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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (02) : 103 -108. doi: 10.3877/cma.j.issn.1674-6880.2017.02.007

所属专题： 文献；

论著

运用超声心动图评价妊娠期高血压疾病患者左室形态和功能变化及其与N端脑利钠肽前体的相关性研究
寿列军1, 解左平1,†(), 孙雪东2, 谭乳燕1, 谢乐燕1, 袁华1, 汪惠琴1, 李红梅1   
  1. 1. 312000　浙江绍兴，绍兴市妇幼保健院超声科
    2. 312000　浙江绍兴，绍兴市人民医院重症监护室
  • 收稿日期:2016-10-26 出版日期:2017-04-01
  • 通信作者: 解左平
  • 基金资助:
    浙江省公益性技术应用研究计划项目(2015C33296); 绍兴市公益性技术应用研究计划项目(2014B70060)

Study of left ventricular morphology and function in patients with hypertensive disorder complicating pregnancy by echocardiography and their correlation with N-terminal probrain natriuretic peptide

Liejun Shou1, Zuoping Xie1,†(), Xuedong Sun2, Ruyan Tan1, Leyan Xie1, Hua Yuan1, Huiqin Wang1, Hongmei Li1   

  1. 1. Department of Diagnostic Ultrasound, Shaoxing Women & Children's Hospital, Shaoxing 312000, China
    2. Intensive Care Unit, Shaoxing People’s Hospital, Shaoxing 312000, China
  • Received:2016-10-26 Published:2017-04-01
  • Corresponding author: Zuoping Xie
  • About author:
    Corresponding author: Xie Zuoping, Email: xzp0126@163.com
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引用本文：

寿列军, 解左平, 孙雪东, 谭乳燕, 谢乐燕, 袁华, 汪惠琴, 李红梅. 运用超声心动图评价妊娠期高血压疾病患者左室形态和功能变化及其与N端脑利钠肽前体的相关性研究[J]. 中华危重症医学杂志(电子版), 2017, 10(02): 103-108.

Liejun Shou, Zuoping Xie, Xuedong Sun, Ruyan Tan, Leyan Xie, Hua Yuan, Huiqin Wang, Hongmei Li. Study of left ventricular morphology and function in patients with hypertensive disorder complicating pregnancy by echocardiography and their correlation with N-terminal probrain natriuretic peptide[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(02): 103-108.

目的

运用超声心动图评价妊娠期高血压疾病患者左室形态和功能变化，及其与N-端脑利钠肽前体（NT-proBNP）的相关性，并探讨利用二尖瓣舒张早期E波峰值流速与舒张早期二尖瓣环心肌运动峰值速度之比（E/Ea）、收缩期二尖瓣环心肌运动峰值速度（Sa）评价妊娠期高血压疾病患者早期左室功能异常的临床意义。

方法

选取2013年10月至2016年3月在绍兴市妇幼保健院住院分娩的140例孕妇，其中观察组89例分为三个亚组：妊娠期高血压组（25例）、轻度子痫前期组（28例）、重度子痫前期组（36例），血压正常孕妇51例为对照组。运用超声心动图测量各组孕妇左室形态参数，包括舒张末期室间隔厚度（IVSd）、舒张末期左室前后径（LVDd）、舒张末期左室后壁厚度（LVPWd）、相对室壁厚度（RWT）和左室质量指数（LVMI）；以及左室功能参数，包括左室射血分数（LVEF）、二尖瓣口舒张早期血流峰值流速与舒张晚期血流峰值流速比值（E/A）、收缩期二尖瓣环左室侧壁、室间隔处心肌运动峰值速度（Sa1、Sa2），舒张早期二尖瓣环左室侧壁、室间隔处心肌运动峰值速度（Ea1、Ea2），计算E/Ea1和E/Ea2。同时检测各组血浆NT-proBNP浓度，采用Pearson相关性分析研究NT-proBNP的相关性。

