多囊卵巢综合征孕妇孕期B型脑钠肽的变化及其与左心室功能的相关性

The changes of BNP and their relation of function with the left ventricle of PCOS during pregnancy

目的监测多囊卵巢综合征(polycystic ovary syndrome,PCOS)孕妇孕期血B型脑钠肽(brain natriuretic peptide,BNP)的变化,分析其与左心室功能变化的相关性。方法选取2013年2~9月在华北理工大学附属医院就诊,孕前诊断为PCOS的孕妇110例为观察组,同期正常孕妇125例为对照组,测定两组孕妇孕早期(10~12周)、孕中期(28~32周)、孕晚期(34~37周)血BNP水平,并当日行超声监测孕妇左心室功能相关指数。结果两组孕前心血管相关风险因素及心脏超声指数比较差异均无统计学意义(P>0.05);两组孕早期BNP水平[(244.20±2.54)pg/m L、(245.10±2.48)pg/m L]比较差异无统计学意义(P>0.05),观察组孕中期和孕晚期BNP水平[(330.10±4.68)pg/m L、(353.17±4.90)pg/m L]高于对照组[(259.48±3.27)pg/m L、(255.10±5.57)pg/m L],差异有统计学意义(P<0.05);孕中期观察组左心室舒张末期内径(left ventricular end diastolic diameter,LVEDd)[(47.32±2.57)mm]、左心室收缩末期内径(left ventricular endsystolic diameter,LVEDs)[(32.10±4.09)mm]均大于对照组[(43.20±2.46)mm、(30.48±3.21)mm],差异有统计学意义(P<0.05);两组左心室射血分数(left ventricular ejection fraction,LVEF%)[(45.10±4.68)%、(55.13±4.54)%]、左心房内径(left atrial diameter,LAD)[(31.23±4.75)mm、(29.17±4.22)mm]比较差异无统计学意义(P>0.05)。孕晚期观察组LVEDd[(48.10±2.43)mm]、LVEDs[(33.10±4.08)mm]、LAD[(32.26±4.65)mm]均大于对照组[(44.10±2.58)mm、(31.48±3.28)mm、(30.18±4.21)mm],LVEF%[(42.07±4.76)%]小于对照组[(53.10±4.27)%],差异均有统计学意义(P<0.05)。结论 PCOS孕妇较正常孕妇易发生心肌功能及BNP水平的变化,监测孕妇血浆BNP水平可提示孕妇发生左心功能变化的风险。

Objective To study changes of brain natriuretic peptide（ BNP） of pregnant women with polycystic ovary syndrome（ PCOS） and analyze the relation of left ventricle function and BNP.Methods 110 cases of pregnant women diagnosed as PCOS before pregnancy in North China University of Science and Technology Affiliated Hospital from February to September 2013 were selected as observation group,and 125 normal pregnant women in the same period were selected as control group.Blood BNP levels were measured in the first trimester（ 10 ~ 12 weeks）,the second trimester（ 28 ~ 32 weeks）,and the third trimester（ 34 ~ 37 weeks） of the pregnant women,and the left ventricular function related index was monitored by ultrasound on the same day.Results There was no significant difference in cardiovascular risk factors and cardiac ultrasound index between the two groups（ P 0.05）.There was no significant difference in BNP levels between the two groups during the first trimester[（ 244.20 ± 2.54） pg/m L,（ 245.10 ± 2.48）pg/m L]（ P 0.05）.BNP levels in the second and third trimesters of the observation group [（ 330.10 ± 4.68） pg/m L,（ 353.17 ±4.90） pg/m L]were higher than those in the control group [（ 259.48 ± 3.27） pg/m L,（ 255.10 ± 5.57） pg/m L],the difference was statistically significant（ P 0.05）; Left ventricular end diastolic diameter（ LVEDd） [（ 47.32 ± 2.57） mm],left ventricular end-systolic diameter（ LVEDs） [（ 32.10 ± 4.09） mm] were greater than the control group [（ 43.20 ± 2.46） mm,（ 30.48 ± 3.21） mm],the differences were statistically significant（ P 0.05）; The difference was not statistically significant（ P 0.05） between the two groups in left ventricular ejection fraction（ LVEF %） [（ 45.10 ± 4.68） %,（ 55.13 ± 4.54） %] and left atrial diameter（ LAD）[（ 31.23 ± 4.75） mm,（ 29.17 ± 4.22） mm].In the third trimester of observation group,LVEDd [（ 48.10 ± 2.43） mm],LVEDs[（ 33.10 ± 4.08） mm],LAD [（ 32.26 ± 4.65） mm]were greater than the control group [（ 44.10 ± 2.58） mm,（ 31.48 ± 3.28）mm,（ 30.18 ± 4.21） mm],LVEF % [（ 42.07 ± 4.76） %] was smaller than the control group [（ 53.10 ± 4.27） % ],the difference was statistically significant（ P 0.05）.Conclusion Pregnant women with PCOS are more likely to have changes in myocardial function and BNP levels during pregnancy.Monitoring plasma BNP levels in pregnant women may indicate the risk of left ventricular function changes in pregnant women.