左心房与左心室舒张功能与不同分期妊娠期高血压的相关性研究

The relationship study between left atrium and left ventricular diastolic function and hypertension during pregnancy in different stages

目的探讨左心房与左心室舒张功能与不同分期妊娠期高血压的相关性。方法选取2019年11月—2020年11月宜春市人民医院收治的66例诊断为妊娠期高血压疾病的患者作为研究对象,参照《妇产科学》中诊断分型标准分为妊娠期高血压组(32例)与子痫前期组(34例),另选同期的30例健康孕产妇作为对照组。检测三组的血浆氨基末端脑钠肽前体(NT-proBNP)水平,采用二维超声心动图测定三组的舒张末期左心室容积(LVEDV)、收缩末期左心室容积(LVESV)、左心室射血分数(LVEF)、左心房容积,计算左心房容积指数(LAVI);采用血流多普勒测定三组的二尖瓣口舒张早期血流速度峰值(E值)、左心房舒张晚期血流速度峰值(A值),采用组织多谱勒测量三组的收缩期二尖瓣环侧壁根部运动速度峰值(Ea值),计算E/Ea比值;采用二维斑点追踪技术测定三组的左房整体纵向应变峰值(LA-GLPS)、收缩期左房应变率(LASRs)、舒张早期左房应变率(LASRe)、左心室整体纵向应变峰值(LV-GLPS)。比较三组的左心室与左心房超声心动图结构指标,采用Pearson相关系数法对三组的左心房应变率与左心室扭转角度指标以及LAVI、LA-GLPS、LASRs、LASRe与E/Ea、氨基末端脑纳肽前体(NT-proBNP)进行相关性分析。结果对照组的LVESV、LAVI、E/Ea比值低于妊娠期高血压组及子痫前期组,妊娠期高血压组的LVESV、LAVI、E/Ea比值低于子痫前期组,差异有统计学意义(P<0.05);对照组、妊娠期高血压组、子痫前期组的LVEDV则呈降低趋势,三组间的LVEDV比较,差异无统计学意义(P>0.05);对照组的LA-GLPS、LV-GLPS、LASRs、LASRe高于妊娠期高血压组及子痫前期组,妊娠期高血压组的LA-GLPS、LV-GLPS、LASRs、LASRe高于子痫前期组,差异有统计学意义(P<0.05);LAVI、LA-GLPS、LASRs、LASRe与E/Ea、NT-proBNP均呈正相关(r=0.881、0.599、0.601、0.499、0.899、0.801、0.598、0.602,P<0.05)。结论对于不同分期的妊娠期高血压疾病患者,心脏功能损伤程度存在差异,以子痫前期损伤较为显著,主要表现为左心房与左心室舒张功能发生障碍,其可作为评估不同分期妊娠期高血压的辅助工具。

Objective To explore the relationship between left atrium and left ventricular diastolic function and hypertension during pregnancy in different stages.Methods A total of 66 patients diagnosed with hypertension in pregnancy who were admitted to Yichun People′s Hospital from November 2019 to November 2020 were selected as the research objects,according to the diagnostic classification standard of Obstetrics and Gynecology,they were divided into the gestational hypertension group(32 cases)and the preeclampsia group(34 cases),and another 30 healthy pregnant women in the same period were selected as the control group.The plasma levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)in the three groups were measured,and the end-diastolic left ventricular volume(LVEDV),end-systolic left ventricular volume(LVESV),left ventricular ejection fraction(LVEF),left atrial volume were measured by two-dimensional echocardiography in the three groups,the left atrial volume index(LAVI)was calculated.Ea values of three groups were measured by tissue Doppler and E/Ea ratio was calculated.The two-dimensional spot tracking technique was used to determine Left atrial global longitudinal peak strain(LA-GLPS),the left atrial strain rate during systole(LASRs),the early diastolic left atrial strain rate(LASRe),and the peak value of the left ventricular longitudinal strain(LV-GLPS).The left ventricle and left atrium echocardiographic structural indicators of the 3 groups of patients were compared,and the Pearson correlation coefficient was used to determine the left atrial strain rate and left ventricular torsion angle indicators,as well as LAVI,LA-GLPS,LASRs,LASRe and E/Ea,N terminal pro B type natriuretic paptide(NT-ProBNP)performs correlation analysis.Results The LVESV,LAVI,E/Ea ratios of the control group were lower than those of the gestational hypertension group and the preeclampsia group,the LVESV,LAVI,E/Ea ratios of the gestational hypertension group were lower than those of the preeclampsia group,and the differences were statistically significant(P<0.05).The control group,the pregnancy-induced hypertension group,and the preeclampsia group showed a decreasing trend in LVEDV.There was no significant difference in LVEDV among the three groups(P>0.05).The LA-GLPS,LV-GLPS,LASRs and LASRe in the control group were higher than those in the pregnancy-induced hypertension group and the preeclampsia group,the LA-GLPS,LV-GLPS,LASRs and LASRe in the gestational hypertension group were higher than those in the preeclampsia group,the differences were statistically significant(P<0.05).LAVI,LA-GLPS,LASRs,LASRe were positively correlated with E/Ea and NT-proBNP(r=0.881,0.599,0.601,0.499,0.899,0.801,0.598,0.602,P<0.05).Conclusion For patients with hypertension in pregnancy at different stages,there are differences in the degree of cardiac function damage.Preeclampsia damage is more significant,mainly manifested as left atrium and left ventricular diastolic dysfunction,which can be used as an aid to assess hypertension in pregnancy at different stages tool.