超声心动图指标与血清心肌酶水平改变对妊娠期高血压的评估价值

Evaluation value of echocardiographic index and serum myocardial enzyme level changes for gestational hypertension

目的:探讨妊娠期高血压(GH)患者病情严重程度与血清心肌酶水平、超声心动图指标的关系。方法:我院2015~2018年妇产科收住院的GH患者101例患者被分为重症组(子痫前期重度以及子痫患者,46例)和轻症组(子痫前期轻度患者,55例),同期选择正常妊娠孕妇60例作为正常对照组。检测比较三组的各项心脏指标以及血清肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)水平。结果:与正常对照组比较,轻症组、重症组的LVESd、LVEDd、右室内径(RVD)、舒张末期室间隔厚度(IVSTd)、左室后壁厚度(LVPWT)均显著增加,且重症组上述指标均显著高于轻症组, P 均<0.01。与正常对照组比较,轻症组、重症组二尖瓣舒张晚期最大流速(A)显著增大,LVEF、心输出量(CO)、心脏指数(CI)、二尖瓣舒张早期最大流速(E)、E/A均显著减小;与轻症组比较,重症组A增大更显著,LVEF、CO、CI、E、E/A减小更显著, P 均<0.01。与正常对照组比较,轻症组、重症组血清CK-MB[(6.2±2.5)IU/L比(9.4±3.2)IU/L比(15.3±5.7)IU/L]和CK[(41.8±7.9)IU/L比(61.7±12.5)IU/L比(88.7±20.4)IU/L]水平均显著升高,且重症组的显著高于轻症组的, P 均=0.001。结论:妊娠期高血压病人进行超声心动图及心肌酶检查,有助于了解心脏的功能状态及结构,对早期及治疗有重大意义。

Objective: To explore relationship among disease severity,serum myocardial enzyme levels and echocardiographic indexes in patients with gestational hypertension (GH). Methods: A total of 101 GH inpatients treated in our department of gynecology from 2015 to 2018 were divided into severe group (severe preeclampsia and eclampsia patients,n=46) and mild group (mild preeclampsia patients,n=55),and another 60 normal pregnant women were simultaneously selected as normal control group. Heart indexes,serum levels of creatine kinase isoenzyme MB (CK-MB) and creatine kinase (CK) were measured and compared among three groups. Results: Compared with normal control group,there were significant rise in LVESd,LVEDd,right ventricular diameter (RVD),end-diastolic interventricular septal thickness (IVSTd) and left ventricular posterior wall thickness (LVPWT) in mild group and severe group,and above indexes of severe group were significantly higher than those of mild group, P <0.01 all. Compared with normal control group,there was significant rise in transmitral late diastolic peak flow velocity (A),and significant reductions in LVEF,cardiac output (CO),cardiac index (CI),transmitral early diastolic peak flow velocity (E) and E/A in mild group and severe group;compared with mild group,there was significant rise in A,and significant reductions in LVEF,CO,CI,E and E/A in severe group, P <0.01 all. Compared with normal control group,there were significant rise in serum levels of CK-MB[(6.2±2.5)IU/L vs.(9.4±3.2)IU/L vs.(15.3±5.7)IU/L] and CK[(41.8±7.9)IU/L vs.(61.7±12.5)IU/L vs.(88.7±20.4) IU/L] in mild group and severe group,and those of severe group were significantly higher than those of mild group, P =0.001 all. Conclusion: Echocardiography and myocardial enzyme examination in GH patients help to understand functional state and structure of heart,which possess important significance for early identification and treatment.