血流介导的血扩张技术对非妊娠、不同孕期妇女肱动脉的检测

目录英文缩略....... (2)中文摘要 (3)英文摘要 (5)前言 (7)材料与方法 (10)结果 (12)讨论 (19)结论 (24)参考文献 (25)致谢 (28)综述 (29)英文缩略词英文缩写英文全称中文全称FMD Flow-mediated dilation 血流介导的血管扩张GDM Gestational diabetes mellitus 妊娠期糖尿病OGTT Oral glucose tolerance test 口服葡萄糖耐量试验NO Nitric oxide 一氧化氮NOS Nitric oxide syntase 一氧化氮合成酶sGC Soluble guanylate cyclase 可溶性鸟苷酸环化酶PKG Protein kinase G 蛋白激酶G ET Endothelin 内皮素PGI2 Prostacyclin前列环素DDAH Dimethylargininedime- （二甲基精氨酸Thylaminohydrolase 二甲胺水解酶）PRMT Protein arginine methyltransferase 蛋白精氨酸甲基转移酶ADMA Asymmetricdimethylarginine 非对称性二甲基精氨酸血流介导的血管扩张技术对非妊娠、不同孕期妇女肱动脉的检测中文摘要目的：利用血流介导的血管扩张技术（flow-mediated dilation FMD）对正常育龄期非妊娠、早孕期、中孕期、晚孕期妇女及晚孕期妊娠期高血压疾病、晚孕期妊娠期糖尿病妇女肱动脉的血管内皮细胞功能进行检测，发现和探讨正常不同孕期及妊娠期合并高血压疾病、妊娠期合并糖尿病妇女的血管内皮功能的变化；分析FMD对正常妊娠及妊娠期合并高血压疾病、妊娠期糖尿病血管内皮功能评估的意义和价值，为临床诊疗提供参数支持。

方法：采用Aloka-10型彩色多普勒超声诊断仪，配有频率为7.0-12.0MHz的线阵探头,对2012年3月至2014年3月就诊我院的育龄期非妊娠妇女32例（其中15例由同一操作者进行不同时间重复测量）、早孕妇女77例、中孕妇女40例、晚孕期妇女73例（其中正常晚孕38例，妊娠期合并高血压疾病20例，妊娠期合并糖尿病15例）进行肱动脉检测，对比育龄期正常非妊娠、早孕、中孕、晚孕期妇女FMD相关参数的变化特征及晚孕期正常孕妇与妊娠期高血压疾病、妊娠期糖尿病孕妇FMD相关参数的变化特征。

结果进行统计学处理，以P<0.05为差异有统计学意义。

结果：1、肱动脉FMD测值在同一操作者对受试者重复测量条件下的一致性显著。

同一操作者对受试者的FMD重复测量值之间差异无统计学意义。

2、正常非妊娠、早孕、中孕、晚孕组妇女肱动脉的FMD值如下：正常育龄期非妊娠妇女肱动脉FMD平均值±标准差：7.66±2.74%；早、中、晚孕妇女肱动脉FMD平均值±标准差分别为：11.06±3.74%、9.32±3.61%、8.26±3.13%。

早中晚孕期FMD分别比非妊娠期增加了44.39％、21.67％、7.83％。

早孕期组FMD值与非妊娠组、中孕组、晚孕组之间及非妊娠组与中孕组之间差异均具有统计学意义（P<0.05）；余各组（非妊娠组与晚孕组、中孕组与晚孕组）之间差异无统计学意义（P>0.05)。

3、晚孕期妊娠期高血压疾病孕妇肱动脉FMD平均值±标准差为：5.94±3.75%。

晚孕期正常组与妊娠期高血压病组FMD值有显著性差异（t=2.51，P<0.05）。

妊娠期糖尿病孕妇肱动脉FMD平均值±标准差为：5.83±3.81%。

晚孕期正常组与妊娠期糖尿病组FMD差异有显著性（t=2.39，P<0.05）。

但晚孕期妊娠期高血压疾病及妊娠期糖尿病组FMD值差异无统计学意义（t=0.08，P>0.05）；以FMD值为7.40%、7.39%分别作为诊断晚孕期妊娠期高血压疾病、妊娠期糖尿病的阈值，其曲线下面积分别为0. 71、0.73。

