24 h动态血压监测联合血清NT-proBNP、T-cadherin水平对子痫前期孕妇围生期结局的预测价值

Predictive value of 24 h ambulatory blood pressure monitoring combined with serum NT-proBNP and T-cadherin levels for perinatal outcome of pregnant women with preeclampsia

目的探讨24 h动态血压监测联合血清N末端B型脑钠肽前体(NT-proBNP)、T-钙黏合素(T-cadherin)水平对子痫前期(PE)孕妇围生期结局的预测价值。方法选择PE孕妇196例,根据围生期结局分为结局不良组128例、结局良好组68例。所有孕妇入组次日,接受24 h动态血压监测,采集外周静脉血,离心留取血清,检测血清NT-proBNP、T-cadherin。比较两组24 h动态血压参数及血清NT-proBNP、T-cadherin水平。采用多因素Logistic回归模型分析PE孕妇围生期结局不良的影响因素。采用受试者工作特征(ROC)曲线分析24 h动态血压参数及血清NT-proBNP、T-cadherin水平对PE孕妇围生期结局的预测价值。结果结局不良组24 h、日间、夜间收缩压(SBP)及其负荷值和24 h、日间、夜间舒张压(DBP)及其负荷值以及血清NT-proBNP水平均显著高于结局良好组(P均<0.05),而血清T-cadherin水平显著低于结局良好组(P<0.05)。多因素Logistic回归分析显示,夜间SBP负荷值、重度PE、血清NT-proBNP水平是PE孕妇围生期结局不良的独立危险因素,而血清T-cadherin水平则为其独立保护因素(P均<0.05)。ROC曲线分析显示,夜间SBP负荷值及血清NT-proBNP、T-cadherin水平单独和联合预测PE孕妇围生期结局不良的曲线下面积分别为0.759、0.666、0.687、0.921,夜间SBP负荷值及血清NT-proBNP、T-cadherin水平联合预测PE孕妇围生期结局不良的曲线下面积显著高于三者单独(P均<0.05)。结论PE孕妇围生期结局不良者夜间SBP负荷值和血清NT-proBNP水平显著升高,血清T-cadherin水平显著降低;夜间SBP负荷值及血清NT-proBNP、T-cadherin水平对PE孕妇围生期结局不良均有一定预测价值,三者联合预测价值更高。

Objective To investigate the predictive value of 24 h ambulatory blood pressure monitoring combined with serum N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)and T-cadherin levels for perinatal out⁃come of pregnant women with preeclampsia(PE).Methods A total of 196 PE pregnant women were selected and divid⁃ed into the poor perinatal outcome group(128 cases)and good perinatal outcome group(68 cases)according to the perina⁃tal outcome.All pregnant women received 24 h ambulatory blood pressure monitoring on the next day after admission;we collected peripheral venous blood,centrifuged serum,and tested serum NT-proBNP,T-cadherin.The 24 h ambulatory blood pressure parameters and serum NT-proBNP and T-cadherin levels were compared between the two groups.Multivari⁃ate Logistic regression model was used to analyze the influencing factors for poor perinatal outcome of PE pregnant women.The predictive value of 24 h ambulatory blood pressure parameters and serum NT-proBNP and T-cadherin levels for the adverse perinatal outcome of PE pregnant women was analyzed by using the receiver operating characteristic(ROC)curve.Results The 24 h,daytime and nighttime systolic blood pressure(SBP)and its load value,24 h,daytime and nighttime diastolic blood pressure(DBP)and its load value,as well as the serum NT-proBNP water in the poor outcome group were significantly higher than those in the good outcome group(all P<0.05),while the serum T-cadherin level was significantly lower than that in the good outcome group(P<0.05).Multivariate Logistic regression analysis showed that nighttime SBP load value,severe PE and serum NT-proBNP level were independent risk factors for poor perinatal outcome of PE pregnant women,while serum T-cadherin level was its independent protective factor(all P<0.05).The ROC curve analysis showed that the area under the curve of nighttime SBP load value and serum NT-proBNP and T-cadherin levels alone and jointly in predicting the poor perinatal outcome of PE pregnant women was 0.759,0.666,0.687 and 0.921,respectively.The area under the curve of nighttime SBP load value and serum NT-proBNP and T-cadherin levels combined in predicting the poor perinatal outcome of PE pregnant women was significantly higher than that of the three alone(P<0.05).Conclusion The nighttime SBP load value and serum NT-proBNP level of PE pregnant women with poor perina⁃tal outcomes significantly increase,while the serum T-cadherin level significantly decreases;the nighttime SBP load value and serum NT-proBNP and T-cadherin levels have certain predictive value for the adverse perinatal outcome of PE pregnant women,and the combined predictive value of the three is higher.