妊娠合并心脏病孕妇NT-proBNP监测与分析

Monitoring and analysis on NT-proBNP in pregnant women with heart diseases

目的:观察妊娠合并心脏病孕妇血清NT-proBNP在妊娠过程中的动态变化及探讨妊娠过程中NT-proBNP的水平与妊娠合并心脏病孕妇发生不良心脏事件的关系。方法:前瞻性研究128例妊娠合并心脏病孕妇在妊娠过程中NT-proBNP的动态变化,并取同期52例正常妊娠的孕妇作为对照组;获取孕妇在孕早期、孕晚期及产后6周的临床资料及相应的血清NT-proBNP数值,分析BNP在妊娠合并心脏病孕妇中的变化与妊娠过程中不良心脏事件发生的相关性。结果:妊娠合并心脏病孕妇血清NT-proBNP浓度为86(65～189)pg/ml,高于正常妊娠孕妇46(31～59)pg/ml(P<0.05),并在孕期进行性升高。在妊娠合并心脏病孕妇中有左室功能障碍患者的BNP水平明显高于没有左室功能障碍的患者,BNP≤100 pg/ml可以作为排除患者孕期发生不良心脏事件的良好的阴性指标之一。结论:妊娠合并心脏病孕妇在孕期随着心脏功能的下降BNP水平进行性升高,因此监测此类患者BNP在临床实践中对病情的观察有一定的指导意义,特别在判断有否可疑不良心脏事件的发生上有重要的作用。

Objective： To observe the dynamic change of serum NT - proBNP in the course of pregnancy in pregnant women with heart diseases, and explore the relationship between NT - proBNP level and onset of adverse cardiac events in pregnant women with heart diseases. Methods ： The dynamic change of serum NT - proBNP in 128 pregnant women with heart diseases in the course of pregnancy were researched, and 52 normal pregnant women during the same period were selected as control group; the clinical data of pregnant women during the first trimester of pregnancy and the third trimester of pregnancy, and at the sixth week after delivery were obtained ; the change of BNP in pregnant women with heart diseases and its correlation with onset of adverse cardiac events in the course of pregnancy were analyzed. Re- suits： The serum concentration of NT -proBNP in pregnant women with cardiac diseases was 86 （65 -189） pg/ml, which was statistically significantly higher than that in normal pregnant women [46 （31 -59） pg/ml] （P 〈 0. 05 ）, and it increased gradually during pregnancy. Among the pregnant women with heart diseases, the serum level of BNP in patients with left ventricular dysfunction was significantly higher than that in patients without left ventricular dysfunction, BNP ≤ 100 pg/ml could be used as one of negative markers to exclude onset of ad- verse cardiac events during pregnancy. Conclusion： BNP level of pregnant women with heart diseases increases gradually with decrease of cardiac function, thus, monitoring BNP level of pregnant women with heart diseases has a certain guiding significance for observing the disea- ses in clinical practive, especially for predicting whether adverse cardiac events occur.