可溶性ST2、NT-proBNP在妊娠期高血压疾病检测的临床意义

Clinical significance of soluble ST2,NT-proBNP in hypertensive disorder complicating pregnancy

目的研究可溶性生长剌激表达基因2蛋白(soluble suppression of tumorigenicity 2;sST2,)、氨基末端脑钠肽前体(N-terminal probrain natriuretic peptide;NT-proBNP)在妊娠期高血压疾病检测的临床意义。方法选择2014年2月-2018年9月衡水市妇幼保健院收治的980例妊娠高血压疾病患者,根据病情分妊娠期高血压组(1组)、子痫前期组(2组)、子痫期组(3组),60名健康孕妇为对照组。依据有无出现妊娠期高血压疾病性心脏病,分并发症组和非并发症组。入院24h内检测超敏肌钙蛋白I(hs-cTnI)、NT-proBNP血管生成素-Ⅱ(Ang-Ⅱ)、sST2。用彩色多普勒超声测定左心室射血分数(LVEF)和E/A值。结果与对照组比较,妊娠高血压疾病各组的Ang-Ⅱ均升高,超声心动图A峰增高,E/A值减少,子痫期组较其他两组变化明显。各组间比较有明显统计学意义(PV0.05)。2组、3组sST2升高,3组较2组升高明显,有统计学差异(P<0.05)。子痫期组NT-proENP、hs-cTnI升高,与对照组及1、2组比较,有统计学意义(P<0.05)。对照组及妊娠高血压疾病各组的LVEF比较,无统计学差异(P>0.05)。与非并发症组比较,并发症组的Ang-Ⅱ、sST2、NT-proBNP、hs-cTnI均升高,超声心动图A峰增高,E峰、E/A值、LVEF降低,组间比较有明显统计学意义(P<0.05)。相关性分析示,妊娠高血压疾病并发症组患者E/A值与sST2、NT-proBNP呈正相关(r=0.864,P<0.01;r=0.913,P<0.01)。妊娠高血压疾病并发症组患者心功能受损越重,sST2xNT-proBNP水平越高。结论sST2、NT-proENP可评估妊娠期高血压疾病患者心功能损害程度,尤其是对合并心脏并发症患者临床价值更大。

Objective To study the clinical significance of soluble growth stimulation gene 2(soluble suppression of tumorigenicity 2;sST2,)and amino terminal brain natriuretic peptide precursor(N-terminal pro brain natriuretic peptide;NT-proBNP)in hypertensive disorder complicating pregnancy.Methods From February 2014 to September 2018,980 patients with pregnancy-induced hypertension were divided into three groups:gestational hypertension group(group 1),preeclampsia group(group 2),eclampsia group(group 3)and 60 healthy pregnant women as control group(n=60).According to the presence or absence of hypertensive heart disease complicating pregnancy,the patierds were divided into two groups:complication group and non-complication group.hs-cTnI,NT-proBNP,Ang-Ⅱ and sST2,were detcted Within 24 hours after admission.Left ventricular ejection fraction(LVEF)and E/A were measured by color Doppler ultrasound.Results Compared with the control group,Ang-Ⅱincreased,ultrasound A peak increased and E/A decreased in each sick group,and the changes in eclampsia group were more obvious than those in the other two groups.The sST2 of the 3 group was higher than that of the 2 group(P<0.05),and there was a significant difference between the three groups(P<0.05).The NT-proBNP,hs-cTnI in the eclampsia group was significantly higher than that in the control group(P<0.05).There was no significant difference in LVEF between control group and gestational hypertension group(P〉0.05).Compared with the non-complication group,the Ang-Ⅱ and sST2,NT-proBNP,hs-cTnI in the complication group were all increased,the A peak of ultrasound was increased,the E peak,E/A,LVEF was decreased,and there was significant difference between the two groups(P<0.05).The correlation analysis showed that there was a positive correlation between E/A value and sST2,NT-proBNP in patients with complications of pregnancy hypertension(r=0.864,P<0.01;r=0.913,P<0.01).The more serious the heart function impairment,the higher the sST2,NT-proBNP level in the group of pregnancy hypertension complicated with complications.Conclusions sST2,NT-proBNP can be used to evaluate the degree of cardiac dysfunction in hypertensive disorder complicating pregnancy,especially in patients with cardiac complications.