Clinical application values of pulmonary artery blood flow indexes and pulmonary surfactant protein level for perinatal lung maturity when pregnant women complicated with severe preeclampsia and gestational diabetes mellitus

doi:10.3877/cma.j.issn.1673-5250.2021.06.011

Objective

To investigate clinical values of pulsatility indexes (PI) and resistance indexes (RI) of fetal pulmonary artery, and pulmonary surfactant protein (SP)-A, SP-B levels in neonatal umbilical cord blood to evaluate perineonate lung maturity when pregnant women complicated with severe preeclampsia (sPE) and gestational diabetes mellitus (GDM).

Methods

A total of 60 perineonates of pregnant women complicated with sPE and GDM delivered in the Second Hospital of Jilin University from January 2018 to October 2019 were selected as research objects. According to gestational age at birth of neonates, they were divided into group A (n=22, gestational age at birth≥37 weeks), group B (n=20, 35 weeks≤ gestational age at birth<37 weeks) and group C (n=18, gestational age at birth<35 weeks). Levels of PI and RI of fetal pulmonary artery, SP-A and SP-B in neonatal umbilical cord blood, and 1 min Apgar scores and neonatal birth weight of three groups were overall compared by Kruskal Wallis H rank sum test, and further compared by Mann-Whitney U test. Chi-square test was used for overall and further comparison of incidences of neonatal respiratory distress syndrome (NRDS) among three groups. The correlation between PI, RI, SP-A, SP-B, Apgar score at 1 min after birth, neonatal birth weight and gestational age at birth in three groups were analyzed by Spearman rank correlation analysis. The procedures in this study were approved by Ethics Committee of the Second Hospital of Jilin University [Approval No. 2019 Yan Shen No. (111)]. All guardians of subjects signed clinical research informed consents.

Results

① There were significant differences in levels of PI and RI of fetal pulmonary artery, and SP-A and SP-B in neonatal umbilical cord blood among three groups, also between any two groups (P<0.05), and levels of PI and RI gradually decreased and SP-A and SP-B gradually increased with the increase of gestational age. ② Apgar score at 1 min after birth and neonatal birth weight in group A and group B were 9 scores (9-9 scores) and 3 010 g (2 777-3 802 g), 9 scores (8-9 scores) and 2 680 g (2 000-3 427 g), respectively, which were significantly higher than those of 8 scores (8-8 scores) and 1 660 g(1 500-2 005 g) in group C; while the incidences of NRDS in group A and group B (4.5% and 20.0%) were significantly lower than that in group C (66.7%), respectively, and all the differences were statistically significant (group A vs group C: Z=28.242, Z=30.202, χ²=17.415; group B vs group C: Z=19.433, Z=21.111, χ²=8.464; all P<0.001). There were no significant differences between group A and group B in these three indexes. ③ The PI and RI of fetal pulmonary artery were negatively correlated with gestational age (r_s=-0.780, r_s=-0.856, all P<0.001). Pulmonary SP-A and SP-B levels in neonatal umbilical cord blood, Apgar score at 1 min after birth and neonatal birth weight were positively correlated with gestational age (r_s=0.842, r_s=0.872, r_s=0.689, r_s=0.820, all P<0.001).

Conclusions

PI and RI of fetal pulmonary artery, and pulmonary SP-A and SP-B levels in neonatal umbilical cord blood, could be used as indexes to evaluate perineonate lung maturity when pregnant women complicated with sPE and GDM.

Key words: Pre-eclampsia, Diabetes, gestational, Pulmonary artery, Pulsatility index, Resistance index, Pulmonary surfactant protein, Fetal lung maturity, Pregnant women, Fetus

表1 3组受试儿肺动脉PI及RI、脐血中肺SP水平总体及两两比较[M(P₂₅~P₇₅)]

组别		例数	肺动脉PI	肺动脉RI	脐血中肺SP-A(ng/L)	脐血中肺SP-B(ng/L)
A组		22	1.9(1.8~2.0)	0.8(0.8~0.9)	522.5(371.0~648.7)	402.6(390.9~434.0)
B组		20	2.0(1.9~2.0)	1.0(0.9~1.0)	261.9(232.5~331.2)	208.9(196.8~250.0)
C组		18	2.3(2.2~2.8)	1.1(1.0~1.2)	141.4(111.4~143.3)	144.8(119.0~161.3)
总体比较(Z值/P值)			42.669/<0.001	47.271/<0.001	51.626/<0.001	51.033/<0.001
两两比较(Z值/P值)
	A组vs B组		13.182/0.043	21.114/<0.001	20.427/<0.001	20.045/0.001
	A组vs C组		35.960/<0.001	37.753/<0.001	39.727/<0.001	39.545/<0.001
	B组vs C组		22.778/<0.001	16.639/0.010	19.300/0.002	19.500/0.002

