血清脑钠肽、肌钙蛋白在预测妊娠合并心脏病患者不良母婴结局中的应用

The application of serum brain natriuretic peptide and cardiac troponin Ⅰ in predicting the bad outcomes of mother and infant in pregnant women with heart disease

目的探讨血清脑钠肽(BNP)、肌钙蛋白(cTn) Ⅰ水平在预测妊娠合并心脏病患者不良母婴结局中的应用。方法选取收治的妊娠合并心脏病患者84例,依据母婴结局分为不良组(n=42)和良好组(n=42),采用化学发光法检测血清BNP、cTnⅠ水平。结果在血清BNP、cTnⅠ水平方面,不良组和良好组孕28周差异无统计学意义(P>0. 05),孕30周明显高于孕28周,孕32周明显高于孕30周,不良组孕30周、孕32周和升高值明显高于良好组,差异有统计学意义(P <0. 05); ROC曲线结果显示,在预测患者不良母婴结局的敏感度、特异度、准确度、曲线下面积(AUC)方面,血清BNP水平升高值以> 72. 68μmol/L为临界值时,分别为76. 19%、83. 33%、79. 77%、0. 735,血清cTnⅠ水平升高值以> 0. 194μg/L为临界值时,分别为80. 95%、85. 71%、83. 33%、0. 712,二者联合时,分别为95. 24%、100%、97. 62%、0. 823,二者联合时明显高于二者单独时,差异有统计学意义(P <0. 05)。结论血清BNP、cTnⅠ水平与妊娠合并心脏病患者不良母婴结局的发生有关,监测其水平变化可能可作为预测患者不良母婴结局发生的重要参考指标,且二者联合时具有更高的预测效能,值得临床作进一步推广。

Objective To investigate the application of serum brain natriuretic peptide( BNP) and cardiac troponin( cTnⅠ) in predicting the bad outcomes of mother and infant in pregnant women with heart disease. Methods A total of 84 pregnant women with heart disease who were admitted and treated in our hospital from June 2014 to June 2017,were divided into bad outcome group( n = 42) and good outcome group( n = 42) according to the outcomes of mother and infant. The levels of BNP and cTnⅠ were detected by chemiluminescence methord. Results There were no significantly differences in serum levels of BNP and cTnⅠ between the two groups at pregnant 28 weeks( P > 0. 05). The serum levels of BNP and cTnⅠ at pregnant 30 weeks were significantly higher than those at pregnant 28 weeks in both groups( P < 0. 05),and those at pregnant32 weeks were significantly higher than those at pregnant 30 weeks( P < 0. 05). Moreover the increasing value of serum levels of BNP and cTnⅠ in bad outcome group at pregnant 30 weeks and 32 weeks were significantly higher than those in good outcome group( P < 0. 05). ROC curve results showed that taking the increasing value of serum BNP level > 72. 68μmol/L as the critical value,the sensitivity,specificity,accuracy and the area under curve( AUC) in predicting the bad outcomes of mother and infant in pregnant women with heart disease were 76. 19%,83. 33%,79. 77%,0. 735 respectively. Moreover when taking the increasing value of serum cTnⅠ level > 0. 194μg/L as the critical value,the sensitivity,specificity,accuracy degrees and AUC in predicting the bad outcomes of mother and infant were 80. 95%,85. 71%,83. 33%,0. 712 respectively,whenthe two indexes were combined,the sensitivity,specificity,accuracy degrees and AUC in predicting the bad outcomes of mother and infant were 95. 24%,100%,97. 62%,0. 823,respectively,which were significantly higher than those by the any single index detection( P < 0. 05). Conclusion The serum levels of BNP and cTnⅠ are associated with the incidence of bad outcome of mother and infant in pregnant women with heart disease. Monitoring the changes of serum levels of BNP and cTnⅠ can be regarded as important reference indexes in predicting the bad outcomes of mother and infant.And the combination detection of the serum levels of BNP and cTnⅠ has higher prediction efficiency,which is worthy of further clinical promotion.