摘要
目的分析妊娠高血压疾病(HDP)孕妇右心功能特征。方法选取2017年7月至2019年3月浙江省立同德医院诊治的98例妊娠期高血压病孕妇作为研究对象。将这98例孕妇设为妊高症组。另选取同期在浙江省立同德医院规律产检并最终分娩的103例健康孕妇设为健康组。比较两组的基线资料、心脏超声指标,比较不同程度妊高症孕妇右心功能特征,分析右心功能指标与不同程度妊高症之间的相关性。结果妊高症组孕妇的平均动脉压(MBP)、收缩压(SBP)、舒张压(DBP)、24h尿蛋白定量、N-末端脑钠尿肽(NT-proBNP)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)和肌钙蛋白(Tn)水平高于健康组孕妇,差异具有统计学意义(P<0.05);相比健康组孕妇,妊高症组孕妇的左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室重量指数(LVMi)、左心室壁相对厚度(LVRWT)、右心室舒张末期内径(RVEDd)、右心房面积(RA-S)、右心室前壁厚度(RVAW)、肺动脉收缩压(PASW)增大,二尖瓣收缩期位移(MAPSE)、三尖瓣收缩期位移(TAPSE)、三尖瓣舒张早期充盈峰速度E峰和舒张晚期充盈峰速度A峰比值(E/A)、二尖瓣舒张早期充盈峰速度E'峰和舒张晚期充盈峰速度A'峰比值(E'/A')、二尖瓣环收缩期峰值速度(S')减小,差异具有统计学意义(P<0.05);轻度子痫前期组孕妇和重度子痫前期组孕妇的E/A值小于妊娠期高血压组孕妇,Tei指数、RVEDd、RVAW和RA-S水平均高于妊娠期高血压组孕妇,差异具有统计学意义(P<0.05);Spearson相关性分析显示,Tei指数(ρ=0.748)、RVEDd(ρ=0.712)、RA-S(ρ=0.842)和RVAW(ρ=0.266)与妊娠期高血压病严重程度呈正相关(P<0.05),E/A值(ρ=-0.625)与妊娠期高血压病严重程度呈负相关(P<0.05)。结论妊娠高血压疾病不仅可影响孕妇左心功能,也与右心功能密切相关,可在临床中留意孕妇右心功能变化,以便及时控制病情,降低孕妇及围产期胎儿发病率和病死率。
Objective To analyze right heart function characteristics in pregnant women with hypertension disorders of pregnancy(HDP).Methods From July 2017 to March 2019,98 pregnant women with gestational hypertension,admitted to the Tongde Hospital of Zhejiang Province,were enrolled in the pregnancy-induced hypertension group,and 103 healthy pregnant women who were routinely examined and finally delivered in the Tongde Hospital of Zhejiang Province were selected as healthy pregnant women group.The general data and the cardiac ultrasound index of the two groups and the right heart function characteristics of pregnant women with different degrees of pregnancy-induced hypertension were compared,and the correlation between right heart function indicators and different degrees of pregnancy-induced hypertension was analyzed.Results The level of mean arterial pressure(MBP),systolic blood pressure(SBP),diastolic blood pressure(DBP),24-hour urine protein quantitation,Nterminal brain natriuretic peptide(NT-proBNP),myoglobin(Mb),creatine kinase-MB(CK-MB)and troponin(Tn)in the pregnancy-induced hypertension group were higher than those of healthy pregnant women group,and the differences were statistically significant(P<0.05).Compared with healthy pregnant women,the left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),left ventricular mass index(LVMi),left ventricular wall relative thickness(LVRWT),right ventricle in pregnant women with pregnancy-induced hypertension end diastolic diameter(RVEDd),right atrial area(RA-S),right ventricular anterior wall thickness(RVAW),pulmonary systolic pressure(PASW),mitral systolic displacement(MAPSE),tricuspid systolic displacement(TAPSE),tricuspid valve early filling peak velocity E peak and late diastolic filling peak velocity A peak ratio(E/A),mitral valve early filling peak velocity E'peak and late diastolic filling peak velocity A'peak ratio(E'/A'),systolic peak velocity(S')of mitral annulus decreased,the difference was statistically significant(P<0.05).The E/A values in the mild preeclampsia group and the severe preeclampsia group were lower than those in the hypertensive group.The Tei index,RVEDd,RVAW,and RA-S levels were higher than those in the hypertensive group(P<0.05).Spearson correlation analysis showed that Tei index(ρ=0.748),RVEDd(ρ=0.712),RA-S(ρ=0.842)and RVAW(ρ=0.266)were positively correlated with the severity of hypertensive disorder in pregnancy(P<0.05).The E/A value(ρ=-0.625)was negatively correlated with the severity of hypertension during pregnancy(P<0.05).Conclusions HDP can not only affect the left heart function of pregnant women,but also closely related to right heart function.The changes of right heart function of pregnant women can be noted in clinical practice,so as to timely control the disease and reduce the morbidity and mortality of pregnant women and perinatal fetuses.
作者
张秋宇
石恒星
张斌
杨春晓
ZHANG Qiuyu;SHI Hengxing;ZHANG Bin;YANG Chunxiao(Department of Ultrasound,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China;Department of Special Surgery,the 9th Hospital of the People's Liberation Army Joint Defense,Hangzhou 310012,Zhejiang,China)
出处
《中国性科学》
2020年第11期63-67,共5页
Chinese Journal of Human Sexuality
关键词
妊娠高血压病
孕妇
右心功能
超声检查
Hypertension disorders of pregnancy
Pregnant women
Right heart function
Ultrasonography
作者简介
通讯作者:张秋宇,E-mail:zjnbhr31@163.com。
