过度滞产会加速多胎妊娠临产时子宫肌肉的电生理变化

IF 5.6 4区 医学 Q1 ENGINEERING, BIOMEDICAL
Irbm Pub Date : 2024-06-01 DOI:10.1016/j.irbm.2024.100837
Alba Diaz-Martinez , Gema Prats-Boluda , Rogelio Monfort-Ortiz , Javier Garcia-Casado , Alba Roca-Prats , Enrique Tormo-Crespo , Félix Nieto-del-Amor , Vicente-José Diago-Almela , Yiyao Ye-Lin
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引用次数: 0

摘要

早产及其相关并发症是全球最大的健康问题之一,因为目前在临床实践中还没有有效的筛查方法来从虚假的早产中准确识别出真正的早产(PTB)。尽管多胎妊娠(MG)妇女的早产率高达 60%,但在文献中却没有任何关于其体内子宫肌电活动的研究。宫体电图(EHG)已成为预测单胎妊娠(SG)妇女宫颈息肉的替代技术。本研究的目的是描述和比较单胎妊娠妇女和多胎妊娠妇女在定期检查时子宫肌电系统的体内活动,为早期发现和预防多胎妊娠早产提供依据。一项前瞻性观察性队列研究针对在拉费理工大学医院(西班牙巴伦西亚)接受定期检查的 31 名 SG 和 18 名 MG 妇女进行,她们的年龄介于 28 至 32 岁之间。30 分钟的双极记录在 0.1-4 Hz 带宽内进行滤波,并降低采样率至 20 Hz。信号分析在 120 秒的移动窗口中进行,重叠率为 50%,然后通过双盲专家程序去除伪差。计算了一组 8 个时间、频谱和非线性参数:均方根(RMS)、希尔伯特包络峰度(KHE)、中值频率(MDF)、H/L 比、在全带宽(WBW)和快波高(FWH)下计算的样本熵(SampEn)和气泡熵(BubbEn)。计算所有分析窗口的第 10、50 和 90 百分位数,以获得记录的代表性值。对于每个参数和百分位数,分别分析了 SG 组和 MG 组之间的统计显著性差异及其统计功率 (SP),以确定是否存在效应和实质显著性。与 SG 相比,MG EHG 的冲动性和可预测性明显高于 SG,这反映在 KHE(SP = 85.2,p < 0.001)和熵指标上(SampEn FWH:SP = 62.0,p = 0.0.016;SP = 52.5,p = 0.059。BubbEn FWH:SP = 75.2,p < 0.001;SP = 60.3,p = 0.002),这表明子宫电生理状况在加速演变。此外,还发现一些 EHG 参数与胎儿体重显著相关,如振幅(RMS:r = 0.311,p = 0.006)、信号冲动性(KHE:r = 0.311,p = 0.006)和熵指标(SampEn FWH:r = -0.317,p = 0.005*;r = -0.279,p = 0.013*。BubbEn FWH:r = -0.370,p = 0.001*;r = -0.313,p = 0.005*),表明在体内系统中子宫过度张力和收缩活动之间存在机电耦合。与 SG 妇女相比,MG 妇女在妊娠早期三个月表现出更高的冲动性和可预测性,这分别反映在 KHE、SampEn 和 BubbEn 上。我们发现,SG 和 MG 孕妇在临产前的细胞兴奋性相似。此外,我们还证实了子宫过度张力与表面肌电活动之间的关系,揭示了子宫平滑肌的机电耦合途径。因此,情境化的 EHG 生物标志物将为早期检测 PTB 风险提供有价值的信息,从而使临床医生能够通过个性化的治疗干预更好地管理 PTB。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Overdistention Accelerates Electrophysiological Changes in Uterine Muscle Towards Labour in Multiple Gestations

Overdistention Accelerates Electrophysiological Changes in Uterine Muscle Towards Labour in Multiple Gestations

Background for the research

Premature birth and its associated complications are one of the biggest global health problems, since there is currently no effective screening method in clinical practice to accurately identify the true Preterm Birth (PTB) from the false threatened ones. Despite the high prevalence of PTB in multiple gestation (MG) women which amounted up to 60%, in the literature there is any work about their uterine myoelectric activities in vivo system. Electrohysterography (EHG) has been emerged as an alternative technique for predicting PTB in single gestation (SG) women.

