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目的研究妊娠高血压综合征(PIH)孕妇肾脏叶间动脉(IRA)的血流动力学及24h尿蛋白水平变化规律,探讨它们在预测围产期结局中的诊断价值及对孕妇肾损害的评估。方法选取2010年11月～2011年9月来河北工程大学检查的妊娠晚期妇女,正常妊娠妇女96例(对照组),妊高征患者110例。应用彩超检测孕妇肾脏叶间动脉的PI、RI及S/D,测量双顶径、股骨长度及超声体重,并结合患者24h尿蛋白水平,应用SPSS16.0软件进行统计分析。结果轻度组与对照组PI、RI及S/D值的比较差异无统计学意义(P﹥0.05);中度组与轻度组RI值的比较差异无统计学意义(P﹥0.05);其他各组间的比较差异均有统计学意义(P﹤0.05);各组之间24h蛋白尿水平比较差异有统计学意义(P﹤0.05);孕妇肾脏叶间动脉RI与24h尿蛋白水平呈正相关(r=0.491,P﹤0.05)。重度组与轻度组及对照组双顶径、股骨长,超声体重的比较差异均有统计学意义(P﹤0.05)。结论妊高征孕妇的肾脏叶间动脉的血流阻力增高,造成相应程度的肾损害。与测定24h尿蛋白水平相结合对肾损害的程度判断更为准确。随血压的升高,胎儿双顶径、股骨长,超声体重逐渐减小,胎儿宫内发育迟缓,预测围产期结局不良。
Objective To investigate the changes of hemodynamics and 24-h urinary protein in pregnant women with gestational hypertension (PIH) and to evaluate their diagnostic value in predicting perinatal outcome and assessment of renal damage in pregnant women . Methods From November 2010 to September 2011, 96 pregnant women (control group) and 110 cases of pregnancy induced hypertension (PIH) were enrolled in this study. The PI, RI and S / D of renal arteries in pregnant women were detected by color Doppler ultrasonography. The biparietal diameter, the length of femur and the weight of ultrasound were measured. Combined with the level of urinary protein in 24 hours, SPSS16.0 software was used for statistical analysis. Results There was no significant difference in PI, RI and S / D between mild group and control group (P> 0.05). There was no significant difference in RI between moderate group and mild group (P> 0.05). (P <0.05). There was significant difference in 24h proteinuria between groups (P <0.05). The RI of renal interstitial artery in kidney and urine protein in 24 hours were positive (R = 0.491, P <0.05). There were significant differences between the severe group and the mild group and the control group in biparietal diameter, femur length and ultrasonic weight (P <0.05). Conclusion Pregnancy-induced hypertension in pregnant women’s renal artery blood flow resistance increased, resulting in a corresponding degree of renal damage. With the determination of 24-hour urinary protein levels combined to determine the extent of renal damage more accurately. With the increase of blood pressure, fetus biparietal diameter, femur length, ultrasound weight gradually decreased, fetal intrauterine growth retardation, poor prognosis perinatal outcome.