妊娠期高血压和子痫前期对孕妇产后血管内皮功能的影响

Effect of Gastational Hypertension and Preeclampsia During Pregnancy on Postpartum Vascular Endothelial Function of Pregnant Women

目的探讨妊娠期高血压(GH)和子痫前期(PE)对孕妇产后血管内皮功能的影响。资料与方法纳入产检并分娩的123例产妇,依据《妊娠期高血压疾病诊治指南》分为正常妊娠的对照组、GH组和PE组。所有研究对象分别于孕前及产后6周、12周和24周进行右侧肱动脉内皮依赖性血流介导的血管扩张(FMD)检测。比较各组不同时间点FMD值和组间相同时间点FMD值;分析产后24周FMD值对GH和PE孕妇产后内皮功能异常的预测价值。结果对照组、GH组和PE组产妇产后不同时期FMD值呈上升趋势(P<0.05)。各组产妇不同时间点FMD值差异有统计学意义(P<0.001)。产后6周、12周及24周组间FMD值为对照组>GH组>PE组,差异均有统计学意义(P<0.05)。年龄、体重指数、舒张压为GH组和PE组FMD值变化的影响因素(P<0.05)。产后24周FMD值对GH及PE产妇产后内皮功能异常具有一定的诊断价值(DRAGON评分AUC=0.821,95%CI 0.756~0.952,P<0.001)。结论GH和PE母体产后的血管内皮功能持续受损。产后血管内皮功能异常对于识别心脑血管疾病高危人群具有重要意义。

Purpose To investigate the effect of gestational hypertension(GH)and preeclampsia(PE)on the function of postpartum vascular endothelial.Materials and Methods 123 parturient with labor examination and delivery were enrolled in this study.All subjects were divided into normal pregnancy as control group,GH group and PE group.The flow mediated dilation(FMD)of right brachial artery was detected before pregnancy,6 weeks,12 weeks and 24 weeks after delivery.FMD values of different periods in each group were compared,and the FMD values of different periods were compared among groups.The FMD value of each group at different periods and those of the same time point among groups were compared;the predictive value of FMD value at 24 weeks after delivery for postpartum endothelial dysfunction of GH and PE pregnant women were analyzed.Results The FMD values of the three groups in different postpartum periods showed an increasing trend(P<0.05).There was significant difference in FMD among the three groups in four periods(P<0.001).The FMD values of 6 weeks,12 weeks and 24 weeks after delivery showed the trend of control group>GH group>PE group,with statistical difference(P<0.05).Age,body mass index and diastolic blood pressure were the influencing factors of FMD value in GH group and PE group(P<0.05).The FMD value of 24 weeks after delivery had a certain diagnostic value for the abnormal endothelial function of GH and PE(AUC=0.821,95%CI 0.756-0.952,P<0.001).Conclusion GH and PE can damage the function of blood vessel endothelium.It is expected that the detection of postpartum vascular endothelial dysfunction will have great significance to identify the high-risk population of cardiovascular and cerebrovascular diseases.