妊娠期高血压疾病不同分期患者左心室功能水平变化研究

Changes of left ventricular function in patients with different stages of pregnancy induced hypertension

目的探讨妊娠期高血压疾病不同分期患者左心室功能水平的变化。方法将200例妊娠期高血压疾病患者依据美国妇产协会妊娠期高血压疾病指南2013年版标准分为妊娠高血压组120例、子痫前期组80例;另取同期正常妊娠孕产妇60例为对照组。采用电化学发光免疫法检测血浆氨基末端脑钠肽前体水平(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平。应用心脏超声心动图测量舒张末期左心室内径(left ventricular end diastolic dimension,LVDd)、左心室后壁厚度(left ventricular posterior wall diastole,LVPWd)、左心房直径(left atrium diameter,LAD)、室间隔后壁厚度(interventricular septal thickness at end diastole,IVSd),计算左心室射血分数(left ventricular ojection fraction,LVEF)。应用血流多普勒测量二尖瓣口舒张早期血流速度峰值(E)、左心房舒张晚期血流速度峰值(A),组织多谱勒测量收缩期左心室侧壁心肌运动峰值速度(systolic movement,Sm)、二尖瓣环根部运动速度峰值(Ea),计算E/A、E/Ea比值。采用二维斑点追踪技术测量左心室整体扭转角度峰值(peak left ventricular twist,Ptw)。比较3组左心室腔结构和功能水平变化以及血浆NT-proBNP水平,分析血浆NTproBNP与E/E、Ptw的相关性。结果 3组LVDd、LVPWd、LAD、IVSd和LVEF差异均无统计学意义(P>0.05)。子痫前期组E/A、Sm值明显低于妊娠高血压组和对照组,妊娠高血压组低于对照组,差异均有统计学意义(P<0.05)。子痫前期组E/Ea、Ptw明显高于对照组,妊娠高血压组高于对照组,差异均有统计学意义(P<0.05)。子痫前期组NT-proBNP水平高于妊娠高血压组和对照组(P<0.05)。血浆NT-proBNP与E/Ea、Ptw呈正相关(r=0.541、0.618,P<0.05)。结论妊娠期高血压疾病患者可表现为不同程度左心室功能损伤,其中以子痫前期患者表现明显。患者血浆NT-proBNP与E/Ea、Ptw呈正相关,可以作为评价妊娠高血压疾病患者左心室结构和功能变化的指标。

Objective To investigate the changes of left ventricular function in patients with different stages of pregnancy induced hypertension.Methods Selected 200 cases of pregnancy induced hypertension,according to the American Obstetrics and Gynecology Association of pregnancy induced hypertension disease guide(2013)standard,were divided into pregnancy induced hypertension group of 120 cases,preeclampsia group of 80 cases.Another 60 pregnant women with normal pregnancy were selected as control group.By electrochemiluminescence immunoassay NT-proBNP level was detected.By echocardiography left ventricular end diastolic diameter(LVDd),left ventricular posterior wall diastole(LVPWd),left atrial diameter(LAD),interventricular septal thickness at end diastole(IVSd)were measured,left ventricular ojection fraction(LVEF)was calculated.The early diastolic blood flow velocity(E)of mitral valve and the peak velocity of left atrial late diastolic blood flow(A)were measured by flow Doppler.The peak velocity(systolic movement,Sm)and the peak velocity of mitral annular root velocity(Ea)were measured by tissue Doppler imaging.E/A and E/Ea ratio were calculated.The peak left ventricular twist(Ptw)were measured by ultrasonic two-dimensional speckle tracking imaging.We compared the changes of left ventricular structure and function and NT-proBNP level of 3 groups,analyzed the correlation between plasma NT-proBNP and E/E,Ptw.Results There was no significant difference in LVDd,LVPWd,LAD,IVSd and LVEF among 3 groups(P>0.05).The levels of E/A and Sm in preeclampsia group were significantly lower than those in pregnancy induced hypertension group and control group,the E/A and Sm values of pregnancy induced hypertension group were significantly lower than those in control group,the difference was statistically significant(P<0.05).E/Ea and Ptw in preeclampsia group were significantly higher than those in control group,and E/Ea and Ptw in pregnancy induced hypertension group were significantly higher than those in control group,the difference was statistically significant(P<0.05).The level of NT-proBNP in preeclampsia group was higher than that in pregnancy induced hypertension group and control group(P<0.05),There was a positive correlation between plasma NT-proBNP and E/Ea,Ptw(r=0.541,0.618,P<0.05).Conclusion Patient with pregnancy induced hypertension may show different degrees of left ventricular dysfunction,among which preeclampsia patient is more obvious.Patient plasma NT-proBNP and E/Ea,Ptw have positive correlation,which can be used as an index to evaluate the changes of left ventricular structure and function in patient with pregnancy induced hypertension.