Effect of variations of heart rate within the normal range on renal artery Doppler indices in nonpregnant and pregnant women

The effect of heart rate on Doppler indices in the renal artery was studied in 21 nonpregnant, 17 normal and 27 preeclamptic pregnant patients. The central hemodynamics was evaluated by Doppler ultrasound in all pregnant women. The study demonstrated no influence of heart rate on renal artery Doppler indices. Central hemodynamic parameters, such as cardiac output, stroke volume, mean arterial pressure and total systemic resistance did not change with increasing heart rate. We do not recommend any correction of the renal artery Doppler indices for heart rate in the range considered clinically normal (60 to 95 beats/min). Above or below this range further investigations are required to determine if corrections would be necessary. © 1993 John Wiley & Sons, Inc.     

正常妊娠妇女肾脏损伤指标检测

目的探讨肾脏损伤检测指标N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿微量清蛋白(mALB)、α_1微球蛋白(α_1-MG),β_2微球蛋白(β_2-MG)水平在正常妊娠妇女中的变化规律。方法将400例正常妊娠妇女纳入本研究,同时选取87例健康的入职体检护士作为对照组。所有纳入研究者留取晨尿先进行尿液常规检测,根据尿液常规检测结果分为尿糖阴性组、尿糖组和尿蛋白组,然后将所有尿液标本以1 500r/min离心5min,取上清液进行NAG、mALB、α_1-MG、β_2-MG检测。结果尿糖阴性组、尿糖组NAG、mALB、α_1-MG、β_2-MG均高于对照组(P0.05),尿糖组上述4项指标均高于尿糖阴性组(P0.05);蛋白20、30组上述4项指标均高于对照组(P0.05);晚期妊娠组上述4项指标均高于对照组(P0.05)。结论尿液常规检查尿糖、尿蛋白阴性的孕妇,肾脏损伤指标NAG、mALB、α_1-MG、β_2-MG水平较低,随着尿糖、尿蛋白的增多,指标相应升高;晚期妊娠较早、中期妊娠者肾脏损伤程度更严重。     

同种异体肾移植患者肾功能变化与叶间动脉阻力指数和搏动指数变化的相关性分析

目的运用彩色多普勒超声测量移植肾叶间动脉的阻力指数(RI)和搏动指数(PI),观察两者的变化情况与肾功能变化的关系。方法在100例无并发症肾移植患者中,应用彩色多普勒超声,于肾移植术后1月测量移植肾叶间动脉的RI和PI。测定患者血清肌酐、非蛋白氮及血白蛋白,根据MDRD公式计算肾小球滤过率(GFR)。随访2年后再行一次上述超声和肾功能检查,比较叶间动脉RI、PI和肾功能的变化情况,作RI、PI变化值与GFR变化值的相关性分析。结果叶间动脉的RI和PI在随访前后与GFR无明显的相关,随访前后RI和PI的改变与GFR的改变呈明显的负相关。100例患者中,21例患者出现了肾功能异常,79例的肾功能仍然正常。根据2年后的肾功能有无异常将患者分为GFR正常组和GFR异常组。两组随访前后叶间动脉的RI和PI变化与GFR变化呈明显的负相关。结论多普勒彩超动态监测移植肾叶间动脉的RI和PI变化能够预测移植肾肾功能的变化。     

Doppler ultrasound examination of the renal artery in healthy women, normotensive pregnant women and in pre-eclampsia.

A combination of real-time linear array ultrasound scanning and pulsed Doppler ultrasonography was used to record blood flow signals from the right renal artery in 17 healthy women, in 15 normotensive pregnant women and in I7 women with pre-eclampsia. The maximum blood velocity waveforms were analyzed for pulsatility index and systolic/diastolic ratio (S/D ratio). As compared with the two healthy groups, in pre-eclamptic women the pulsatility index was slightly lower (p < 0.05), and the systolic/diastolic ratio non-significantly different. These variables were unrelated to mean arterial pressure or the degree of proteinuria. A theory of renal arteriovenous shunts in pre-eclampsia is proposed. Doppler ultrasound examination of the renal artery would seem to be of limited value-for the purpose of monitoring renal vascular pathology in pre-eclampsia.     

