心肌做功指数在评价帆状胎盘孕妇胎儿心功能中的应用

目的应用心肌做功指数（MPI）评价帆状胎盘孕妇胎儿心功能的变化及与不良妊娠结局的关系。 方法选取2016年1月至2018年12月在北京妇产医院确诊帆状胎盘孕妇70例（帆状胎盘组）,孕周28~40周,同时选取同孕周正常孕妇89例（对照组）,采用t检验比较两组左心室MPI、二三尖瓣口血流速度（E/A比值）及脐动脉搏动指数（UA-PI）、大脑中动脉搏动指数（MCA-PI）和静脉导管搏动指数（DV-PI）。采用ROC曲线分析MPI预测不良妊娠结局,将不良妊娠结局定为如下任意一个：胎儿窘迫、新生儿转ICU、新生儿窒息、呼吸性酸中毒。 结果帆状胎盘组左心室MPI显著高于正常组,差异有统计学意义（t=4.593,P<0.001）;帆状胎盘组UA-PI显著高于正常组,差异有统计学意义（t=-4.142,P<0.05）;帆状胎盘组二尖瓣E/A值、三尖瓣E/A值、MCA-PI、DV-PI与正常组比较,差异均无统计学意义（P均>0.05）。ROC曲线分析显示帆状胎盘组胎儿左心室MPI预测不良结局的ROC曲线下的面积为0.690（95%置信区间为0.580~0.799）。最佳截断值为0.45,其敏感度为83.3%,特异度为38.1%。 结论帆状胎盘孕妇胎儿心功能是降低的,左心室MPI升高在一定程度上与不良妊娠结局显著性相关,从而为监测宫内胎儿安危及改善妊娠结局提供依据。

Myocardial performance index for evaluation of fetal cardiac function in pregnant women with velamentous cord insertion

ObjectiveTo determine whether there are any changes in fetal cardiac function in pregnant women with velamentous cord insertion by using the myocardial performance index and whether there are any influence on perinatal outcome. MethodsSeventy singleton pregnant women diagnosed with velamentous cord insertion at 28-40 weeks of gestation were recruited to the study from January 2016 to December 2018. They were matched with 89 healthy women with normal pregnancies. Using Doppler echocardiography, the modified myocardial performance index (Mod-MPI) and ratios of E wave/A wave peak velocities (E/A) were determined. The Doppler indices of ductus venosus and umbilical and middle cerebral arteries were also determined in both groups. Adverse perinatal outcome was defined as fetal distress, admission to neonatal intensive care unit, neonatal asphyxia, and respiratory acidosis. ResultsThe Mod-MPI (t=4.593, P<0.001) and umbilical artery PI were increased (t=-4.142, P<0.05) in fetuses of pregnant women with velamentous cord insertion compared with controls. The two groups had no significant differences in MV E/A ratio, TV E/A ratio, MCA-PI, or DV-PI (P>0.05 for all). Receiver operating characteristic analysis revealed>0.45 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 83.3%; specificity: 38.1%; area under the curve: 0.690; 95% confidence interval: 0.580-0.799). ConclusionsFetuses of pregnant women with velamentous cord insertion have significantly impaired cardiac function. There is an association between the MPI elevation and adverse perinatal outcome. The Mod-MPI has the potential to provide a theoretical basis for monitoring intrauterine environment.