Purpose

The aim of this study was to characterize and compare the uterine myoelectrical activity in vivo system of SG and MG women in regular check-ups, to provide the basis for early detection and prevention of preterm labour in MG.

Basic procedures

A prospective observational cohort study was conducted on 31 SG and 18 MG women between the 28th and 32th WoG who underwent regular check-ups in the Polytechnic and University Hospital La Fe (Valencia, Spain). The 30-minute bipolar recording was filtered in the 0.1-4 Hz bandwidth and downsampled to 20 Hz. Signal analysis was performed in 120-second moving windows with 50% overlap, after removing artefacts by a double- blind expert process. A set of 8 temporal, spectral and non-linear parameters were calculated: root mean square (RMS), kurtosis of the Hilbert envelope (KHE), median frequency (MDF), H/L ratio, and sample entropy (SampEn) and bubble entropy (BubbEn) calculated in the whole bandwidth (WBW) and the fast wave high (FWH). The 10th, 50th and 90th percentiles of all windows analysed were calculated to obtain representative values of the recordings. For each parameter and percentile, statistically significant differences between the SG and MG groups and their statistical power (SP) were analysed to determine both the existence of an effect and substantive significance, respectively.

Main findings

In comparison to SG, MG EHG exhibited significant higher impulsiveness and higher predictability than SG which was reflected in the KHE (SP10 = 85.2, p10 < 0.001) and entropy measures (SampEn FWH: SP50 = 62.0, p50 = 0.0.016; SP90 = 52.5, p90 = 0.059. BubbEn FWH: SP50 = 75.2, p50 < 0.001; SP90 = 60.3, p90 = 0.002), suggesting an accelerated evolution of uterine electrophysiological condition. In addition, several EHG parameters were found to significantly correlate with foetal weight such as amplitude (RMS: r90 = 0.311, p90 = 0.006), signal impulsiveness (KHE: r10 = 0.311, p10 = 0.006) and entropy measures (SampEn FWH: r50 = −0.317, p50 = 0.005*; r90 = −0.279, p90 = 0.013*. BubbEn FWH: r50 = −0.370, p50 = 0.001*; r90 = −0.313, p90 = 0.005*), suggesting an electromechanical coupling between uterine overdistension and contractile activity in vivo system.

Principal conclusions

In comparison to SG women, MG showed higher impulsiveness and predictability in early third gestational trimester, as reflected in KHE, SampEn and BubbEn, respectively. We found similar cell excitability between SG and MG women far from delivery. In addition, we confirmed the relationship between uterine overdistension and surface myoelectric activity, revealing the electromechanical coupling pathway in uterine smooth muscle. Therefore, contextualized EHG-biomarkers would provide valuable information for early detection of PTB risk, which would allow clinicians better PTB management through personalised therapeutic interventions.

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来源期刊
Irbm
Irbm ENGINEERING, BIOMEDICAL-
CiteScore
10.30
自引率
4.20%
发文量
81
审稿时长
57 days
期刊介绍: IRBM is the journal of the AGBM (Alliance for engineering in Biology an Medicine / Alliance pour le génie biologique et médical) and the SFGBM (BioMedical Engineering French Society / Société française de génie biologique médical) and the AFIB (French Association of Biomedical Engineers / Association française des ingénieurs biomédicaux). As a vehicle of information and knowledge in the field of biomedical technologies, IRBM is devoted to fundamental as well as clinical research. Biomedical engineering and use of new technologies are the cornerstones of IRBM, providing authors and users with the latest information. Its six issues per year propose reviews (state-of-the-art and current knowledge), original articles directed at fundamental research and articles focusing on biomedical engineering. All articles are submitted to peer reviewers acting as guarantors for IRBM''s scientific and medical content. The field covered by IRBM includes all the discipline of Biomedical engineering. Thereby, the type of papers published include those that cover the technological and methodological development in: -Physiological and Biological Signal processing (EEG, MEG, ECG…)- Medical Image processing- Biomechanics- Biomaterials- Medical Physics- Biophysics- Physiological and Biological Sensors- Information technologies in healthcare- Disability research- Computational physiology- …
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