结论：1、FMD测量重复性好，E-Tracking模式下的自动跟踪测量血管径避免了测量血管径最大值（加压后血管舒张末期最大内径，Dd2）的时间性依赖、测量者经验性依赖及受试者个体差异性的影响；尽可能减少操作者的主观性，所得的结果客观，真实。

2、正常妊娠时，孕妇肱动脉FMD测值受孕周影响，随着孕周的增加FMD 值下降。

妊娠期高血压疾病及妊娠期糖尿病时，孕妇肱动脉FMD值比正常同孕期FMD值下降，血管反应性下降。

晚孕期妊娠期糖尿病与妊娠期高血压疾病之间FMD 值差异无统计学意义。

3、本研究结果显示，肱动脉FMD测定可反映血管内皮细胞的反应性，其操作省时易行，是无创性评价血管内皮细胞功能的一种可行的方法。

关键词：血流介导的血管扩张肱动脉妊娠期高血压疾病妊娠期糖尿病The detection of Flow-mediated vasodilation in brachial artery of nonpregnant and pregnant womenAbstractObjectiveThe purpose of the detection of flow-mediated vasodilation technology ( FMD) in women,s brachial artery who is non-pregnancy, normal pregnancy, pregnancy- induced hypertension and gestational diabetes mellitus is to discover and explore the changes in vascular function; analysis the meaning and value in assessment of vascular function,and to provide parameters for clinical diagnosis and treatment. MethodsWe performed the examinations with a 7.0-12.0MHz linear transducer ofAloka-10 ultrasound scanner.32 cases non-pregnant women (15cases were repeated measurements by the same operator at different times ), 77 cases of first trimester pregnancy women, 40 cases of second trimester pregnant women, and 73 cases of third trimester pregnancy women ( 38 cases of normal pregnant, 20 cases of pregnant women with hypertensive disorders, 15 cases of gestational diabetes mellitus）between March 2012 and March 2014 were examined.The purpose of the etection is to compare the changes of FMD.The results were statistically analyzed with P<0.05 indicating significant differerces.Results1、The consistency of branchial FMD measurements were significant in the same operator on the the repeated measurement.2、The value of FMD of Normal non-pregnant is 7.66±2.74%, the first,second and third trimester pregnant are 11.06±3.74%,9.32±3.61%,8.26±3.13%.Compared to nonpregancy,FMD of the first,second and third trimester pregnant increased by 44.39% ,21.67%, 7.83%. FMD values between first trimester pregnancy group a nd non-pregnant group, first trimester pregnancy and second trimester pregnancy group ,first trimester pregnancy and third trimester pregnancy were significantdiffererces(P<0.05);the FMD values between other groups were no significant difference (P> 0.05).3、The value of FMD of hypertensive disorders in pregnancy in third trimester pregnancy is 5.94±3.75%. And there was a significant difference (t = 2.51, P <0.05) with normal group in third trimester pregnancy.The value of FMD of gestational diabetes mellitus in third trimester pregnancy is 5.83±3.81%. And there was a significant difference (t=2.39，P <0.05) with normal group in third trimester pregnancy.But there is not significant difference between hypertensive disorders in pregnancy and gestational diabetes ing the cutoff values of 7.40%、7.39% for diagnosis of hypertensive disorder in pregnancy,gestational diabetes mellitus,the corresponding AUCs were 0.71,0.73,respectively.Conclusions1、The measurement of FMD is repeatable, the mode of automatic tracking to measure vascular max diameter avoid the time-dependence,experience-dependence and individual differences of subjects,and minimize operating's subjection,the results is objection and true.2、In normal pregnancy, maternal brachial artery FMD is affected by the different ages of pregnancy.with increasing gestational ages,FMD values decreased. The values of FMD in hypertensive disorder in pergnancy or gestational diabetes mellitus decreased.3、The results of this study showed that the measurement of FMD of the brachial artery can reflects the reactivity of vascular endothelial cells.With its easy operation、time saving and non-invasive，it is able to be a method of evaluation of endothelial cell function.Key words:flow-mediated dilation,branchial artery,hypertensive disorder in pergnancy, gestational diabetes mellitus.前言正常妊娠时孕妇心血管功能发生了显著的适应性变化，包括心输出量、心率、血浆容量、心脏的收缩和舒张功能的改变。