血清脑钠肽、25-羟维生素D、半乳糖凝集素-3与妊娠期高血压疾病患者左心室舒张功能的相关性及对妊娠结局的影响

Correlation between Serum Brain Natriuretic Peptide,25 Hydroxyvitamin D,Galectin-3 and Left Ventricular Diastolic Function and its Effect on Pregnancy Outcome in Patients with Hypertensive Disorders of Pregnancy

目的:探讨妊娠期高血压疾病(HDP)患者血清脑钠肽(BNP)、25-羟维生素D[25(OH)D]、半乳糖凝集素-3(Gal-3)与左心室舒张功能的相关性,并分析其对患者妊娠结局的影响。方法:选择2019年6月至2021年12月我院收治的HDP患者114例纳入研究组,其中妊娠期高血压组39例,轻度子痫前期组44例,重度子痫前期组31例,另选择同期在我院产检的健康孕妇30例作为对照组。比较各组血清BNP、25(OH)D、Gal-3及左心室舒张功能,分析患者血清BNP、25(OH)D、Gal-3与左心室舒张功能的相关性。根据妊娠结局将患者分为妊娠结局良好组65例、妊娠结局不良组49例,收集两组患者临床资料,应用单因素分析和多因素Logistic回归分析HDP患者妊娠结局不良的影响因素。结果:各组血清BNP、25(OH)D、Gal-3水平比较差异有统计学意义(P<0.05),HDP患者随疾病严重程度的升高血清BNP、Gal-3水平逐渐升高,25(OH)D水平逐渐降低。各组左心室舒张早期充盈峰速度(E峰)、左心室舒张晚期充盈峰速度(A峰)、E/A比较差异有统计学意义(P<0.05)。Pearson相关分析显示,HDP患者血清BNP、Gal-3水平与E峰、E/A呈负相关(P<0.05),与A峰呈正相关(P<0.05),血清25(OH)D水平与E峰、E/A呈正相关(P<0.05),与A峰呈负相关(P<0.05)。多因素Logistic回归分析显示:收缩压≥158.02 mm Hg、舒张压≥104.32 mm Hg、血清BNP≥406.42 ng/L、血清25(OH)D≤14.94μg/L、血清Gal-3≥16.17 ng/mL是HDP妊娠结局不良的危险因素(P<0.05)。结论:HDP患者血清BNP、Gal-3水平异常升高、25(OH)D水平异常降低均为HDP患者妊娠结局不良的危险因素,三者水平与患者左心室舒张功能相关,检测三者水平有助于对患者妊娠结局的临床判断。

Objective:To investigate the correlation between serum brain natriuretic peptide(BNP),25 hydroxyvitamin d[25(OH)D],galactose lectin-3(Gal-3)and left ventricular diastolic function in patients with hypertensive disorders of pregnancy(HDP),and to analyze its effect on pregnancy outcome.Methods:114 patients with HDP who were treated in our hospital from June 2019 to December2021 were selected as the study group,including 39 cases of gestational hypertension group,44 cases of mild preeclampsia group and 31cases of severe preeclampsia group.In addition,30 healthy pregnant women examined in our hospital in the same period were selected as the control group.The serum BNP,25(OH)D,Gal-3 and left ventricular diastolic function were compared in each group,and the correlation between serum BNP,25(OH)D,Gal-3 and left ventricular diastolic function were analyzed.According to the pregnancy outcome,the patients were divided into 65 cases in the good pregnancy outcome group and 49 cases in the poor pregnancy outcome group.The clinical data of the two groups were collected.The influencing factors of poor pregnancy outcome in patients with HDP were analyzed by univariate analysis and multivariate Logistic regression.Results:There were significant difference in the levels of serum BNP,25(OH)D and Gal-3 in each group(P<0.05).With the increase of disease severity,the levels of serum BNP and Gal-3 in patients with HDP gradually increased,and the level of 25(OH)D gradually decreased.There were significant differences in the peak velocity of early diastolic filling(E peak),late diastolic filling(A peak)and E/A among the groups(P<0.05).Pearson correlation analysis showed that the levels of serum BNP and Gal-3 in patients with HDP were negatively correlated with E peak and E/A(P<0.05),and positively correlated with A peak(P<0.05),serum 25(OH)D was positively correlated with E peak and E/A(P<0.05),and negatively correlated with A peak(P<0.05).Multivariate Logistic regression analysis showed that systolic blood pressure≥158.02 mm Hg,diastolic blood pressure≥104.32mm Hg,serum BNP≥406.42 ng/L,serum 25(OH)D≤14.94μg/L and serum Gal-3≥16.17 ng/mL were the risk factors of poor pregnancy outcome of HDP(P<0.05).Conclusion:The abnormal increase of the levels of serum BNP and Gal-3,and the abnormal decrease of the level of 25(OH)D in patients with HDP are the risk factors of poor pregnancy outcome in patients with HDP.The levels of the three are related to the left ventricular diastolic function.The detection of the levels of the three is helpful to the clinical judgment of pregnancy outcome.