作者：S. H. Bao, et al.
翻譯：重慶醫科大學附屬第一醫院 楊涓
譯者簡介：女，博士，重慶醫科大學附屬第一醫院中西醫結合科主治醫師。畢業於天津中醫藥大學中西醫結合婦科專業，現任重慶市醫師協會風濕免疫科醫師分會第一屆委員會免疫相關生殖疾病學組委員，承擔重慶市衛生局科研課題1項，發表SCI及CSCD論著數篇。擅長常見、多發風濕性疾病病的診治，能夠熟練處理風濕病危重症，擅長中西醫結合婦科內分泌疾病及不孕症的診治。
【摘要】
都卜勒超聲檢測子宮動脈阻力指數（URa-RI）可以反映子宮胎盤循環的變化，並與妊娠早期的不良事件相關。復發性流產（RPL）與血栓形成傾向相關，低分子肝素抗凝治療可改善RPL和血栓形成傾向女性的妊娠結局。一項回顧性隊列研究在139名有3次或3次以上RPL且有血栓形成傾向的孕婦中進行。
分析了116例活產嬰兒孕婦和23例流產孕婦的妊娠結局與URa-RI動態變化之間的關係。
患者接受了低分子肝素、小劑量阿司匹林（每天81mg）和潑尼松治療。在排卵期間、妊娠試驗陽性時測定URa-RI，然後每兩周重複一次，直到妊娠32周或流產為止。
在妊娠8周時，流產孕婦的URa-RI明顯高於活產嬰兒孕婦(0.51±0.08 vs. 0.42±0.03,P<0.001)。受試者特徵曲線分析表明，妊娠8周時的URa-RI有效地將流產的孕婦和活產的孕婦區分開來，前者的曲線下面積為82.6%(95%CI69.01-97.17)。
在校正了包括年齡、BMI和流產次數在內的協變量之後，多重邏輯回歸模型顯示，妊娠8周的URa-RI每升高0.1個單位，流產風險就會增加18.70分（OR 19.70, 95％可信區間4.26-91.1，P<0.001），與那些URa-RI < 0.45的孕婦相比，URa-RI≥0.45的孕婦流產的OR為49.48 (95% CI8.01 - 307.95; P < 0.001)。在患有RPL和遺傳性血栓傾向的女性中，在抗凝治療期間，妊娠8周時URa-RI增加與自然流產相關，而與其他危險因素無關。
附原文：
Uterine radial arteryresistance index (URa-RI) by Doppler ultrasoundmay reflect the changes in the uteroplacentalcirculation and be associated with adverse events in early pregnancy. Recurrent pregnancy losses (RPL) are associated with thrombophilia, and anticoagulation treatment with low molecular weight heparin improves pregnancy outcome in women with RPL and thrombophilia.
Aretrospectivecohortstudywasconductedin139pregnantwomenwith3ormoreRPLandthrombophilia.The relationship between pregnancy outcome and dynamic changes of URa-RI was analyzed in 116 women who delivered a liveborn infant and 23 who miscarried the index pregnancy.Patients were on preconception low molecular weight heparin,low-dose aspirin (81mg per day), and prednisone treatment. URa-RI was measured during periovulation time, at the time of positive pregnancy test, and then repeated every two weeks until 32-week gestation or the time of miscarriage. The URa-RI at 8-week gestation was significantly higher in women who miscarried the index pregnancy than those who delivered alive born infant (0.51±0.08 vs. 0.42±0.03, P<0.001).Receiver operating characteristic curve analysis demonstrated that URa-RI of 8 wk gestation effectively distinguished women who miscarried from those who had a live birth with an area under the curve of 82.6%(95%CI69.01-97.17).After adjusting for covariates including age,BMI,and number of miscarriages, multiple logistic regression models showed that each 0.1 unit increase of URa-RI of 8 wk gestation was associated with 18.70-point increase in the risk of miscarriage(OR19.70,95%CI 4.26-91.1,P<0.001),and women with an URa-RI≥0.45 had an OR of 49.48(95%CI8.01-307.95;P<0.001) for miscarriage compared to those who had URa-RI<0.45.In women with RPL and inherited thrombophilia, increased URa-RI at 8-week gestation was associated with spontaneous abortion independent of other risk factors while they were on anticoagulation treatment.
引自：
S. H. Bao, N. Chigirin,V. Hoch,et al. Uterine Radial Artery Resistance Index Predicts Reproductive Outcome in Women with Recurrent Pregnancy Losses and Thrombophilia，BioMed Research International，2019（4）:1-11