不同NYHA分级妊娠期高血压疾病患者正常血浆BNP变化及其与心功能关系的研究

Changes of plasma BNP and its relationship with cardiac function in different NYHA grades of pregnancy-induced hypertension

目的研究不同美国纽约心脏病学会(NYHA)分级妊娠期高血压疾病患者血浆脑钠肽(BNP)变化及其与心功能的关系,为患者的临床诊断提供指导。方法选取2017年1月-2019年6月在该院妇产科诊断为妊娠期高血压疾病且在该院有完整产前定期体检记录的62例孕妇作为观察组。同时选取在该院建档生产的正常妊娠孕妇50例作为对照组。按照NYHA制定的心功能分级将观察组患者分为心功能正常的A组(22例)、Ⅱ级的患者为B组(20例)、Ⅲ级的患者为C组(11例)、Ⅳ级的患者为D组(9例)。分别在妊娠早、晚期与产后6周对研究对象的血浆BNP水平以及心功能进行测定比较,对不同NYHA分级妊娠期高血压疾病患者血浆BNP变化及其与心功能的关系进行分析。结果观察组不同NYHA分级孕妇的血浆BNP水平明显高于对照组孕妇,差异有统计学意义(P<0.05)。观察组不同NYHA分级的A、B、C、D组间血浆BNP水平两两相比,差异有统计学意义(P<0.05);NYHA分级等级越高,孕妇的血浆BNP水平越高。观察组孕妇妊娠早期、妊娠晚期以及产后6周的血浆BNP水平均明显高于对照组孕妇,差异有统计学意义(P<0.05)。观察组孕妇的二尖瓣血流舒张早期充盈峰(E)、E峰速度时间积分(EVTI)以及E/A比值均明显低于对照组孕妇,差异有统计学意义(P<0.05)。观察组孕妇的舒张晚期充盈峰(A)、A峰速度时间积分(AVTI)均明显高于对照组孕妇,差异有统计学意义(P<0.05)。结论血浆BNP浓度不仅与产妇妊娠期高血压疾病的严重程度有关,还与心力衰竭的发生有着较为密切的关系,NYHA分级等级越高,孕妇的血浆BNP水平越高。

Objective To study the changes of plasma brain natriuretic Peptide(BNP)and its relationship with cardiac function in patients with pregnancy-induced hypertension(PIH)classified by the New York Heart Association(NYHA),and to provide guidance for clinical diagnosis.Methods From January 2017 to June 2019,62 pregnant women with pregnancy-induced hypertension diagnosed in our gynecology and obstetrics department and complete prenatal physical examination records were selected as observation group.At the same time,50 pregnant women with normal pregnancy in our hospital during the same period were selected as the control group.The patients in the observation group were divided into normal group(22 cases),group B(20 cases),group C(11 cases)and group D(9 cases)according to the cardiac function classification established by the New York Heart Association(NYHA).The levels of BNP and cardiac function were measured and compared in the early,late pregnancy and 6 weeks postpartum respectively.The changes of plasma BNP and the relationship between plasma BNP and cardiac function in different NYHA grades of pregnancy-induced hypertension were analyzed.Results The plasma BNP levels of pregnant women with different NYHA grades in the observation group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).There were significant difference in BNP level between groups A,B,C and D with different NYHA grades in the observation group(P<0.05).The higher the NYHA grade,the higher the plasma BNP level of pregnant women.The plasma BNP levels of the observation group were significantly higher than those of the control group in early pregnancy,late pregnancy and 6 weeks postpartum(P<0.05).The early diastolic filling peak(E),peak velocity time integral(EVTI)and E/A ratio of pregnant women in the observation group were significantly lower than those in the control group(P<0.05).The late diastolic filling peak(A)and peak velocity time integral(AVTI)of pregnant women in the observation group were significantly higher than those in the control group(P<0.05).Conclusion The concentration of plasma brain natriuretic peptide is not only related to the degree of pregnancy induced hypertension,but also closely related to the occurrence of heart failure.The higher the grade of New York Heart Association,the higher the level of plasma brain natriuretic peptide in pregnant women.