结果

与对照组比较，重度子痫前期组左室形态各参数包括IVSd [（0.79 ± 0.09）cm vs.（0.91 ± 0.12）cm]、LVDd [（4.61 ± 0.38）cm vs.（4.84 ± 0.27）cm]、LVPWd [（0.80 ± 0.10）cm vs.（0.90 ± 0.15）cm]、RWT [（0.35 ± 0.04）vs.（0.38 ± 0.05）]和LVMI[（58 ± 8）g/m2 vs.（72 ± 13）g/m2]均显著增加，差异有统计学意义（P均< 0.01）；同时，轻度子痫前期组Sa1[（10.7 ± 2.3）cm/s vs.（9.7 ± 1.9）cm/s]、Sa2[（9.2 ± 1.6）cm/s vs.（8.4 ± 1.5）cm/s]均降低，E/Ea1 [（6.5 ± 1.9）vs.（7.8 ± 2.6）]、E/Ea2[（8.3 ± 2.1）vs.（9.6 ± 2.5）]均升高（P均< 0.05）；同样，重度子痫前期组Sa1[（10.7 ± 2.3）cm/s vs.（9.4 ± 1.7）cm/s]、Sa2 [（9.2 ± 1.6）cm/s vs.（8.2 ± 1.4）cm/s]均显著降低，E/Ea1 [（6.5 ± 1.9）vs.（8.0 ± 2.6）]、E/Ea2 [（8.3 ± 2.1）vs.（10.6 ± 2.4）]均显著升高（P均< 0.05），E/A [（1.30 ± 0.26）vs.（1.15 ± 0.29）]减小（P < 0.05）。Pearson相关性分析提示血浆中NT-proBNP与E/Ea1、E/Ea2、IVSd、LVDd、LVPWd及LVMI均呈正相关（r = 0.58、0.42、0.25、0.27、0.20、0.25，P均< 0.05）；NT-proBNP与Sa1、Sa2均呈负相关（r = -0.69、-0.30，P均< 0.05）。

结论

妊娠期高血压疾病可以导致患者左室形态和功能发生变化，并且左室功能可先于左室形态发生改变，应用超声心动图测量E/Ea、Sa与NT-proBNP相关性良好，可以作为评价妊娠期高血压疾病患者左室功能的早期指标。

关键词: 超声心动描记术, 组织多普勒, N-端脑利钠肽前体, 心室功能，左, 妊娠期高血压疾病
Objective

To assess the changes of left ventricular morphology and function in patients with hypertensive disorder complicating pregnancy and their correlation with the N-terminal brain natriuretic peptide precursor (NT-proBNP) by echocardiography, as well as to investigate the clinical value of the ratio of mitral valve diastolic early E wave peak velocity and early diastolic myocardial motion peak velocity in the mitral annulus (E/Ea), systolic myocardial motion peak velocity in the mitral annulus (Sa) in evaluating early left ventricular dysfunction.

Methods

One hundred and forty parturients admitted to Shaoxing Women & Children’s Hospital from October 2013 to March 2016 were enrolled in this study. The observation group (89 cases) was divided into three subgroups: pregnancy induced hypertension group (25 cases), mild preeclampsia group (28 cases) and severe preeclampsia group (36 cases). Fifty-one cases of normotensive parturients were enrolled in the control group. The parameters of left ventricular structure were measured by echocardiography, including interventricular septal thickness at end diastole (IVSd), left ventricular diameter at end diastole (LVDd), left ventricular posterior wall thickness at end diastole (LVPWd), relative wall thickness (RWT) and left ventricular mass index (LVMI); the parameters of left ventricular function were also measured by echocardiography, including left ventricular ejection fraction (LVEF), E/A, systolic myocardial motion peak velocity of left ventrical lateral wall and ventricular septum in the mitral annulus (Sa1 and Sa2), early diastolic myocardial motion peak velocity of left ventrical lateral wall and ventricular septum in the mitral annulus (Ea1 and Ea2). E/Ea1, E/Ea2 were calculated. Meanwhile, plasma NT-proBNP concentrations of each group were detected. The method of Pearson correlation analysis investigated the correlation of NT-proBNP.

Results

Compared with the control group, the parameters of left ventricular morphology in the severe preeclampsia group increased significantly, including IVSd [(0.79 ± 0.09) cm vs. (0.91 ± 0.12) cm], LVDd [(4.61 ± 0.38) cm vs. (4.84 ± 0.27) cm], LVPWd [(0.80 ± 0.10) cm vs. (0.90 ± 0.15) cm], RWT [(0.35 ± 0.04) vs. (0.38 ± 0.05)] and LVMI [(58 ± 8) g/m2 vs. (72 ± 13) g/m2] (all P < 0.05); In the mild preeclampsia group, Sa1 [(10.7 ± 2.3) cm/s vs. (9.7 ± 1.9) cm/s] and Sa2 [(9.2 ± 1.6) cm/s vs. (8.4 ± 1.5) cm/s] decreased, E/Ea1[(6.5 ± 1.9) vs. (7.8 ± 2.6)] and E/Ea2 [(8.3 ± 2.1) vs. (9.6 ± 2.5)] increased (all P < 0.05); In the severe preeclampsia group, Sa1 [(10.7 ± 2.3) cm/s vs. (9.4 ± 1.7) cm/s] and Sa2 [(9.2 ± 1.6) cm/s vs. (8.2 ± 1.4) cm/s] significantly decreased, E/Ea2 [(6.5 ± 1.9) vs. (8.0 ± 2.6)] and E/Ea1 [(8.3 ± 2.1) vs. (10.6 ± 2.4)] significantly increased (all P < 0.05), E/A decreased [(1.30 ± 0.26) vs. (1.15 ± 0.29)] (P < 0.05). Pearson correlation analysis showed plasma NT-proBNP was positively correlated with E/Ea1 and E/Ea2 (r = 0.58, 0.42; all P < 0.05); NT-proBNP was negatively correlated with Sa1 and Sa2 (r = -0.69, -0.30; all P < 0.05).

