妊娠高血压综合征患者左心室舒张功能与脑利钠肽浓度相关性的研究

Relationship between left ventricular diastolic function and plasma brain natriuretic peptide concentration during severe pregnancy-induced hypertension syndrome

目的 研究重度妊娠高血压综合征 (简称妊高征 )患者左心室的舒张功能及其与血浆脑利钠肽水平的相关性。方法 对重度妊高征患者 36例、正常晚期妊娠孕妇 32例及正常未孕育龄妇女 2 1名 (为对照 ) ,应用彩色多普勒超声测定左心室舒张功能 ,以二尖瓣和肺静脉血流频谱参数作为观察指标 ,用放射免疫方法测定血浆脑利钠肽浓度。结果 妊高征患者的舒张功能指标 :二尖瓣舒张早期充盈峰 (E)、E峰的速度时间积分 (EVTI)、二尖瓣舒张早期充盈峰与舒张晚期充盈峰的比值 (E/A)、肺静脉心室舒张期充盈峰 (D)、D峰的速度时间积分 (DVTI)均显著低于正常妊娠组和对照组 ,而二尖瓣舒张晚期充盈峰 (A)、A峰的速度时间积分 (AVTI)、肺静脉心房收缩期反向血流充盈峰 (AR)则均显著高于正常妊娠和未孕对照组的相应指标。正常妊娠组二尖瓣和肺静脉血流频谱指标 :E/A比值、D和DVTI较对照组显著降低 ,而A、AVTI、肺静脉心室收缩期血流充盈峰与心室舒张期血流充盈峰比值 (S/D)及AR则均显著升高。血浆脑利钠肽浓度妊高征组、正常妊娠及对照组分别为 43pmol/L± 40pmol/L、8pmol/L± 4pmol/L和 2pmol/L± 2pmol/L ,前两组比较及后两组比较均P <0 .0 1。

Objective To evaluate the relationship between the left ventricular diastolic function and plasma level of plasma brain natriuretic peptide (BNP) among patients with pregnancy-induced hypertension (PIH) syndrome. Methods The left ventricular diastolic function was evaluated by Doppler echocardiography, and plasma BNP level was tested by radioimmunoassay among 36 pregnant women with severe PIH, 32 normal pregnant women, and 21 normal non-pregnant women of childbearing age. Results The parameters such as peak mitral flow velocity in early diastole (E), E-wave velocity-time integral (EVTI), the ratio of peak mitral flow velocity in early diastole and peak A-wave velocity in late diastole (E/A), peak pulmonary venous diastolic forward flow velocity (D) and D-wave velocity-time integral (DVTI) of the 36 severe PIH patients were significantly lower than those of the 32 normal pregnant women and those of the 21 normal non-pregnant women of child-bearing age. But the parameters such as A, A-wave velocity integral (AVTI), and peak pulmonary venous diastolic forward flow velocity (AR) were significantly higher than those of the normal pregnant women and those of the normal non-pregnant women of child-bearing age. E/A ratio, D and DVTI of the normal pregnant women were significantly lower than those of the normal non-pregnant women of child-bearing age, however, A, AVTI, S/D, and AR were significantly higher than those of the normal non-pregnant women of child-bearing age. The BNP concentration of the normal pregnant women was significantly higher than that of the normal non-pregnant women of childbearing age, but significantly lower than that of the severe PIH patients. There were significant correlations between left ventricular diastolic function variables (E/A ratio and AR) and BNP concentration in normal pregnant women and in PIH patients. Conclusion The left ventricular diastolic function is slightly damaged in normal pregnant women and significantly damaged in patients with severe PIH. The plasma BNP level of pregnant women can become an excellent index to predict their left ventricular diastolic function.