The interpretation of uterine artery pulsatility index in normal and hypertensive pregnancy.

The Doppler flow velocity pulsatility index (PI) of the uteroplacental vascular bed is of debatable value for the interpretation of hemodynamic changes, when these are due both to pathological alterations in the vasculature, as in mild pre-eclampsia, and to physiological adjustments to vasoactive substances. The aim of this study was to apply a mathematical model, which includes maternal pulse pressure and mean arterial pressure, to the PI and to investigate whether this formula would add information with respect to discrimination between normal women and those with mild or severe pre-eclampsia. The subjects were patients with mild (n = 41) and severe (n = 34) pre-eclampsia and, as a control group, healthy pregnant women (n = 46). The uterine artery PI was studied by spectral Doppler analyses and compared to a P(z) value, theoretically representing a 'back pressure' in the uteroplacental circulation. Additionally, P(z) values were computed from earlier data concerning the dynamic circulatory effects of dihydralazine and acute volume expansion. The basal PI was significantly higher in the severely pre-eclamptic patients but not in the mildly pre-eclamptic patients compared to the controls. However, the P(z) was significantly higher in patients with both mild (p < 0.001) and severe pre-eclampsia (p < 0.0001) compared to the normal group. In the severely pre-eclamptic patients receiving dihydralazine, the P(z) tended to decrease (p = 0.07), in contrast to the volume-expansion group where P(z) was unaffected by the procedure. In conclusion, it seems that including measurement of the mean arterial pressure and pulse pressure with the PI adds valuable information about the circulatory status in this particular vasculature, regarding both 'basal' values and hemodynamic changes.     

Validity of pulsatility and resistance indices in classification of adnexal tumors with transvaginal color Doppler ultrasound.

Transvaginal pulsed color Doppler ultrasound was used to examine 72 patients with a pelvic mass preoperatively. Tumor morphology was assessed, prominent areas of vascularization within the tumor were observed and the pulsatility index and the resistance index of tumor and uterine arteries were measured. Flow velocity waveforms with low pulsatility are considered to reflect neovascularization. The ultrasound diagnoses were compared with histopathological or cytological diagnoses. There were 61 benign, eight malignant and three borderline cases. In 75% of the malignant and 23% of the benign tumors, an intratumoral flow with a low pulsatility was detectable. The mean pulsatility index of tumor blood vessels was 1.2 in benign, 0.7 in malignant and 0.6 in borderline neoplasms. The corresponding mean resistance index values were 0.6, 0.5 and 0.5. The differences were not significant and the overlap between the malignant and benign lesions was large. The pulsatility index and resistance index of uterine arteries were significantly decreased in malignant tumors. The results show that, using a cut-off resistance index value of 0.6, the sensitivity and specificity of color Doppler in the detection of malignant and potentially malignant tumors were 82% and 72%, respectively. However, a practical cut-off level for either pulsatility or resistance indices, that could assist in differentiating between malignant or benign lesions, does not seem to exist.     

Effects of oophorectomy and hormone replacement therapy on the pulsatility indices of hepatic and renal arteries.

OBJECTIVE: To investigate the flow velocity waveform changes of the hepatic and renal arteries in women with surgical menopause who received hormone replacement therapy versus those who did not. METHODS: Eighty women who had undergone surgical menopause were divided into 2 groups. The first group (n = 38) consisted of patients who did not receive estrogen treatments after surgery; patients in the second group (n = 42) did receive treatments. The hepatic and renal arteries of patients in both groups were examined by duplex Doppler ultrasonography before the commencement of hormone replacement therapy and after 2 years of treatment, and the pulsatility indices were calculated. RESULTS: No significant differences were detected in the renal and hepatic artery pulsatility indices of patients in the estrogen treatment group (group 2) before and after total abdominal hysterectomy and bilateral salpingo-oophorectomy (P > .05). No significant differences in preoperative and postoperative hepatic arterial pulsatility indices were detected among patients in group 1 (P > .05). Renal artery pulsatility indices measured before and after total abdominal hysterectomy and bilateral salpingooophorectomy did show a statistically significant difference in group 1 (P < .001). In addition, a statistically significant difference was detected before and after surgery in both groups when pulsatility indices were measured at the second-year control dose. CONCLUSIONS: Hepatic arterial pulsatility indices are not affected in postmenopausal women, but renal artery pulsatility indices rise to some extent in women not receiving hormone replacement therapy.     

Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies.

OBJECTIVES: To calculate the normal range for the fetal middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio in the third trimester of pregnancy and to assess its value, compared with that of the MCA/umbilical artery PI ratio, in predicting an unfavorable outcome of pregnancies complicated by pre-eclampsia. METHODS: Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was performed. We calculated the ratios between 1) the PI of the MCA and the mean PI value of both uterine arteries and 2) the PI of the MCA and the PI of the umbilical artery. All women were examined at or beyond 26 weeks of gestation. A cross-sectional study of 231 normal pregnancies was conducted to construct the reference range. Values below the 5th percentile or an MCA/umbilical artery PI ratio lower than 1.08 were defined as brain-sparing. A further 115 pregnancies with pre-eclampsia (50 mild and 65 severe) were assessed prospectively and the results were related to perinatal outcome. The accuracy of MCA/uterine artery and MCA/umbilical artery PI ratios for prediction of unfavorable pregnancy outcome was compared. RESULTS: Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n=15) and 46% of the severe (n=30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile. However, there was no difference between the groups in the rate of low 5-min Apgar scores, admission to the neonatal intensive care unit, or deliveries before 34 weeks. The MCA/uterine artery and MCA/umbilical artery PI ratios were similar in the prediction of adverse perinatal outcome. Both ratios were better at predicting the outcome of pregnancy than were signs of increased vascular impedance in either the umbilical or uterine arteries. CONCLUSIONS: Normal MCA/uterine artery PI ratio decreases with gestational age. Abnormally low MCA/ uterine artery PI ratios are related to unfavorable pregnancy outcome. The predictive value of the MCA/uterine artery PI ratio is similar to that of the MCA/umbilical artery PI ratio.     

The minimum number of cardiac cycles necessary for calculation of renal blood flow velocity indices in pregnant and non-pregnant women.

In this study Doppler ultrasound was used to measure the blood flow velocity in the main and segmental renal arteries in 16 healthy non-pregnant women. There were no differences in blood flow indices between the right and left kidneys as well as between the main and segmental arteries. The variability of the indices in the main and segmental renal arteries in healthy non-pregnant and in the segmental renal artery in normal pregnant women (32-37 weeks of gestation) was investigated. The within-patient error standard deviations of ten cycles and two, and three to nine averaged cycles were compared. In non-pregnant women, values for the error standard deviation comparable with those obtained from ten cycles for the systolic/diastolic ratio and pulsatility index from both main and segmental arteries were obtained by averaging from five to six consecutive cycles, while the error standard deviation for the resistance index stabilized when averaging only two to four cycles. In pregnant women, the error standard deviations for both the systolic/diastolic ratio and pulsatility index reached quite stable values after three cycle had been averaged as did the error standard deviation for the resistance index. We speculate that this difference between non-pregnant and pregnant women is due to more favorable conditions for renal visualization and consequently higher quality Doppler signals during pregnancy. A knowledge about the number of cardiac cycles required for an accurate calculation of renal blood flow velocity indices may prevent time-consuming calculations and inaccurate conclusions.     

