羊水NT-proBNP及cTnT水平与单绒毛膜双羊膜囊双胎妊娠结局的关系

Relationship between NT-proBNP and cTnT levels in amniotic fluid and the outcome of monochorionic diamniotic twin pregnancies

目的探讨羊水氨基末端脑利钠肽前体(NT-proBNP)及心肌肌钙蛋白T(cTnT)水平与单绒毛膜双羊膜囊(MCDA)双胎妊娠结局的关系。方法收集行羊水穿刺的MCDA双胎100例,排除母体严重并发症者及胎儿畸形者14例,共86例MCDA双胎纳入研究。按其并发症分为双胎输血综合征受血胎(TTTS-R)组37例、sIUGR大胎(sIUGR-L)组14例、sIUGR小胎(sIUGR-S)组14例,将至妊娠晚期母体及胎儿未发生并发症的正常MCDA双胎35例作为对照组。检测并比较各组胎儿羊水中NT-proBNP、cTnT水平,分析其与分娩孕周及新生儿阿普加评分1 min分值的相关性。结果 TTTS-R组、sIUGR-L/sIUGR-S组和对照组孕妇的年龄、检测时孕周比较差异均无统计学意义(P均>0.05)。TTTS-R组羊水NT-proBNP水平高于其他3组(P均<0.008),TTTS-R组羊水cTnT水平高于sIUGR-L组、sIUGR-S组(P均<0.008)。86例MCDA中,减胎14例、引产7例、流产3例、胎儿宫内死亡4例,失访12例,期待治疗并且获随访妊娠结局者共46例,其中对照组29例、TTTS-R组11例、sIUGR组6例。Spearman秩相关分析显示,TTTS-R组的分娩孕周与羊水NT-proBNP水平呈负相关(r_s=-0.415,P=0.020),且TTTS-R组新生儿阿普加评分1 min分值与NT-proBNP(r_s=-0.412,P=0.031)及cTnT(r_s=-0.641,P=0.022)水平有关。结论 TTTS-R的不良妊娠结局可能与胎儿心功能下降有关。

Objective To investigate the relationship between the levels of brain natriuretic peptide precursor （NT-proBNP） and cardiac troponin T （cTnT） in alnniotic fluid and the outcomes of lnonochorionic diamniotic twin pregnancies （MCDA）. Methods A total of 100 MCDA cases undergoing alnniotic fluid puncture were collected. Among them, 14 cases of severe maternal complications and fetal Inalformation were excluded and the remaining 86 MCDA cases were included in the study. According to maternal complications, all participants were divided into TTTS-R group （n= 37） , sIUGR-L group （n=14） and sIUGR-S group （n= 14）. Norlnal MCDA twins without maternal and fetal complications in the late pregnancy were assigned into the control group （n 35）. The NT-proBNP and cTnT levels in alnniotic fluid were quantitatively detected and statistically compared among different groups. The correlation between NT-proBNP and cTnT levels and I-min Apgar score was analyzed. Results The age and gestational weeks did not algnificantly differ among all groups （ all P 〉 0. 05）. The NT-proBNP level in alnniotic fluid in the TTTS-R group was significantly higher compared with those in the other groups （all P 〈 0. 008）. The cTnT level in the TTTS-R group was considerably higher than those in the sIUGR-L and sIUGR-S groups （both P 〈0. 008）. Of 86 MCDA cases, 14 cases were subject to fetal reduction, 7 of labor induction, 3 of abortion, 4 of intrauterine fetal death and 12 cases were lost to follow-up, Forty-six cases were expected to receive treatment and the pregnancy outcomes were obtained during follow-up including 29 cases in the control group, 11 in the TTTS group and 6 in the sIUGR group. Spearman＇s rank correlation analysis demonstrated that the gestational week of deliver7 was negatively correlated with the concentration of NT-proBNP in the amniotic fluid （r =-0. 415, P 0. 020） , and the 1-min Apgar score was significantly correlated with the concentration of NT-proBNP （r=- 0.412, P 0. 031） and cTnT （rs=0. 641, P 0. 022） in the TTTS-R group. Conclusion The adverse pregnancy outcomes of TTTS-R are probably associated with the decline of fetal heart function.