表1 3组受试儿肺动脉PI及RI、脐血中肺SP水平总体及两两比较[M(P₂₅~P₇₅)]

组别		例数	肺动脉PI	肺动脉RI	脐血中肺SP-A(ng/L)	脐血中肺SP-B(ng/L)
A组		22	1.9(1.8~2.0)	0.8(0.8~0.9)	522.5(371.0~648.7)	402.6(390.9~434.0)
B组		20	2.0(1.9~2.0)	1.0(0.9~1.0)	261.9(232.5~331.2)	208.9(196.8~250.0)
C组		18	2.3(2.2~2.8)	1.1(1.0~1.2)	141.4(111.4~143.3)	144.8(119.0~161.3)
总体比较(Z值/P值)			42.669/<0.001	47.271/<0.001	51.626/<0.001	51.033/<0.001
两两比较(Z值/P值)
	A组vs B组		13.182/0.043	21.114/<0.001	20.427/<0.001	20.045/0.001
	A组vs C组		35.960/<0.001	37.753/<0.001	39.727/<0.001	39.545/<0.001
	B组vs C组		22.778/<0.001	16.639/0.010	19.300/0.002	19.500/0.002

表2 3组新生儿FLM参考指标总体及两两比较

组别		例数	生后1 min Apgar评分[分，M(P₂₅~P₇₅)]	出生体重[g，M(P₂₅~P₇₅)]	NRDS[例数(%)]
A组		22	9(9~9)	3 010(2 777~3 802)	1(4.5)
B组		20	9(8~9)	2 680(2 000~3 427)	4(20.0)
C组		18	8(8~8)	1 660(1 500~2 005)	12(66.7)
总体比较(检验值/P值)			Z＝34.219/<0.001	Z＝30.626/<0.001	χ²＝19.841/<0.001
两两比较(检验值/P值)
	A组vs B组		Z＝8.809/0.192	Z＝9.091/0.274	—^a/0.174
	A组vs C组		Z＝28.242/<0.001	Z＝30.202/<0.001	χ²＝17.415/<0.001
	B组vs C组		Z＝19.433/<0.001	Z＝21.111/0.001	χ²＝8.464/<0.001

表2 3组新生儿FLM参考指标总体及两两比较

组别		例数	生后1 min Apgar评分[分，M(P₂₅~P₇₅)]	出生体重[g，M(P₂₅~P₇₅)]	NRDS[例数(%)]
A组		22	9(9~9)	3 010(2 777~3 802)	1(4.5)
B组		20	9(8~9)	2 680(2 000~3 427)	4(20.0)
C组		18	8(8~8)	1 660(1 500~2 005)	12(66.7)
总体比较(检验值/P值)			Z＝34.219/<0.001	Z＝30.626/<0.001	χ²＝19.841/<0.001
两两比较(检验值/P值)
	A组vs B组		Z＝8.809/0.192	Z＝9.091/0.274	—^a/0.174
	A组vs C组		Z＝28.242/<0.001	Z＝30.202/<0.001	χ²＝17.415/<0.001
	B组vs C组		Z＝19.433/<0.001	Z＝21.111/0.001	χ²＝8.464/<0.001