Changes in umbilical artery,middle cerebral artery,and aorta blood flow Doppler waveform pulsatility indices after funisocentesis

This study evaluates the effect of funisocentesis on umbilical artery, fetal cerebral artery, and aortic circulation. The pulsatility index in the umbilical artery, fetal middle cerebral artery, and descending aorta was measured by pulsed Doppler ultrasonography before and after 41 diagnostic funisocenteses. Percutaneous umbilical artery blood sampling was associated with a significant decrease in umbilical artery pulsatility index (mean -0.132, standard deviation 0.259, P = 0.002) and in middle cerebral artery pulsatility index (mean -0.143, standard deviation 0.260, P = 0.001). The decline in resistance to flow of the umbilical artery (r = 0.340, P = 0.029) and middle cerebral artery (r = 0.457, P = 0.002) was correlated with gestational age at sampling. These findings suggest that alterations in the waveforms from both the umbilical and the fetal cerebral circulations can be induced by fetal blood sampling.     

正常妊娠妇女血D-二聚体的检测

目的:检测正常孕妇的血浆D-二聚体(D-D)水平,观察其在不同孕期的变化。方法:采用免疫比浊法检测222名不同孕期妇女及60名正常非孕妇女(正常非孕组)血中D-D质量浓度,并分析结果。结果:早孕组与正常非孕组比较,血浆D-D水平差异无统计学意义(P>0.05),而中孕组、晚孕组及产褥期组与正常非孕组比较,血浆D-D水平差异有统计学意义(P<0.05),中孕组与早孕组、晚孕组与中孕组比较,差异亦有统计学意义(P0.05)。结论:随着孕期发展,妊娠妇女血中D-D水平呈上升趋势,检测D-D有助于预测和判断高凝状态和纤溶活性。     

正常妊娠妇女血清瘦素水平测定及临床意义

目的探讨正常妊娠妇女血清瘦素水平的变化及其临床意义.方法测定89例正常妊娠妇女(研究组)和18例年龄、体重等指数相近的正常非孕妇女(对照组)的血清瘦素水平,并分析瘦素水平与孕妇的孕周、体重及体重指数的相关性.结果①研究组瘦素水平为(14.9±7.2)g/L,对照组瘦素水平为(7.88±4.32)μg/L,两组比较,有显著性差异(P＜0.01).相关分析显示,孕妇血清瘦素水平与其孕周有相关性,随孕周增加,血清瘦素水平逐渐上升;②妊娠晚期妇女血清瘦素水平与体重及体重指数明显正相关(r分别为0.33、0.35,P＜0.05);③对照组妇女血清瘦素水平与其体重、体重指数明显正相关(r分别为0.72、0.75,P＜0.001).结论正常妊娠妇女除妊娠时胎盘能够分泌一定量瘦素外,妊娠时的激素变化也能刺激脂肪组织合成瘦素,可能与妊娠期间瘦素水平升高有关.     

Pulsatility and resistance indices in intrarenal arteries of normal adults

In order to establish the normal range of values of Pulsatility (PI) and Resistance (RI) Indices in the intrarenal vasculature, a study of 50 healthy volunteers (23 males, 27 females), divided into five groups of 10 according to age, was performed with Duplex Doppler ultrasound. Both kidneys were examined in all individuals and, in 12, indices were also compared between upper and lower poles of both kidneys. In addition, repeat examinations were performed in nine subjects on three different days, in order to assess the reproducibility of the method. No differences were found in the mean values of both indices between males and females, upper and lower poles, right and left kidneys. A statistically significant increase (p < 0.01, unpaired t-test) was demonstrated when the oldest age group (7th decade) was compared to the youngest age group (3rd decade). The method appeared remarkably reproducible for RI (4.2–7%), with wider variation in the PI (9.5–22.7%).     

