双胎与单胎妊娠孕晚期、产时和产后血清脑钠肽(BNP)水平差异

Differences in serum brain natriuretic peptide(BNP)levels between twins pregnancy and singleton pregnancy during late pregnancy,delivery and postpartum period

目的通过比较双胎妊娠与单胎妊娠孕晚期、产时和产后的脑钠肽(brain natriuretic peptide,BNP),探索双胎妊娠不同时期的心脏负荷状况。方法回顾性收集复旦大学附属妇产科医院2015年7月至2017年4月产科分娩人群。分娩孕周为孕28~41周,按相同的入组和排除标准控制组间均衡性,共收取252例孕妇分为双胎妊娠组和单胎妊娠组,两组内再按妊娠和产褥时期分为产前、分娩当天、产后第1天及产后第2天等4个亚组,应用非参数检验分析组间差异。结果共有252例孕妇入组,两组年龄差异无统计学意义,两组在不同时间点的妊娠合并贫血(Hgb>80 g/L)及妊娠期糖尿病比例均无统计学意义。两组BNP值比较,产前、分娩当天及产后第2天BNP值差异无统计学意义,但产后第1天双胎组BNP值显著高于单胎组(P<0.05)。按分娩方式进行亚组分析,剖宫产后第1天单胎组及双胎组组间BNP值差异有统计学意义(P<0.05);单胎组内阴道分娩与剖宫产在产后第1天及产后第2天BNP水平差异有统计学意义(P<0.05)。结论单胎及双胎妊娠人群产后第1天BNP值最高;双胎妊娠较单胎妊娠人群在产后第1天心脏负荷显著加重。

Objective By comparing the changes of brain natriuretic peptide(BNP)between twin pregnancy and singleton pregnancy during pregnancy,delivery and postpartum period,to explored the status of heart load in twins pregnancy at different stages.Methods A total of 252 patients admitted to the obstetics and Gynecology Hospital of Fudan University from Jul 2015 to Apr 2017 were incloded in our study and were analyzd retrospectively.The gestational week of delivery was set at 28-41 weeks of gestation.According to the same admission and exclusion criteria,pregnant women were divided into twins pregnancy group and single pregnancy group.The two groups were further divided into prenatal,day of delivery,the first day and second day after delivery according to the time of pregnancy and puerperium.Nonparametric test was used to analyze the differences between different groups.Results A total of 252 pregnant women were enrolled.There was no significant difference in age between the two groups.Pregnancy with anemia(Hgb>80 g/L),the proportion of gestational diabetes mellitus between the two groups at different time points had no statistical difference.There was no significant difference in BNP level between the two groups before and on the day of delivery and on the secend day of delivery.The BNP level of twins pregnancy group was significantly higher than that of singleton pregnancy group on the first day of delivery(P<0.05).According to the subgroup analysis of delivery mode,there was significant difference in BNP level between the two groups on the first day after cesarean section(P<0.05).There was statistical difference in BNP distribution between vaginal delivery and cesarean section in singleton pregnancy group on the first day and the second day after delivery(P<0.05).Conclusion BNP was the highest on the first day after delivery in singleton and twins pregnancy group,and the heart load of twins pregnancy was significantly heavier than that of singleton pregnancy.