| Pregnancy-induced hypertension(PIH)is a common disorder complicating main clinical features of high blood pressure,proteinuria and edema after 20 weeks of pregnancy,which can eventually result in the risk of maternal and infant,the damage of target organs and postpartum lifetime of hypertension after delivery on pregnant women with main pathophysiological changes of small arteries spasm systemically.The onset of PIH is earlier while its pathogenesis is not obvious,but PIH can affect multiple organs during middle-late pregnancy.Heart,brain,kidney and so on are the most common target organs which could be important risk factors on pregnant women and fetuses.It is of great significance for PIH patients to reduce the risk of maternal and infant and to identify high-risk patients earlier by assessing hemodynamic changes of peripheral target vessels(including uterine arteries?interlobular arteries and middle brain arteries)comprehensively.Objective1.To explore features of hemodynamic changes on bilateral uterine arteries(UA),renal interlobular arteries(IRA)and middle cerebral arteries(MCA)of PIH patients.2.To discuss the value of hemodynamic indexes of UA on predicting the prognosis of adverse outcomes combined with a number of clinical data from PIH patients.Method87 PIH singleton patients in middle-late pregnancy(23 PIH patients with gestational hypertension,12 PIH patients with mild preeclampsia,42 PIH patients with severe preeclampsia and 10 PIH patients with chronic hypertension with severe preeclampsia.)were enrolled in this study as subjects(the age range was from 16 to 48 years old with the average range of 31.02±4.91 years)during May 2016 to August 2016 from The northwest women and children hospital(PIH group;n=87).The range of gestational weeks was from 22 to 41 weeks old with the average range of 35.53±4.29 weeks.67 normal singleton pregnancy women(the age range was from 22 to 43 years old with the average range of 29.78±3.55 years)in the same antenatal period with general materials matched were enrolled in as the control group(NP group;n=67).The range of gestational weeks was from 23 to 41 weeks with the average range of 34.33±4.26 weeks.The standard reference of PIH diagnosis and classification is from obstetrics and gynecology.Doppler spectrum parameters of bilateral UA,IRA and MCA were detected by Color doppler flow imaging(CDFI): resistivity index(RI),pulsatility index(PI),the ratio of the peak systolic flow velocity and end-diastolic flow velocity(S/D),minimum diastolic flow velocity(MDV),end-diastolic flow velocity(EDV),peak systolic flow velocity(PSV),accelerating index(AI),accelerating time(AT),time-averaged peak or maximum velocity(TAPV or TAMAX)and time-averaged mean velocity(TAMEAN).The mean value of each parameter was calculated from the left and right sides of three stable consecutive spectrums and the bilateral average value of the index was taken for statistically analysis.All pregnant women were followed-up.87 PIH patients were divided into benign outcomes group and adverse outcomes group according to the termination of delivery.To screen the risk factors of adverse outcomes of PIH patients by creating polynomial logistic regression analysis;p<0.05 was considered statistically significant.Result1.Compared with the hemodynamic parameters of peripheral vessels between NP group and PIH group: PI,RI and S/D of the uterine artery in PIH group were significantly increased while PI,RI and S/D of the middle cerebral artery were significantly decreased compared with NP group(p(27)0.05)respectively,However,the change of parameters of the interlobular artery was not significant(p(29)0.05).2.The analysis of ROC curve on predicting PIH with the hemodynamic parameters of peripheral vessels: 1)On the uterine artery: when the predicted cut-off value of PI was 0.94,the prediction sensitivity and specificity of adverse outcomes were 47.1% and 97% respectively;when the predicted cut-off value of RI was 0.49,the prediction sensitivity and specificity of adverse outcomes were 59.8% and 85.1% respectively;when the predicted cut-off value of S/D was 1.98,the prediction sensitivity and specificity of adverse outcomes were 60.9% and 83.6% respectively;when the predicted cut-off value of AI was 645 cm/s2,the prediction sensitivity and specificity of adverse outcomes were 81.6% and 68.7% respectively.2)On the middle cerebral artery: when the predicted cut-off value of PI was 0.73,the prediction sensitivity and specificity of adverse outcomes were 52.2% and 64.4% respectively;when the predicted cut-off value of RI was 0.48,the prediction sensitivity and specificity of adverse outcomes were 61.3% and 57.5% respectively;when the predicted cut-off value of S/D was 1.99,the prediction sensitivity and specificity of adverse outcomes were 52.2% and 47.8% respectively.3.The analysis of ROC curve on predicting SPE with the hemodynamic parameters of peripheral vessels: 1)On the uterine artery: when the predicted cut-off value of PI was 0.96,the prediction sensitivity and specificity of adverse outcomes were 71.2% and 96.1% respectively;when the predicted cut-off value of RI was 0.53,the prediction sensitivity and specificity of adverse outcomes were 73.1% and 92.2% respectively;when the predicted cut-off value of S/D was 2.31,the prediction sensitivity and specificity of adverse outcomes were 69.2% and 95.1% respectively;2)The parameters of MCA were not feasible to predict SPE.4.PIH patients(72.4%)presented adverse outcomes during the followed-up period.The proportion of severe preeclampsia in adverse group increased significantly compared with the benign group(58.7%vs.20.8%,p=0.003).In adverse group,patients were more likely to have the early diastolic notch in both sides of uterine arteries compared to the patients in benign group(39.7%vs.16.7%,p=0.042).The PI?RI and S/D values of UA were increased significantly in PIH patients presented adverse outcomes in late pregnancy(p<0.05);when the predicted cut-off value of PI was 0.97,the prediction sensitivity and specificity of adverse outcomes were 50.8% and 83.8% respectively;when the predicted cut-off value of RI was 0.51,the prediction sensitivity and specificity of adverse outcomes were 63.5%and 70.8%respectively;when the predicted cut-off value of S/D was 2.1,the prediction sensitivity and specificity of adverse outcomes were 65.1%and 70.8%respectively;The polynomial logistic regression analysis showed that RI>0.51 was the independent predictive factor of adverse outcomes of PIH patients(OR=4.224,P=0.006).Conclusion1.Multiple hemodynamic parameters of UA and MCA on patients with PIH had changed significantly while the change of hemodynamic parameters of IRA had no significance.2.The changes of hemodynamic parameters(PI,RI and so on)of UA and MCA were in different trends in patients with PIH which inffered that it may have certain difference in perfusion of target organs on PIH patients.3.The hemodynamic parameters of UA(PI,RI and so on)could predict PIH and SPE.It had medium prediction efficiency to predict PIH while it might have higher prediction efficiency to predict SPE by those indexes.The hemodynamic parameters of MCA(PI,RI and S/D)could predict PIH which had lower prediction efficiency than the parameters of UA and it wasn't feasible to predict SPE by those indexes.4.The hemodynamic indexes of UA(PI,RI,S/D and so on)have certain significance for the prognosis of PIH and RI could be the independent predictive factor of adverse pregnancy outcomes. |
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