轻度妊娠高血压左心室重构的危险性

Impact of altered left ventricular geometry on the outcome of pregnancy in mild gestational hypertension

目的 探讨轻度妊娠高血压初孕妇左心室重构与预后的关系。方法 200例妊娠（28～31）周的轻度妊娠高血压初孕妇，由产科医师随访至正常分娩或胎）L／孕妇出现异常情况（先兆子痫、在34周前分娩、胎盘早剥、与妊娠有关的疾病、胎儿窘迫、低体重新生儿、入新生儿监护室），由Logistic回归法分析不良妊娠结果与左心室构型的关系。结果 138例（69．0％）妊娠平稳，62例（31．0％）出现不良妊娠结果，向心性重构孕妇和向心性肥大孕妇的不良妊娠结果构成比较高（分别为64．7％和63．2％，χ^2=29．5，v=3，P=0．000）；Logistic回归分析显示向心性重构（OR5．5，95％CI1．1-28．4，P=0．042）和向心性肥大（OR6．0，95％CI1．1～32．6，P=0．038）是不良妊娠结果的独立预报因子。结论 轻度妊娠高血压左心室向心性重构和左心室向心性肥大与不良妊娠结果有关。

Objective The present study was designed to evaluate the prognostic impact on the outcome of pregnancy of an altered geometry of the left ventricle in mild gestational hypertension. Methods Two hundred consecutive, nulliparously pregnant, mild gestational hypertensive women （systolic and diastolic blood pressure, 140 to 149 mm Hg and 90 to 99 mm Hg,respectively） were included in the study. Patients were monitored until term to detect subsequent fetal and/or maternal adverse outcomes （preeclampsia, preterm delivery,abniptil placentae, other maternal medical problems, fetal distress, neonatal low birth weight, admittance to neonatal intensive care unit）. Results One hundred thirty eight gestational hypertensive patients（69.0% ） had an uneventful pregnancy, sixty two patients （31.0% ）showed a subsequent development of maternal and/or fetal complications. Concentric remodeling and concentric hypertrophy were prevalent among patients with the subsequent development of complicated gestatinnal hypertension（22 out of 34 patients and 24 out of 38 patients,respectively） .The multivariate analysis showed conecntric remodeling and concentric hypertrophy as independent predictoros of adverse outcomes（ odds ratio, 5.5,95 % confidence interval, 1.1 to 28.4, P = 0.042, and 6.0,95 % confidence interval, 1.1 to 32.6, P = 0. 038, respectively ）. Conclusion In patients with gestational hypertension, blood pressure values alone appear to be insufficient to Mentify the effective risk of adverse events. Ventficular geometry gives additional prognostic information, possibly improving our clinical ability to follow and eventually treat these patients.