子宮動脈血流偵測子癲前症之風險

Diagnostic Performance of First Trimester Screening of Preeclampsia Based on Uterine Artery Pulsatility Index

彭賢雯(PENG,HSIEN WEN)

指導教授 ： 張振榮

中臺科技大學/健康科學院/醫學影像暨放射科學系暨研究所/碩士(2020年)

摘要

研究目的:子癲前症為全球孕產婦死亡的三大主因，它所帶來的併發症也影響了全球衛生單位醫療成本，包含新生兒短期與長期的疾病，母體慢性病的發生。因此要如何降低它的發病率與死亡率是每位婦產科專家學者共同的目標。方法:本研究收集了2015 年至2018 年在臺中榮總350 位產檢婦女，使用GE Vluson S6 超音波，在初期妊娠11 週又0 天至13 週又6 天時測兩側子宮動脈血流脈動係數平均值，進而了解血流阻力，並與孕婦年齡、身體質量指數、生產週數、新生兒體重與子癲前症發生做統計上的分析，找尋其關聯性。結果:ROC 曲線顯示，子宮動脈血流阻力與子癲前症有良好的AUC 面積(0.835，95% CI:0.84-0.36)，代表診斷準確性較佳，另外使用獨立樣本T 檢定發現子宮動脈血流阻力、出生週數、新生兒體重都有統計上顯著意義(P value<0.05)，與國際研究子癲前症使孕婦提早分娩，新生兒體重低的論點不謀而合。結論:使用彩色血流都卜勒超音波偵測子宮動脈血流阻力參數，與子癲前症發生有相當的關連，可以用來偵測降低或預防疾病的發生。

關鍵字

超音波 ； 子宮動脈血流阻力 ； 子癲前症

並列摘要

Objective: Preeclampsia is one of the three main causes of maternal mortality in the world, and its complications also impact on the medical cost of health providers globally, including short-term and long-term illnesses of new-borns and maternal chronic morbidity. Therefore, how to reduce the incidence and mortality of preeclampsia is the common goal of every obstetrics and gynaecology specialist and researcher. Methods: Selected 350 women who received prenatal care in Taichung Veterans General Hospital from 2015 to 2018.The GE Vluson S6 ultrasound was used to measure the mean value of bilateral uterine-artery pulsatility index from 11 weeks and 0 days to 13 weeks and 6 days of early pregnancy to find out the uterine artery resistance. Statistical analysis was performed to detect the correlations between the blood flow resistance and the age and body mass index of the pregnant women, the weeks of pregnancy before delivery, the weights of new-borns and the incidence of preeclampsia. Results: The ROC curve showed that there was a good AUC area (0.835, 95% CI: 0.84-0.36) between the uterine artery resistance and preeclampsia, indicating a good diagnostic accuracy. Moreover, the independent sample t test showed that the uterine artery resistance, the weeks of pregnancy before delivery, and the weights of new-borns were statistically significant (P Value < 0.05), which is consistent with the studies that preeclampsia causes early delivery and low birth weight. Conclusion: The detection by color Doppler ultrasound revealed that uterine artery resistance is closely related to the occurrence of preeclampsia, which can be used to monitor and prevent the occurrence of the disease.

並列關鍵字

Color Doppler ； Uterine Artery Pulsatility Index ； Preeclampsia

參考文獻

1.行政院衛生福利部統計處孕產婦死亡率(2019),取自:https://dep.mohw.gov.tw/DOS/cp-4231-45169-113.html。

2.Lale Say, Doris Chou, Alison Gemmill, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2014; 2: 323–333.

3.Emile R. Mohler, Raymond R. Townsend(2006). Advanced Therapy in Hypertension and Vascular Disease (1th Edition). Canada: Pmph inc.

4.Liona C. Poon, Andrew Shennan, Jonathan A. Hyett , et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention.Int J Gynaecol Obstet.2019; 145: 1-33.

5.Redman CW, Sargent IL. Latest advances in understanding preeclampsia.Science. 2005; 308: 1592–1594.