[1]	王艳，查文慧，陈洋. 妊娠期糖尿病与妊娠期高血压疾病病理机制的相关性[J]. 国际生殖健康/计划生育杂志，2020, 39(1): 63-66. DOI: 10.3969/j.issn.1674-1889.2020.01.014.
[2]	Weissgerber TL, Mudd LM. Preeclampsia and diabetes[J]. Curr Diab Rep, 2015, 15(3): 9. DOI: 10.1007/s11892-015-0579-4.
[3]	谢幸，孔北华，段涛. 妇产科学[M]. 9版. 北京：人民卫生出版社，2018: 105-107.
[4]	Filipek A, Jurewicz E. Preeclampsia-a disease of pregnant women[J]. Postepy Biochem, 2018, 64(4): 232-229. DOI: 10.18388/pb.2018_146.
[5]	许燕. 胎儿肺动脉及左、右肺动脉分支的超声诊断研究[D]. 青岛：青岛大学，2016.
[6]	官勇，李胜利，付倩，等. 正常胎儿主肺动脉多普勒流速曲线参数测值与孕龄相关性的研究[J/CD]. 中华医学超声杂志(电子版), 2014, 11(1): 38-43. DOI: 10.3877/cma.j.issn.1672-6448.2014.01.009.
[7]	Moety GA, Gaafar HM, El Rifai NM. Can fetal pulmonary artery Doppler indices predict neonatal respiratory distress syndrome？[J]. J Perinatol, 2015, 35(12): 1015-1019. DOI: 10.1038/jp.2015.128.
[8]	Morrisey EE, Hogan BL. Preparing for the first breath: genetic and cellular mechanisms in lung development[J]. Dev Cell, 2010, 18(1): 8-23. DOI: 10.1016/j.devcel.2009.12.010.
[9]	Besnard AE, Wirjosoekarto SA, Broeze KA, et al. Lecithin/sphingomyelin ratio and lamellar body count for fetal lung maturity: a Meta-analysis[J]. Eur J Obstet Gynecol Reprod Biol, 2013, 169(2): 177-183. DOI: 10.1016/j.ejogrb.2013.02.013.
[10]	Cao Z, Liu J, Xie X, et al. Lipidomic profiling of amniotic fluid and its application in fetal lung maturity prediction[J]. J Clin Lab Anal, 2020, 34(4): e23109. DOI: 10.1002/jcla.23109.
[11]	宋良，庞丽红. 胎肺成熟预测技术的研究进展[J]. 广西医学，2021, 43(9): 1141-1144. DOI: 10.11675/j.issn.0253-4304.2021.09.24.
[12]	Sardesai S, Biniwale M, Wertheimer F, et al. Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future[J]. Pediatr Res, 2017, 81(1-2): 240-248. DOI: 10.1038/pr.2016.203.
[13]	Nathan N, Taytard J, Duquesnoy P, et al. Surfactant protein A: a key player in lung homeostasis[J]. Int J Biochem Cell Biol, 2016, 81(Pt A): 151-155. DOI: 10.1016/j.biocel.2016.11.003.
[14]	Sunde M, Pham C, Kwan AH. Molecular characteristics and biological functions of surface-active and surfactant proteins[J]. Annu Rev Biochem, 2017, 86: 585-608. DOI: 10.1146/annurev-biochem-061516-044847.
[15]	张斌，钱美英，胡建铭，等. 羊水中S/A值预测胎肺成熟度的临床价值[J]. 苏州大学学报(医学版), 2004, 24(5): 748-750. DOI: 10.3969/j.issn.1673-0399.2004.05.063.
[16]	董卫江，谢小岚，李芹. 胎儿肺动脉血流指数与肺成熟度关系的临床研究[J]. 中国超声医学杂志，2010, 26(9): 837-839. DOI: 10.3969/j.issn.1002-0101.2010.09.023.
[17]	Qin C, Mi C, Xia A, et al. A first look at the effects of long inter-pregnancy interval and advanced maternal age on perinatal outcomes: a retrospective cohort study[J]. Birth, 2017, 44(3): 230-237. DOI: 10.1111/birt.12289.
[18]	Kamath BD, Macguire ER, McClure EM, et al. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries[J]. Pediatrics, 2011, 127(6): 1139-1146. DOI: 10.1542/peds.2010-3212.
[19]	Tang Y, Jin XD, Xu L, et al. The value of ultrasonography in assessing fetal lung maturity[J]. J Comput Assist Tomogr, 2020, 44(3): 328-333. DOI: 10.1097/RCT.0000000000001011.
[20]	Schittny JC. Development of the lung[J]. Cell Tissue Res, 2017, 367(3): 427-444. DOI: 10.1007/s00441-016-2545-0.
[21]	Martínez-Calle M, Alonso A, Pérez-Gil J, et al. Native supramolecular protein complexes in pulmonary surfactant: evidences for SP-A/SP-B interactions[J]. J Proteomics, 2019, 207: 103466. DOI: 10.1016/j.jprot.2019.103466.
[22]	Fittschen M, Reinhard I, Wellek S, et al. Advanced dynamic Doppler flow of the pulmonary artery in a normal population: reference values from 18 to 41 weeks of gestation calculated by automatic Doppler waveform analysis[J]. Arch Gynecol Obstet, 2014, 289(5): 973-980. DOI: 10.1007/s00404-013-3071-x.
[23]	Laban M, Mansour GM, Elsafty MS, et al. Prediction of neonatal respiratory distress syndrome in term pregnancies by assessment of fetal lung volume and pulmonary artery resistance index[J]. Int J Gynaecol Obstet, 2015, 128(3): 246-250. DOI: 10.1016/j.ijgo.2014.09.018.
[24]	Laban M, Mansour GM, El-Kotb A, et al. Combined measurement of fetal lung volume and pulmonary artery resistance index is more accurate for prediction of neonatal respiratory distress syndrome in preterm fetuses: a pilot study[J]. J Matern Fetal Neonatal Med, 2019, 32(4): 626-632. DOI: 10.1080/14767058.2017.1387891.
[25]	Laudy JA, Tibboel D, Robben SG, et al. Prenatal prediction of pulmonary hypoplasia: clinical, biometric, and Doppler velocity correlates[J]. Pediatrics, 2002, 109(2): 250-258. DOI: 10.1542/peds.109.2.250.
[26]	唐萍，许川一，王莉贞，等. 胎儿肺主动脉血流动力指数与胎儿肺成熟度关系的探讨[J]. 中国妇幼保健，2008, 23(20): 2833-2834. DOI: 10.3969/j.issn.1001-4411.2008.20.028.
[27]	官勇，叶海腾. 超声多普勒评估子痫前期胎儿肺成熟度[J]. 临床肺科杂志，2017, 22(11): 1959-1961. DOI: 10.3969/j.issn.1009-6663.2017.11.006.
[28]	Cho K, Matsuda T, Okajima S, et al. Prediction of respiratory distress syndrome by the level of pulmonary surfactant protein A in cord blood sera[J]. Biol Neonate, 2000, 77(2): 83-87. DOI: 10.1159/000014198.
[29]	Kaneko K, Shimizu H, Arakawa H, et al. Pulmonary surfactant protein A in sera for assessing neonatal lung maturation[J]. Early Hum Dev, 2001, 62(1): 11-21. DOI: 10.1016/s0378-3782(00)00133-x.
[30]	于令娟. 不同胎龄新生儿羊水、脐血SP-A、SP-B水平的测定及其影响因素的临床研究[D]. 石家庄：河北医科大学，2015.

