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首页> 外文期刊>American Journal of Obstetrics and Gynecology >Doppler parameters of fetal lung hypoplasia and impact of sildenafil
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Doppler parameters of fetal lung hypoplasia and impact of sildenafil

机译：胎儿肺发育不全的多普勒参数和西地那非的影响

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摘要

Objective Congenital diaphragmatic hernia (CDH) is clinically challenging because of associated lung hypoplasia (LH). There have been no validated parameters to evaluate fetal LH severity. Sildenafil has been shown to improve LH mass in nitrofen-induced pulmonary artery (PA) models, but the pulmonary vascular tone has not been evaluated in vivo. The aim of this study was to identify the PA Doppler parameter that best predicts LH severity and to investigate the efficacy of antenatal sildenafil treatment in experimental CDH. Study Design Nitrofen (50-60% CDH in offspring) or vehicle on E9.5 and sildenafil or vehicle on E11.5-20.5 were administrated to pregnant rats. On E20.5, PA Doppler indices were investigated with and without maternal hyperoxia. The presence/absence of CDH, lung/body weight ratio and radial saccular count were assessed at E20.5. Results At baseline, CDH rats had lower PA Doppler acceleration/ejection time ratios and pulsatility index (PI). Maternal hyperoxia resulted in a significant decrease in the PA/PI suggesting pulmonary vasodilation. In contrast, in CDH fetuses, the ipsilateral PA/PI showed little or no response to hyperoxia (P >.05), and in those with LH, PI response to maternal hyperoxia correlated positively with hernia, lung/body weight ratio (r = 0.70, P =.01). Maternal sildenafil therapy significantly improved PA response to hyperoxia and lung growth in CDH fetuses (P <.01). Conclusion Pulmonary vasodilation that occurs in E20.5 fetal rats in response to maternal hyperoxia is blunted in CDH. Change in PA/PI with hyperoxia is a useful predictor of LH severity. Sildenafil improves pulmonary vascular response and lung growth in fetal CDH.
机译：目的由于伴有肺发育不全（LH），先天性diaphragm肌疝（CDH）在临床上具有挑战性。没有验证胎儿LH严重程度的有效参数。西地那非在硝苯芬诱导的肺动脉（PA）模型中已显示可改善LH量，但尚未在体内评估肺血管张力。这项研究的目的是确定最能预测LH严重程度的PA多普勒参数，并研究实验性CDH中产前西地那非治疗的疗效。将研究设计的硝基苯酚（后代中50-60％的CDH）或E9.5上的媒介物或西地那非或E11.5-20.5上的媒介物施用于孕鼠。在E20.5上，研究有无母体高氧的PA多普勒指数。 CDH的存在/不存在，肺/体重比和骨囊计数在E20.5处评估。结果在基线时，CDH大鼠的PA多普勒加速/喷射时间比和搏动指数（PI）较低。产妇高氧导致PA / PI明显降低，提示肺血管扩张。相反，在CDH胎儿中，同侧PA / PI对高氧反应几乎没有或没有反应（P> .05），而在LH胎儿中，对母体高氧反应的PI与疝气，肺/体重比呈正相关（r = 0.70，P = .01）。母体西地那非治疗可显着改善CDH胎儿对高氧和肺生长的PA反应（P <.01）。结论EH20.5胎鼠对母体高氧反应的肺血管舒张作用在CDH中减弱。高氧导致PA / PI的变化是LH严重程度的有用预测指标。西地那非可改善胎儿CDH中的肺血管反应和肺部生长。

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