摘要目的 探讨正常妊娠妇女和妊娠期高血压疾病(HDP)孕妇妊娠早、中、晚期子宫动脉及其胎儿脐动脉血流动态变化的规律.方法 选择2005年4月-2006年7月在四川大学华西第二医院、南京医科大学第一附属医院、首都医科大学附属北京妇产医院、华中科技大学同济医学院附属协和医院和上海交通大学医学院附属仁济医院,行产前检查的正常单胎孕妇1098例,平均年龄(28.3±3.3)岁.在妊娠早期(10～14周)、妊娠中期(20～26周)、妊娠晚期(30～36周)采用彩色多普勒超声(彩超)检测孕妇子宫动脉及其胎儿脐动脉的搏动指数(PI)、阻力指数(RI)和脐动脉收缩压最大血流速度(S)与舒张末期最大血流速度(D)比值(S/D).在孕期发生HDP的孕妇为HDP组,未发生HDP的孕妇为正常妊娠组.结果 (1)HDP发生率:1098例孕妇中,正常妊娠分娩者1054例(正常妊娠组),发生HDP44例(HDP组,其中妊娠期高血压20例,轻度子痫前期15例,重度子痫前期9例),发生率为4.01%(44/1098).(2)子宫动脉血流动态变化:正常妊娠组妊娠早、中、晚期孕妇子宫动脉RI分别为0.64、0.57及0.50,PI分别为1.24、0.98及0.80,S/D分别为3.26、2.58及2.20,3项指标随妊娠进展而逐渐降低,妊娠早、中、晚期分别比较,差异均有统计学意义(P<0.01).HDP组妊娠早、中、晚期孕妇子宫动脉RI分别为0.55、0.67及0.64,PI分别为1.22、1.36及1.20,S/D分别为3.18、3.41及3.05,3项指标中孕中期最高,妊娠早、中、晚期分别比较,差异均有统计学意义(P<0.01).HDP组孕妇妊娠中、晚期子宫动脉RI、PI及S/D均高于正常妊娠组,两组比较,差异有统计学意义(P<0.01).(3)胎儿脐动脉血流动态变化:正常妊娠组妊娠中、晚期胎儿脐动脉RI分别为0.71及0.58,PI分别为1. 16及0.87,S/D分别为3.58及2.48,3项指标随妊娠进展而逐渐降低,妊娠中期与晚期比较,差异有统计学意义(P<0.01).HDP组妊娠中、晚期胎儿脐动脉RI分别为0.71及0.63,PI分别为1.20及0.95,S/D分别为3.71及2.69,3项指标随妊娠进展虽有逐渐降低趋势,但与正常妊娠组比较,差异无统计学意义(P>0.05).结论 随着妊娠进展,正常妊娠妇女子宫动脉的血流阻力逐渐下降,舒张末期血流增加;而HDP孕妇随妊娠进展子宫动脉的血流阻力明显升高;正常妊娠妇女和HDP孕妇随妊娠进展其胎儿脐动脉血流阻力均明显下降.

abstractsObjective To investigate the dynamic changes of uterine artery and umbilical artery in the first, second, and third trimester of normal pregnancy and hypertensive disorders in pregnancy (HDP).Methods A multi-center prospective study was conducted on 1098 women with normal singleton pregnancies at the first prenatal visit in the Second West China Hospital of Sichuan University, First Affiliated Hospital with Nanjing Medical University, Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University, Wuhan Union Hospital Affiliated to Medical School of Huazhong University of Science and Technology and Renji Hospital Affiliated to Medical School of Shanghai Jiao Tong University from April 2005 to July 2006, with the average age of (28. 3±3.3). The pulsatility indices (PI),resistance indices (RI) and systolic to diastolic velocity ratios (S/D) of uterine artery and umbilical artery were measured for all subjects in the first (10th -14th gestationa] weeks), second (20th-26th gestational weeks) and third trimester(30th -36th gestational weeks), respectively. In this longitudinal study, women who developed HDP were classified into HDP group, and the rest into normal pregnancy group. Results (1) Among the 1098 pregnant women, 44 developed HDP during the index pregnancy, including 20 gestational hypertension, 15 mild pre-eclampsia and 9 severe pre-eclampsia, giving an incidence of 4.17%,and the rest 1054 were normal until delivery.(2) In the normal pregnancy group, the RI, PI and S/D of uterine artery were decreased with the progress of pregnancy (RI: 0. 64, 0. 57, 0. 50; PI: 1.24, 0. 98,0. 80; S/D: 3.26, 2. 58, 2. 20; P<0.01). However, the above indices showed an increasing trend with the increase of gestations in the HDP group (RI: 0. 55, 0. 67, 0. 64; PI: 1.22, 1.36, 1.20; S/D: 3.18,3.41,3.05; P <0. 01). In the second and third trimester, the RI, PI and S/D of uterine artery in the HDP group were higher than those in the normal pregnancy group (P<0.01). (3) In the normal pregnancy group, the RI, PI and S/D of the umbilical artery decreased from the secondto the third trimester (RI:0. 71 and 0. 58; PI: 1.16 and 0. 87; S/D: 3.58 and 2. 48; P<0.01). However, no significant difference was found in the RI, PI and S/D value of umbilical artery in the second and third trimester between the normal and HDP group (RI:0.71 and 0.63; PI: 1.20 and 0.95; S/D: 3.71 and 2.69; P>0.05,respectively), despite the decreasing trend in the HDP group. Conclusions In uncomplicated pregnancies,the blood flow resistance of uterine artery decreases and the end-diastolic blood flow of uterine artery increases with the progress of pregnancy. However, in pregnant women with HDP, the blood flow resistance of uterine artery increases significantly with the increase of gestations which shows significant difference to that in normal pregnancies. The blood flow resistance of umbilical artery decreases in both normal and HDP pregnant women with the increasing gestational age.