Doppler ultrasound evaluation of advanced portal vein pulsatility in patients with normal echocardiograms

The hypothesis tested that mechanisms other than retrograde transsinusoidal fluid wave transfer reported in patients with right heart failure are responsible for the ultrasonographic sign of advanced portal vein pulsatility (APP). Within a time-period of 3 years we have seen 13 patients with APP, defined as temporary portal flow reversal in the face of a normal echocardiogram. Nine of these patients had biopsy-proven liver cirrhosis and four with liver disease were without cirrhosis or cardiac pathology. A randomly selected control group of 18 healthy subjects was studied. Doppler ultrasound evaluation of the hepatic veins as well as the intra and extrahepatic portal vein territories was performed in both groups. Hepatopetal portal flow with APP reversed to hepatofugal flow in follow up studies in two patients. In another two hepatopetal flow with APP in the main portal vein and hepatofugal flow in the intrahepatic portal radicles was recorded during the same examination. The remaining group displayed APP in the intra and extrahepatic portal vein territories. None of the normal subjects presented with APP. Hepatic venous outflow obstruction associated with excessive arterioportal shunting is likely to account for APP of all of our patients. Based on a causal link between angiographic ‘to-and-fro’ flow pattern and the sonographic APP sign in patients with sinusoidal outflow obstruction we suggest, that APP expresses a short, transitional period of portal hypertension just before the occurence of flow reversal.     

Uterine-umbilical artery Doppler velocimetry in pregnant women with systemic lupus erythematosus.

We evaluated continuous wave uterine-umbilical artery Doppler velocimetry for predicting pregnancy outcome in women with systemic lupus erythematosus (SLE). Lupus anticoagulant (LAC) and anticardiolipin (ACL) antibody status also were correlated with Doppler results and outcome. Three Doppler vascular patterns were identified in 27 pregnancies of 26 women with SLE. Patients with normal flow velocity in both vessels had normal outcomes (n = 18). Reduced flow velocity of the umbilical artery only was present in five women, whose newborn infants were of lesser gestational age and birthweight, two being small for gestational age. In four pregnancies reduced flow velocity was noted in both vessels. These cases had the poorest outcome, with three perinatal losses and all fetuses being small for gestational age. Doppler velocimetry showed 100% sensitivity and negative predictive value in the detection of the small for gestational age fetus and abnormal antepartum fetal heart rate tracing. Fourteen of 18 women with normal Doppler studies did not have preeclampsia or SLE flare-ups, whereas all nine women with abnormal Doppler studies had such complications. In all 27 pregnancies the women were screened for LAC, and 21 women also were tested for the ACL antibody. Poor correlation was found between antiphospholipid antibody status and Doppler results in three of the six pregnancies with positive antibody testing the patients had normal Doppler studies and outcomes. Thus, Doppler velocimetry may help determine when these substances will affect the outcome adversely. In this study the umbilical-placental vascular system was affected more often. Uterine-umbilical arterial Doppler velocimetry uniquely identified the fetus at risk for adverse perinatal outcome in pregnancies complicated by SLE. Thus, it is a potentially valuable tool in clarifying the pathophysiology and in the management of SLE in pregnancy.     

石家庄地区正常妊娠妇女甲状腺功能指标正常值范围探讨

目的 通过测定石家庄地区妊娠女性在妊娠各个时期血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)以及血清促甲状腺激素(TSH)的水平,建立该地妊娠妇女的特异性正常参考值范围。方法 试验组按筛选标准纳入妊娠妇女442例,对照组按入组标准纳入健康非妊娠育龄妇女123例。血清FT3、FT4、TSH采用免疫发光化学法测定,按不同孕周分层后对化验指标进行统计分析。结果 血清FT3在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为:3.39~5.97 pmol/L,3.39~5.14 pmol/L,2.91~5.03 pmol/L;血清FT4在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为:12.72~18.15 pmol/L,8.81~17.15 pmol/L,6.65~16.82 pmol/L;血清TSH在妊娠早期、妊娠中期、妊娠晚期的参考值范围分别为:1.24~2.46 mU/L,1.46~3.13 mU/L,1.75~3.47 mU/L。按照该参考值为标准,妊娠期临床甲状腺功能减退症(甲减)患病率0.5%,亚临床甲减患病率3.6%,单纯低T4血症的患病率2.0%,TPOAb阳性患病率6.8%。结论 石家庄地区正常妊娠妇女血清甲状腺激素水平正常范围的制定有利于妊娠期甲状腺功能异常疾病的正常诊断和治疗。