1.81±0.38)，均明显高于对照组的(0.35±0.04)、(0.49±0.93)、(1.68±0.37)，差异均有统计学意义(P<0.05)；不良妊娠结局组孕妇的子宫螺旋动脉RI、PI、S/D值分别为(0.47±0.18)、(0.63±0.23)、(1.91±0.96)，高于无不良妊娠结局组孕妇的(0.52±0.12)、(0.4±0.15)、(1.78±0.31)，差异均有统计学意义(P<0.05)。结论 妊娠糖尿病孕妇于孕11~13+6周超声监测子宫螺旋动脉的血流参数能较早地了解胎盘血流情况，可以作为一种有效的监测手段，以降低孕产妇及胎儿的死亡率。
      【关键词】 孕11~13+6周；螺旋动脉；妊娠糖尿病；血流参数
      【中图分类号】 R714.256 【文献标识码】 A 【文章编号】 1003—6350（2018）21—3004—03

Value of uterine spiral artery blood flow parameters in pregnant women with gestational diabetes during earlypregnancy.
ZHU Yan-fang, DU Yan-fei, QIU Yan-sheng, LIN Qing-mei, XIE Xian-hua, DENG Su-ming. Department ofUltrasound, Nanhai Maternity & Child Healthcare Hospital of Foshan, Foshan 528200, Guangdong, CHINA
【Abstract】 Objective To explore the clinical application value of uterine spiral artery blood flow parameters inpregnant women with gestational diabetes in early pregnancy. Methods A prospective case-control study was conduct-ed. A total of 406 pregnant women, who use color Doppler ultrasonography to monitor the blood flow parameters of spi-ral artery in uterine placental bed at 11-13+ 6 weeks and gave birth in Nanhai Maternity & Child Healthcare Hospital ofFoshan from April 2016 to December 2017, were selected and divided into the gestational diabetes group (n=106) andthe control group (n=300) according to whether pregnancy was associated with diabetes mellitus. The gestational diabe-tes group was further divided into the adverse pregnancy outcome group (n=33) and non-adverse pregnancy outcomegroup (n=73). The differences of blood flow parameters of uterine spiral artery between the case group and the controlgroup, the gestational diabetes group and the adverse pregnancy outcome group were analyzed. Results The value of Sand D in the spiral arteries of the pregnant women in the gestational diabetes group were respectively (35.89±11.69) cm/sand (20.59±7.96) cm/s, both significantly lower than corresponding (43.44±15.28) cm/s and (26.36±10.06) cm/s in thecontrol group (P<0.05). RI, PI, S/D of pregnant women in the gestational diabetes group were (0.41±0.10), (0.55±0.16),and (1.81±0.38), respectively, all significantly higher than corresponding (0.35±0.04), (0.49±0.93) and (1.68±0.37) in thecontrol group (P<0.05). The values of RI, PI and S/D of the spiral artery in the adverse pregnancy outcome group were(0.47±0.18), (0.63±0.23) and (1.91±0.96), which were significantly higher than corresponding (0.52±0.12), (0.4±0.15)and (1.78±0.31) in the non-adverse pregnancy outcome group (P<0.05). Conclusion The gestation ultrasonic monitor-ing of uterine spiral artery blood flow parameters of pregnant women with gestational diabetes in 11-13+6 weeks can pro-vide early insight into early placental blood flow condition, which can be used as an effective monitoring tool to reducematernal and fetal mortality.
      【Key words】 11-13+6 weeks pregnancy; Spiral artery; Gestational diabetes mellitus; Blood flow parameter·论 著·doi:10.3969/j.issn.1003-6350.2018.21.013