PDF(Pubmed)
Abstract：
OBJECTIVE: During human pregnancy, placental extravillous trophoblasts replace vascular smooth muscle and elastic tissue within the walls of the uterine spiral arteries, thereby remodeling them into distensible low-resistance vessels to promote placental perfusion. The present study determined whether B-flow/spatiotemporal image correlation (STIC) M-mode ultrasonography provides an in-vivo imaging method able to digitally quantify spiral artery luminal distensibility as a physiological index of spiral artery remodeling during the advancing stages of normal human pregnancy.
METHODS: A prospective, longitudinal, observational study was conducted to quantify spiral artery distensibility (i.e. vessel luminal diameter at systole minus diameter at diastole) by B-flow/STIC M-mode ultrasonography during the first, second and third trimesters in 290 women exhibiting a normal pregnancy. Maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), growth factors that modulate important events in spiral artery remodeling, were quantified in a subset of the women in the first, second and third trimesters of pregnancy.
RESULTS: Median (interquartile range (IQR)) spiral artery distensibility increased progressively between the first (0.17 (0.14-0.21) cm), second (0.23 (0.18-0.28) cm) and third (0.26 (0.21-0.35) cm) trimesters of pregnancy (P < 0.0001 for all). Median (IQR) spiral artery volume flow increased progressively between the first (2.49 (1.38-4.99) mL/cardiac cycle), second (3.86 (2.06-6.91) mL/cardiac cycle) and third (7.79 (3.83-14.98) mL/cardiac cycle) trimesters (P < 0.001 for all). In accordance with the elevation in spiral artery distensibility, the median (IQR) ratio of serum PlGF/sFlt-1 × 103 levels increased between the first (7.2 (4.5-10.0)), second (22.7 (18.6-42.2)) and third (56.2 (41.9-92.5)) trimesters (P < 0.001 for all).
CONCLUSIONS: The present study shows that B-flow/STIC M-mode ultrasonography provides an in-vivo imaging technology to quantify digitally the structural and physiological expansion of the walls of the spiral arteries during the cardiac cycle as a consequence of their transformation into compliant vessels during advancing stages of normal human pregnancy. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
METHODS: A prospective, longitudinal, observational study was conducted to quantify spiral artery distensibility (i.e. vessel luminal diameter at systole minus diameter at diastole) by B-flow/STIC M-mode ultrasonography during the first, second and third trimesters in 290 women exhibiting a normal pregnancy. Maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1), growth factors that modulate important events in spiral artery remodeling, were quantified in a subset of the women in the first, second and third trimesters of pregnancy.
RESULTS: Median (interquartile range (IQR)) spiral artery distensibility increased progressively between the first (0.17 (0.14-0.21) cm), second (0.23 (0.18-0.28) cm) and third (0.26 (0.21-0.35) cm) trimesters of pregnancy (P < 0.0001 for all). Median (IQR) spiral artery volume flow increased progressively between the first (2.49 (1.38-4.99) mL/cardiac cycle), second (3.86 (2.06-6.91) mL/cardiac cycle) and third (7.79 (3.83-14.98) mL/cardiac cycle) trimesters (P < 0.001 for all). In accordance with the elevation in spiral artery distensibility, the median (IQR) ratio of serum PlGF/sFlt-1 × 103 levels increased between the first (7.2 (4.5-10.0)), second (22.7 (18.6-42.2)) and third (56.2 (41.9-92.5)) trimesters (P < 0.001 for all).
CONCLUSIONS: The present study shows that B-flow/STIC M-mode ultrasonography provides an in-vivo imaging technology to quantify digitally the structural and physiological expansion of the walls of the spiral arteries during the cardiac cycle as a consequence of their transformation into compliant vessels during advancing stages of normal human pregnancy. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：在人类怀孕期间，胎盘外滋养层替代子宫螺旋动脉壁内的血管平滑肌和弹性组织，从而将这些动脉重塑为可扩张的低阻力血管以促进胎盘灌注。本研究,确定B流/时空图像相关性（STIC）M型超声检查是否提供了一种体内成像方法来数字量化螺旋动脉管腔扩张性，作为螺旋动脉重塑的生理指标，在正常人类怀孕的推进阶段。
方法：进行了一项前瞻性纵向观察研究，以量化螺旋动脉扩张性，即收缩期血管腔直径减去舒张期血管腔直径，通过B流/STICM型超声检查，290名正常妊娠妇女的第二和第三三个月。母体血清胎盘生长因子（PlGF）和可溶性fms样酪氨酸激酶（sFlt-1）水平，调节螺旋动脉重塑中重要事件的生长因子，在第一次被量化的受试者的子集，第二和第三学期。
结果：中位数[第一个四分位数，第三四分]螺旋动脉扩张性在妊娠早期之间逐渐增加(P<0.0001)(0.17[0.14,0.21]),第二（0.23[0.18,0.28]）和第三（0.26[0.21,0.35]）妊娠三个月。螺旋动脉容积流量（ml/心动周期）逐渐增加（P<0.001）之间的第一个2.49[1.38，4.99]，第二个3.86[2.06,6.91]和第三个7.79[3.83,14.98]三个月。伴随着螺旋动脉扩张性的升高，血清PlGF/sFlt-1水平的中位数比值增加（P<0.001）之间的第一个（7.2[4.5，10]，第二（22.7[18.6，42.2]）和第三（56.2[41.9，92.5]三个月。
结论：本研究表明，B流/STICM型超声检查提供了一种体内成像技术，以数字方式量化心动周期期间螺旋动脉壁的结构/生理扩张。在正常人怀孕的晚期阶段，螺旋动脉转化为顺应性血管。本文受版权保护。保留所有权利。
方法：进行了一项前瞻性纵向观察研究，以量化螺旋动脉扩张性，即收缩期血管腔直径减去舒张期血管腔直径，通过B流/STICM型超声检查，290名正常妊娠妇女的第二和第三三个月。母体血清胎盘生长因子（PlGF）和可溶性fms样酪氨酸激酶（sFlt-1）水平，调节螺旋动脉重塑中重要事件的生长因子，在第一次被量化的受试者的子集，第二和第三学期。
结果：中位数[第一个四分位数，第三四分]螺旋动脉扩张性在妊娠早期之间逐渐增加(P<0.0001)(0.17[0.14,0.21]),第二（0.23[0.18,0.28]）和第三（0.26[0.21,0.35]）妊娠三个月。螺旋动脉容积流量（ml/心动周期）逐渐增加（P<0.001）之间的第一个2.49[1.38，4.99]，第二个3.86[2.06,6.91]和第三个7.79[3.83,14.98]三个月。伴随着螺旋动脉扩张性的升高，血清PlGF/sFlt-1水平的中位数比值增加（P<0.001）之间的第一个（7.2[4.5，10]，第二（22.7[18.6，42.2]）和第三（56.2[41.9，92.5]三个月。
结论：本研究表明，B流/STICM型超声检查提供了一种体内成像技术，以数字方式量化心动周期期间螺旋动脉壁的结构/生理扩张。在正常人怀孕的晚期阶段，螺旋动脉转化为顺应性血管。本文受版权保护。保留所有权利。
