合并妊娠期高血压疾病的高龄孕妇心肌损伤的临床研究

Clinical study on myocardial damage in pregnant women at advanced maternal age with hypertensive disorder complicating pregnancy

目的通过分析比较不同类型妊娠期高血压疾病(HDCP)的高龄孕妇心电图及心肌肌钙蛋白Ⅰ(cTnⅠ)水平,以探讨该类孕妇心肌损伤情况。方法选取合并HDCP的妊娠晚期高龄孕妇95例作为观察组(A组),参照HDCP分类标准分为妊娠期高血压孕妇35例(A1组)、轻度子痫前期孕妇25例(A2组)、重度子痫前期孕妇12例(A3组)、慢性高血压合并妊娠孕妇23例(A4组);选取同期正常妊娠孕妇125例作为对照组(B组),其中高龄孕妇58例(B1组),适龄孕妇67例(B2组)。所有研究对象均行心电图、血压、实验室检查,并比较各组各指标水平,分析比较各组孕妇心电图及cTnⅠ异常情况,分析cTnⅠ与收缩压(SBP)、舒张压(DBP)、24 h尿蛋白定量值、肌酸激酶同工酶(CK-MB)的相关性。结果 A1组、A2组、A3组、A4组的SBP、DBP水平均明显高于B组,差异具有统计学意义(P<0.05);A2、A3组的24 h尿蛋白定量明显高于A1、A4组,差异具有统计学意义(P<0.05), A2组、A3组的24 h尿蛋白定量均>0.3 g/24 h。A3组的SBP、DBP、肌酸激酶(CK)、CK-MB、24 h尿蛋白定量、产前及产后24 h cTnⅠ水平均明显高于其他各分组,差异具有统计学意义(P<0.05);A组中除了A3组(A3组仅有2例产后24 h cTnⅠ水平未恢复正常, A1组、A2组及A4组产后24 h cTnⅠ水平均恢复正常)外,各分组间产后24 h cTnⅠ水平比较差异无统计学意义(P>0.05), A3组产后24 h cTnⅠ水平较产前明显下降,差异具有统计学意义(P<0.05)。A组心电图异常率55.8%明显高于B组的16.0%,差异具有统计学意义(P<0.05);心电图异常类型主要包括窦性心动过速、房性早搏、室性早搏、ST-T改变、短P-R间期、左室面高电压。心电图异常率比较:B1组明显高于B2组, A3组明显高于A1组、A2组及A4组, A4组明显高于A1组、A2组,差异具有统计学意义(P<0.05);A1与A2组比较差异无统计学意义(P>0.05)。cTnⅠ异常率比较:产前,A3组cTnⅠ异常率66.7%明显高于其他各分组, A2组明显高于A1组及A4组,差异具有统计学意义(P<0.05);产前A1组及A4组比较差异无统计学意义(P>0.05);各组产后24 h cTnⅠ异常率均较产前明显下降。相关性分析显示,合并HDCP孕妇的cTnⅠ与SBP、DBP、24 h尿蛋白定量值及CK-MB呈正相关(r=0.713、0.635、0.664、0.509, P<0.05)。结论重度子痫前期高龄孕妇并发心肌损伤几率高,合并HDCP高龄孕妇应定期监测心电图及cTnⅠ水平,以尽早发现该类孕妇心肌损伤情况。

Objective To investigate the myocardial damage through analyze and compare the electrocardiogram(ECG)and cardiac troponin I(cTnI)levels in in pregnant women at advanced maternal age with different types of hypertensive disorder complicating pregnancy(HDCP).Methods A total of 95 pregnant women at advanced maternal age in trimester of pregnancy with HDCP were selected as observation group(group A),and they were divided into 35 cases of gestational hypertension(group A1),25 cases of mild preeclampsia(group A2),12 cases of severe preeclampsia(group A3)and 23 cases of chronic hypertension with pregnancy(group A4)refer to HDCP classification standard.125 normal pregnancy pregnant women were selected during the same period as control group(group B),among them,there were 58 pregnant women at advanced maternal age(group B1)and 67 pregnant women of the right age(group B2).All subjects underwent electrocardiogram,blood pressure and laboratory examination,and the levels of indexes in each group were compared.The abnormalities of ECG and cTnI of pregnant women in each group were analyzed and compared.The correlation between cTnI and systolic blood pressure(SBP),diastolic blood pressure(DBP),24-hour urinary protein quantification and creatine kinase isoenzyme(CK-MB)were analyzed.Results The levels of SBP and DBP in group A1,group A2,group A3 and group A4 were significantly higher than those in B group,the differences were statistically significant(P<0.05).The 24-hour urinary protein quantification in group A2 and group A3 were significantly higher than those in group A1 and group A4,the differences were statistically significant(P<0.05).The 24 h urinary protein quantitation in group A2 and group A3 were all above 0.3 g/24 h.The levels of SBP,DBP,creatine kinase(CK),CK-MB,24-hour urinary protein,cTnI before and 24-hour postpartum in the group A3 were significantly higher than those in other subgroups,the differences were statistically significant(P<0.05).In group A,except for 2 cases of postpartum 24 h cTnI level did not return to normal in group A3,the levels of cTnI in group A1,A2 and A4 were all restored to normal at 24 hours postpartum,and there were no significant differences among the each subgroups(P>0.05).In group A3,the level of 24 h cTnI after delivery was significantly lower than that before delivery,the difference was statistically significant(P<0.05).The abnormal rate of ECG in group A was 55.8%,which was significantly higher than 16.0%in group B,the difference was statistically significant(P<0.05).The main types of ECG abnormalities included sinus tachycardia,atrial premature beats,ventricular premature beats,ST-T changes,short P-R intervals and left ventricular high voltage.Comparison of the abnormal rate of ECG:the abnormal rate of ECG in group B1 was significantly higher than that in group B2,that in group A3 was significantly higher than those in group A1,group A2 and group A4,and that in group A4 was significantly higher than those in group A1 and group A2,the differences were statistically significant(P<0.05).There was no significant difference between group A1 and group A2(P>0.05).Comparison of cTnI abnormal rate:before delivery,the cTnI abnormality rate of group A3 was 66.7%,which was significantly higher than those of other subgroups,and that of group A2 was significantly higher than those of group A1 and group A4,the differences were statistically significant(P<0.05),there was no significant difference between group A1 and group A4 before delivery(P>0.05).The abnormal rates of 24 h cTnI after delivery were significantly lower than those before delivery.Correlation analysis showed that cTnI was positively correlated with SBP,DBP,24 h urinary protein quantification and CK-MB(r=0.713,0.635,0.664,0.509,P<0.05).Conclusion There is high probability of myocardial damage in pregnant women at advanced maternal age with severe preeclampsia.ECG and cTnI in pregnancy with HDCP at advanced maternal age should be monitored regularly in order to find early myocardial damage in this type of patients.