妊娠期高血压疾病患者左心室结构和功能变化及其与新生儿生长发育的关系

Left ventricular structural and functional changes in patients with pregnancy-induced hypertension and their relationship with the growth and development of newborns

目的观察妊娠期高血压疾病(HDCP)患者的左心室结构和功能变化,并探讨其与新生儿生长发育的相关性。方法87例HDCP患者,其中66例妊娠期高血压患者(HDP组)、21例子痫前期患者(子痫前期组),另选择50例正常妊娠孕妇为对照组,超声心动图观察三组左心室结构和功能,追踪其妊娠结局,记录新生儿出生5 min Apgar评分、出生体质量、头围和身长。Pearson相关性分析HDCP患者左心室结构和功能参数与新生儿Apgar评分、出生体质量、头围和身长的相关性。结果与HDP组、对照组比较,子痫前期组左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)高,左心室舒张早期充盈峰最大充盈速度和舒张晚期充盈峰最大峰值速度(E/A)比值低(P<0.05);与对照组比较,HDP组E/A低(P均<0.05)。与HDP组、对照组比较,子痫前期组新生儿出生5 min Apgar评分、出生体质量、头围、身长低(P均<0.05)。子痫前期患者LVEDD与新生儿出生5 min Apgar评分、出生体质量呈负相关(P均<0.05),E/A比值与新生儿出生5 min Apgar评分、出生体质量呈正相关(P均<0.05)。结论HDCP患者尤其是子痫前期患者存在明显左心室结构和功能受损,左心室结构和功能受损与新生儿低出生体质量和Apgar评分有关。积极治疗HDCP保护患者心功能有助于改善新生儿结局。

Objective To observe the changes of left ventricular structure and function in patients with hypertensive disorders complicating pregnancy(HDCP),and to explore their correlations with the growth and development of the newborns.Methods Eighty-seven patients with HDCP were selected,including 66 patients with gestational hypertension(HDP group),21 patients with preeclampsia(preeclampsia group),and 50 normal pregnant women(control group).The left ventricular structure and function of the three groups were observed by echocardiography,and the pregnancy outcomes were tracked.Apgar score at 5 min of birth,birth mass,head circumference and body length were recorded.Pearson correlation was used to analyze the correlations between left heart structure and function parameters of HDCP patients and Apgar score,birth mass,head circumference and body length of newborns.Results Compared with the HDP group and control group,the left ventricular end-diastolic diameter(LVEDD)and interventricular septal thickness(IVST)in the preeclampsia group were higher(all P<0.05),the ratio of early diastolic peak filling velocity to late diastolic peak filling velocity(E/A)was lower(P<0.05);compared with the control group,the E/A ratio of the HDP group was lower(P<0.05).Compared with HDP group and control group,the Apgar score at 5 min of birth,birth mass,head circumference and body length of newborns were lower in the preeclampsia group(P<0.05).LVEDD in the preeclampsia group was negatively correlated with Apgar score at 5 min of birth and birth mass(both P<0.05),and E/A ratio was positively correlated with Apgar score at 5 min of birth and birth mass(both P<0.05).Conclusion HDCP patients,especially complicated with preeclampsia,have significant left ventricular structural and functional impairment,which is related to low birth mass and Apgar score;active treatment of HDCP to protect patients′heart function is helpful to improve neonatal outcomes.