运用超声心动图评价妊娠期高血压疾病患者左室形态和功能变化及其与N端脑利钠肽前体的相关性研究

Study of left ventricular morphology and function in patients with hypertensive disorder compli cating pregnancy by echocardiography and their correlation with N-terminal probrain natriuretic peptide

目的运用超声心动图评价妊娠期高血压疾病患者左室形态和功能变化,及其与N端脑利钠肽前体(NT-pro BNP)的相关性,并探讨利用二尖瓣舒张早期E波峰值流速与舒张早期二尖瓣环心肌运动峰值速度之比(E/Ea)、收缩期二尖瓣环心肌运动峰值速度(Sa)评价妊娠期高血压疾病患者早期左室功能异常的临床意义。方法选取2013年10月至2016年3月在绍兴市妇幼保健院住院分娩的140例孕妇,其中观察组89例分为三个亚组:妊娠期高血压组(25例)、轻度子痫前期组(28例)、重度子痫前期组(36例),血压正常孕妇51例为对照组。运用超声心动图测量各组孕妇左室形态参数,包括舒张末期室间隔厚度(IVSd)、舒张末期左室前后径(LVDd)、舒张末期左室后壁厚度(LVPWd)、相对室壁厚度(RWT)和左室质量指数(LVMI);以及左室功能参数,包括左室射血分数(LVEF)、二尖瓣口舒张早期血流峰值流速与舒张晚期血流峰值流速比值(E/A)、收缩期二尖瓣环左室侧壁、室间隔处心肌运动峰值速度(Sa1、Sa2),舒张早期二尖瓣环左室侧壁、室间隔处心肌运动峰值速度(Ea1、Ea2),计算E/Ea1和E/Ea2。同时检测各组血浆NT-pro BNP浓度,采用Pearson相关性分析研究NT-pro BNP的相关性。结果与对照组比较,重度子痫前期组左室形态各参数包括IVSd[(0.79±0.09)cm vs.(0.91±0.12)cm]、LVDd[(4.61±0.38)cm vs.(4.84±0.27)cm]、LVPWd[(0.80±0.10)cm vs.(0.90±0.15)cm]、RWT[(0.35±0.04)vs.(0.38±0.05)]和LVMI[(58±8)g/m^2 vs.(72±13)g/m^2]均显著增加(P均<0.01);同时,轻度子痫前期组Sa1[(10.7±2.3)cm/s vs.(9.7±1.9)cm/s]、Sa2[(9.2±1.6)cm/s vs.(8.4±1.5)cm/s]均降低,E/Ea1[(6.5±1.9)vs.(7.8±2.6)]、E/Ea2[(8.3±2.1)vs.(9.6±2.5)]均升高(P均<0.05);同样,重度子痫前期组Sa1[(10.7±2.3)cm/s vs.(9.4±1.7)cm/s]、Sa2[(9.2±1.6)cm/s vs.(8.2±1.4)cm/s]均显著降低,E/Ea1[(6.5±1.9)vs.(8.0±2.6)]、E/Ea2[(8.3±2.1)vs.(10.6±2.4)]均显著升高(P均<0.05),E/A[(1.30±0.26)vs.(1.15±0.29)]减小(P<0.05)。Pearson相关性分析提示血浆中NT-pro BNP与E/Ea1、E/Ea2、IVSd、LVDd、LVPWd及LVMI均呈正相关(r=0.58、0.42、0.25、0.27、0.20、0.25,P均<0.05);NT-pro BNP与Sa1、Sa2均呈负相关(r=-0.69、-0.30,P均<0.05)。结论妊娠期高血压疾病可以导致患者左室形态和功能发生变化,并且左室功能可先于左室形态发生改变,应用超声心动图测量E/Ea、Sa与NT-pro BNP相关性良好,可以作为评价妊娠期高血压疾病患者左室功能的早期指标。

