作者：S. H. Bao, et al.
翻译：重庆医科大学附属第一医院 杨涓
译者简介：女，博士，重庆医科大学附属第一医院中西医结合科主治医师。毕业于天津中医药大学中西医结合妇科专业，现任重庆市医师协会风湿免疫科医师分会第一届委员会免疫相关生殖疾病学组委员，承担重庆市卫生局科研课题1项，发表SCI及CSCD论著数篇。擅长常见、多发风湿性疾病病的诊治，能够熟练处理风湿病危重症，擅长中西医结合妇科内分泌疾病及不孕症的诊治。
【摘要】
多普勒超声检测子宫动脉阻力指数（URa-RI）可以反映子宫胎盘循环的变化，并与妊娠早期的不良事件相关。复发性流产（RPL）与血栓形成倾向相关，低分子肝素抗凝治疗可改善RPL和血栓形成倾向女性的妊娠结局。一项回顾性队列研究在139名有3次或3次以上RPL且有血栓形成倾向的孕妇中进行。
分析了116例活产婴儿孕妇和23例流产孕妇的妊娠结局与URa-RI动态变化之间的关系。
患者接受了低分子肝素、小剂量阿司匹林（每天81mg）和泼尼松治疗。在排卵期间、妊娠试验阳性时测定URa-RI，然后每两周重复一次，直到妊娠32周或流产为止。
在妊娠8周时，流产孕妇的URa-RI明显高于活产婴儿孕妇(0.51±0.08 vs. 0.42±0.03,P<0.001)。受试者特征曲线分析表明，妊娠8周时的URa-RI有效地将流产的孕妇和活产的孕妇区分开来，前者的曲线下面积为82.6%(95%CI69.01-97.17)。
在校正了包括年龄、BMI和流产次数在内的协变量之后，多重逻辑回归模型显示，妊娠8周的URa-RI每升高0.1个单位，流产风险就会增加18.70分（OR 19.70, 95％可信区间4.26-91.1，P<0.001），与那些URa-RI < 0.45的孕妇相比，URa-RI≥0.45的孕妇流产的OR为49.48 (95% CI8.01 - 307.95; P < 0.001)。在患有RPL和遗传性血栓倾向的女性中，在抗凝治疗期间，妊娠8周时URa-RI增加与自然流产相关，而与其他危险因素无关。
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