[1]	Xining Wu, Yunshu Ouyang, Yixiu Zhang, Hua Meng, Zhonghui Xu, Peipei Zhang, Ke Lyu. Application of fetal echocardiography in prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1056-1060.
[2]	Shuihua Yang, Guidan He, Guican Qin, Mengfeng Liang, Yanhe Luo, Xueqin Li, Juansong Tang. Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1061-1067.
[3]	Jingjing Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Yankai Mao, Chenke Pan, Lingyan Zhu, Linlin Zhu, Qiuye Lan. Evaluation of fetal pulmonary development using McGoon index measured by fetal echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 860-865.
[4]	Peng Xu, Jun Li, Weilun Gao, Zheng Wang, Shen Pang, Chunni Li, Ting Zhu. Application of fast rotary scanning method in fetal echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 761-766.
[5]	Gang Luo, Silin Pan, Taotao Chen, Qian Xu, Zhixian Ji, Sibao Wang, Lingyu Sun. Application of echocardiography in fetal cardiac intervention of pulmonary atresia with intact ventricular septum[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 605-609.
[6]	Jia Huang, Hua Shi, Yuguo Zhang, Jiaqi Hu, Qian Chen. Ultrasonographic features of normal and abnormal fetal left brachiocephalic vein and their clinical significance[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 610-617.
[7]	Ze Yuan, Li Zhuang. Value of ultrasound detection of fetal umbilical artery and middle cerebral artery blood flow in diagnosis of fetal intrauterine distress[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 618-621.
[8]	Tiantian Chen, Xiaodong Wang, Haiyan Yu. Pregnancy outcome of twin pregnancy with Gitelman syndrome: a case report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 559-568.
[9]	Xiaoqing Ju, Yunjie Jin, Xiaoyan Wang. Influencing factors of uterine rupture during vaginal delivery in patients with scarred uterus after cesarean section[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 575-581.
[10]	Beibei Wang, Qixiu Dong, Hongyan Xi, Qingyun Yu, Lijun Zhang, Guang Shi. Analysis of influencing factors of medical abortion failure of pregnant women in early pregnancy and construction of related prediction model and its predictive value for medical abortion success[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 588-594.
[11]	Xu Chen, Yuru Zhan, Chunhua Wang. Clinical value of ABO blood group combined with thyroid function in prediction of gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 604-610.
[12]	Mengling Zhou, Zhiwei Xue, Shu Zhou. Changes in size of uterine myoma during pregnancy and its association with adverse pregnancy outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 611-615.
[13]	Chao Xue, Ye Zhang, Ying Zhao, Jiancheng Han, Xiaoyan Gu, Lin Sun, Xiaowei Liu, Wei Song, Yihua He. Ultrasonographic characteristics and prognosis of fetal congenital absent pulmonary valve syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 410-418.
[14]	Xiya Jin, Xiaosong Huang, Cheng Tan, Qin Jiang, Fang Hou, Yaoyue Li, Bing Xu, Honghui Jia, Wenying Liu. Antenatal treatment of tacrolimus on pulmonary vascular remodeling in rat with experimental pathological model of congenital diaphragmatic hernia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 428-436.
[15]	Jie Huang, Yu Xia, Yanjiao Jiang, Yun Liu. Effects of GPR146 on vascular remodeling in mice with pulmonary hypertension via P-JNK pathway[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(04): 460-465.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export