Objective To assess the changes of left ventricular morphology and function in patients with hypertensive disorder complicating pregnancy and their correlation with the N-terminal pro-brain natriuretic peptide （NT-proBNP） by echocardiography, as well as to investigate the clinical value of the ratio of mitral valve diastolic early E wave peak velocity and early diastolic myocardial motion peak velocity in the mitral annulus （E/Ea）, systolic myocardial motion peak velocity in the mitral annulus （Sa） in evaluating early left ventricular dysfunction. Methods One hundred and forty parturients admitted to Shaoxing Women ＆ Children＇s Hospital from October 2013 to March 2016 were enrolled in this study. The observation group （89 cases） was divided into three subgroups： pregnancy induced hypertension group （25 cases）, mild preeclampsia group （28 cases） and severe preeclampsia group （36 cases）. Fifty-one cases of normotensive parturients were enrolled in the control group. The parameters of left ventricular structure were measured by echocardiography, including interventricular septal thickness at end diastole （IVSd）, left ventricular diameter at end diastole （LVDd）, left ventricular posterior wall thickness at end diastole （LVPWd）, relative wall thickness （RWT） and left ventricular mass index （LVMI）; the parameters of left ventricular function were also measured by echocardiography, including left ventricular ejection fraction （LVEF）, E/A, systolic myocardial motion peak velocity of left ventrical lateral wall and ventricular septum in the mitral annulus （Sal and Sa2）, early diastolic myocardial motion peak velocity of left ventrical lateral wall and ventricular septum in the mitral annulus （Eal and Ea2）. E/Eal, E/Ea2 were calculated. Meanwhile, plasma NT- proBNP concentrations of each group were detected. The method of Pearson correlation analysis investigated the correlation of NT-proBNP. Results Compared with the control group, the parameters of left ventricular morphology in the severe preeclampsia group increased significantly, including IVSd [（0.79±0.09） cm vs. （0.91±0.12） cm], LVDd [（4.61±0.38） cm vs. （4.84 ±0.27） cm], LVPWd [（0.80±0.10） cm vs. （0.90 ±0.15） cm], RWT [（0.35±0.04） vs. （0.38±0.05）] and LVMI [（58± 8） g / m^2 vs. （72±13） g / mz] （all P 〈 0.05）; In the mild preeclampsia group, Sal [（10.7±2.3） cm / s vs. （9.7±1.9） cm / s] and Sa2 [（9.2±1.6） cm / s vs. （8.4±1.5） cm / s] decreased, E / Eal[（6.5±1.9） vs. （7.8±2.6）] and E / Ea2 [（8.3±2.1） vs. （9.6±2.5）] increased （all P 〈 0.05）; In the severe preeclampsia group, Sal [（10.7± 2.3） cm / s vs. （9.4±1.7） cm / s] and Sa2 [（9.2±1.6） cm / s vs. （8.2±1.4） cm / s] significantly decreased, E / Ea2 [（6.5±1.9） vs. （8.0±2.6）] and E / Eal [（8.3 ±2.1） vs. （10.6±2.4）] significantly increased （all P 〈 0.05）, and E / A decreased [（1.30±0.26） vs. （1.15±0.29）] （P 〈 0.05）. Pearson correlation analysis showed that plasma NT-proBNP was positively correlated with E/Eal, E/Ea2, IVSd, LVDd, LVPWd and LVMI （r=0.58, 0.42, 0.25, 0.27, 0.20, 0.25; all P〈 0.05）; NT-proBNP was negatively correlated with Sal and Sa2 （r =-0.69, -0.30; all P 〈 0.05）. Conclusions Hypertensive disorder complicating pregnancy can lead to the changes of left ventricular morphology and function. In addition, left ventricular function can be changed ahead of left ventricular morphology. Measurement of E/Ea and Sa by using echocardiography showed a good correlation with NT-proBNP, which can be used as the early indicators to evaluate left ventricular function of patients with hypertensive disorder complicating pregnancy.