不同心功能分级妊娠高血压性心力衰竭患者临床特点分析比较

Comparison of clinical characteristics of patients with preeclampsia complicated with heart failure in different grades of heart function

目的比较不同心功能分级妊娠高血压性心力衰竭患者临床指标,为妊高症性心力衰竭的诊断及其严重程度的临床判断提供依据。方法选取181例均为符合妊娠高血压性心力衰竭的患者,其中温州医大附属三院89例,克拉玛依市中心医院92例,根据NYHA标准分级分为心功能Ⅱ、Ⅲ、Ⅳ级三组,用化学发光法测定各组脑钠肽水平,同期采取血常规、血脂血糖肝肾功能等常规生化指标。所有研究对象均进行二维超声、频谱多普勒及应变/应变率成像技术检查,取得应变率数据并进行比较。结果心功能Ⅱ、Ⅲ、Ⅳ级组血浆脑钠肽水平分别为(252.70±22.55)pg/ml、(360.50±26.90)pg/ml、(479.50±32.75)pg/ml。心功能越差,血浆脑钠肽水平越高,差异有统计学意义(F=8.18,P<0.05)。心功能Ⅱ级组左室前壁、后间隔、后壁、下壁、侧壁舒张期早期应变率(SRe)与心功能Ⅲ级组比较,差异无统计学意义(t分别=1.88、1.07、0.93、1.01、0.99,P均>0.05),但心功能Ⅲ级组左室前间隔SRe明显低于心功能Ⅱ级组,差异有统计学意义(t=33.03,P<0.05)。心功能Ⅳ级组左室前壁、前间隔、后间隔、后壁、下壁、侧壁SRe较心功能Ⅱ级组明显降低,差异均有统计学意义(t分别=22.34、34.07、25.06、19.93、20.72、18.13,P均<0.05)。心功能Ⅳ级组左室前壁、前间隔、后间隔、后壁、下壁、侧壁收缩期应变率(SRs)均低于心功能Ⅱ级、心功能Ⅲ级组,差异均有统计学意义(t分别=24.56、21.38;36.03、33.04;18.92、16.81;20.21、17.31;23.47、21.37;19.62、16.95,P均<0.05)。结论心肌应变率显像是是评价心脏舒缩功能和室壁运动的新方法,为及早发现妊高症性心力衰竭的发生及判断病变的严重程度提供诊断和治疗抢救依据,同时血浆中脑钠肽水平增加反映妊高症合并心力衰竭患者的心功能越差。

Objective To compare the clinical indexes of patients with different functional grades of PIH complicated with heart failure,so as to provide basis for the diagnosis and clinical judgment of the severity of PIH heart failure. Methods A total of 181 patients with pregnancy hypertensive heart failure(89 cases in Wenzhou Third Hospital and 92 cases in Karamay Central Hospital)were selected.They were divided into three groups of cardiac function Ⅱ,Ⅲ and Ⅳ according to NYHA standard. The levels of brain natriuretic peptide were measured by chemiluminescence method,and blood lipid,blood glucose,liver and kidney function and other routine biochemical indexes were taken at the same time.All subjects were examined by two-dimensional ultrasound,spectral Doppler and strain/strain rate imaging techniques,and the strain rate data were obtained and compared. Results The plasma brain natriuretic peptide levels of patients in cardiac function grade Ⅱ,Ⅲ and Ⅳ groups were(252.70±22.55)pg/ml,(360.50±26.90)pg/ml and(479.50±32.75)pg/ml respectively.The worse the cardiac function,the higher the plasma brain natriuretic peptide level,the difference was statistically significant(F=8.18,P<0.05).There was no significant difference in SRe of left ventricular anterior wall,posterior septum,posterior wall,inferior wall and lateral wall between cardiac function grade Ⅱ group and cardiac function grade Ⅲ group(t=1.88,1.07,0.93,1.01,0.99,P>0.05),but SRe of left ventricular anterior septum in cardiac function grade Ⅲ group was significantly lower than that in cardiac function grade Ⅱ Group(t=33.03,P<0.05).The SRe of left ventricular anterior wall,anterior septum,posterior septum,posterior wall,inferior wall and lateral wall in grade Ⅳgroup was significantly lower than that in grade Ⅱ group(t=22.34,34.07,25.06,19.93,20.72,18.13,P<0.05).The SRs of left ventricular anterior wall,anterior septum,posterior septum,posterior wall,inferior wall and lateral wall in grade Ⅳgroup were significantly lower than those in grade Ⅱ and Ⅲ groups(t=24.56,21.38,36.03,33.04,18.92,16.81,20.21,17.31,23.47,21.37,19.62,16.95,P<0.05). Conclusion Myocardial strain rate imaging is a new method to evaluate cardiac systolic and diastolic function and ventricular wall motion.It provides the basis for diagnosis and treatment of heart failure in pregnancy induced hypertension and judging the severity of the disease.At the same time,the increase of plasma brain natriuretic peptide level can also reflect the cardiac function of patients with pregnancy induced hypertension complicated with heart failure.The higher the plasma brain natriuretic peptide level,the worse the cardiac function.