Conclusions

Hypertensive disorder complicating pregnancy can lead to the changes of left ventricular morphology and function. In addition, left ventricular function can be changed ahead of left ventricular morphology. Measurement of E/Ea and Sa by using echocardiography showed a good correlation with NT-proBNP, which can be used as the early indicators to evaluate left ventricular function of patients with hypertensive disorder complicating pregnancy.

Key words: Echocardiography, Tissue Doppler, N-terminal brain natriuretic peptide precursor, Ventricular function, left, Hypertensive disorder complicating pregnancy
表1 妊娠期高血压疾病患者与对照组一般临床资料的比较（ ± s）
组别 例数 年龄（岁） 孕龄（周） 身高（cm） 体质量（kg） 心率（次/min） 收缩压（mmHg） 舒张压（mmHg）
对照组 51 31 ± 5 35.0 ± 2.8 160 ± 5 67 ± 6 92 ± 7 109 ± 12 69 ± 7
妊娠期高血压组 25 31 ± 4 34.0 ± 2.4 160 ± 4 67 ± 6 92 ± 5 146 ± 7a 96 ± 6a
轻度子痫前期组 28 31 ± 5 35.5 ± 2.0 159 ± 3 69 ± 6 93 ± 6 149 ± 8a 98 ± 6a
重度子痫前期组 36 31 ± 6 35.3 ± 2.2 159 ± 4 69 ± 8 93 ± 6 164 ± 13ab 111 ± 13ab
F值 ? 0.109 0.634 0.569 1.486 0.255 196.640 180.150
P值 ? 0.955 0.595 0.636 0.221 0.857 < 0.001 < 0.001
表2 妊娠期高血压疾病患者与对照组左室形态参数的比较（ ± s）
组别 例数 IVSd（cm） LVDd（cm） LVPWd（cm） RWT LVMI（g/m2）
对照组 51 0.79 ± 0.09 4.61 ± 0.38 0.80 ± 0.10 0.35 ± 0.04 58 ± 8
妊娠期高血压组 25 0.81 ± 0.11 4.63 ± 0.37 0.82 ± 0.12 0.35 ± 0.05 59 ± 8
轻度子痫前期组 28 0.79 ± 0.09 4.65 ± 0.43 0.82 ± 0.11 0.35 ± 0.05 59 ± 9
重度子痫前期组 36 0.91 ± 0.12ab 4.84 ± 0.27ab 0.90 ± 0.15ab 0.38 ± 0.05ab 72 ± 13ab
F值 ? 11.587 3.163 5.230 3.699 17.222
P值 ? < 0.001 0.027 0.002 0.013 < 0.001
表3 妊娠期高血压疾病患者与对照组左室功能指标及NT-proBNP的比较（ ± s）
组别 例数 LVEF（%） E/A Sa1（cm/s） Sa2（cm/s） E/Ea1 E/Ea2 血浆NT-proBNP（pg/mL）
对照组 51 67 ± 7 1.30 ± 0.26 10.7 ± 2.3 9.2 ± 1.6 6.5 ± 1.9 8.3 ± 2.1 90 ± 61
妊娠期高血压组 25 67 ± 5 1.30 ± 0.24 10.7 ± 2.0 9.2 ± 2.1 6.6 ± 1.6 8.8 ± 2.5 121 ± 90
轻度子痫前期组 28 67 ± 6 1.19 ± 0.25 9.7 ± 1.9a 8.4 ± 1.5a 7.8 ± 2.6a 9.6 ± 2.5a 307 ± 203ab
重度子痫前期组 36 67 ± 6 1.15 ± 0.29ab 9.4 ± 1.7ab 8.2 ± 1.4ab 8.0 ± 2.6ab 10.6 ± 2.4ab 413 ± 201ab
F值 ? 0.029 3.065 3.838 4.169 4.798 7.106 41.630
P值 ? 0.993 0.030 0.011 0.007 0.003 < 0.001 < 0.001
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