剪切波弹性成像、超声微血管成像技术及子宫动脉多普勒超声血流成像在子痫前期孕晚期孕妇中的应用价值

The Application Value of Shear Wave Elastography, Ultrasound Microvascular Imaging Technology and Uterine Artery Doppler Ultrasound Blood Flow Imaging in Pregnant Women with Preeclampsia in the Third Trimester

摘要: 目的：探讨胎盘剪切波弹性成像、超声微血管成像技术及子宫动脉多普勒超声血流成像在子痫前期孕晚期孕妇中的应用价值。方法：回顾性选取2023年1月至2025年1月我院产检并住院分娩的180例孕晚期妊娠妇女(子痫前期组80例，正常组100例)，使用剪切波弹性成像(SWE)测量两组孕妇前壁胎盘弹性值；采用频谱多普勒检测子宫动脉血流动力学参数(RI, S/D, PI)，并同步进行微血管成像(VFI)评估胎盘灌注情况，记录两组孕妇脐动脉血流(S/D)、搏动指数(PI)、阻力指数(RI)以及胎盘血管化指数(VI)，依据妊娠结局差异，将子痫前期(PE)孕妇划分为：不良结局组(n = 25)与良好结局组(n = 55)，Logistic回归分析各参数与胎儿不良结局的关系。绘制ROC曲线，分析各指标对PE组孕妇不良妊娠结局的预测价值。结果：PE组孕妇胎盘弹性、脐动脉血流、子宫动脉各血流参数均高于正常组，胎盘血管化指数(VI)低于正常组(P < 0.05)。PE组中不良组胎盘弹性、脐动脉血流S/D、PI、RI，以及子宫动脉阻力指标(S/D, PI, RI)异常升高，同时伴随微血管灌注量(VI)下降，组间差异具有临床显著性(P < 0.05)，Logistic回归分析显示，胎盘平均弹性、脐血流PI，子宫动脉S/D、RI、胎盘VI值都为导致子痫前期晚孕期孕妇不良结局的主要因素。ROC曲线分析结果显示，胎盘平均弹性，脐动脉血流PI，胎盘血管化指数VI，子宫动脉S/D、RI预测不良妊娠结局的曲线下面积(AUC)分别为0.780、0.670、0.771、0.621、0.760 (P < 0.05)。结论：在孕晚期子痫前期患者中，通过胎盘弹性联合超声微血管成像技术监测血流相关参数，结合子宫动脉的各项血流参数变化对妊娠结局预测具有重要的临床参考价值。

Abstract: Objective: To explore the application value of placental shear wave elastography, ultrasound microvascular imaging technology and uterine artery Doppler ultrasound blood flow imaging in pregnant women with preeclampsia in the third trimester. Method: A retrospective selection was made of 180 pregnant women in the third trimester who underwent prenatal examinations and delivered in our hospital from January 2023 to January 2025 (80 cases in the preeclampsia group and 100 cases in the normal group). Shear wave elastography (SWE) was used to measure the placental elasticity values of the anterior wall in the two groups of pregnant women. The hemodynamic parameters of uterine arteries (RI, S/D, PI) were detected by spectral Doppler, and microvascular imaging (VFI) was simultaneously performed to evaluate placental perfusion. The umbilical artery blood flow (S/D), pulsatility index (PI), resistance index (RI), and placental vascularization index (VI) of the two groups of pregnant women were recorded. According to the differences in pregnancy outcomes, pregnant women with preeclampsia (PE) were divided into the poor outcome group (n = 25) and the good outcome group (n = 55), Logistic regression analysis was conducted to explore the relationship between each parameter and adverse fetal outcomes. The ROC curve was plotted. The predictive value of each index for adverse pregnancy outcomes is analyzed in pregnant women of the PE group. Results: The placental elasticity, umbilical artery blood flow, placental vascularization index (VI), and various blood flow parameters of the uterine artery in the PE group of pregnant women were all higher than those in the normal group (P < 0.05). In the PE group, the placental elasticity, umbilical artery blood flow S/D, PI and RI, and uterine artery S/D, PI and RI in the poor group were all higher than those in the control group, and VI was lower than that in the control group. The differences were statistically significant (P < 0.05). In the PE group, the placental elasticity, umbilical artery blood flow S/D, PI, RI, as well as uterine artery S/D, PI, and RI were significantly higher than those in the control group, while the VI was lower than that in the control group, and the differences were statistically significant (P < 0.05). Logistic regression analysis indicated that the average elasticity of the placenta, umbilical blood flow PI, uterine artery S/D, RI, and placental VI values were all the main factors leading to adverse outcomes in late pregnancy for preeclamptic pregnant women. The results of ROC curve analysis showed that the areas under the curve (AUC) for predicting adverse pregnancy outcomes by the average elasticity of the placenta, umbilical artery blood flow PI, placental vascularization index VI, uterine artery S/D, and RI were 0.780, 0.670, 0.771, 0.621 and 0.760 respectively (P < 0.05). Conclusion: In patients with preeclampsia in the third trimester of pregnancy, monitoring blood flow-related parameters through placental elasticity combined with ultrasound microvascular imaging technology, and combining the changes in various blood flow parameters of the uterine artery to predict pregnancy outcomes has important clinical reference value.