血浆脑利钠肽浓度与孕妇心衰发生的相关性研究

目的研究孕妇血浆脑利钠肽孕妇心衰发生的相关性。方法对苏州市立医院2011年9月至2013年9月间收治的孕妇重度子痫前期患者123例和双胎妊娠孕妇26例病例资料,并随机选择同期正常晚期妊娠孕妇78例作为对照。采用放射免疫方法测定孕妇血浆脑利钠肽（BNP）浓度,另根据孕妇血浆BNP水平,分为低水平组202例（BNP〈500 pg/ml）及高水平组（BNP〉500 pg/ml）,分析危险因素和妊娠结局。结果 （1）重度子痫前期组患者BNP浓度（252.51±375.95）pg/ml高于正常孕妇组（45.94±47.63）pg/ml差异有统计学意义（P〈0.05）;重度子痫前期组并发心衰组12例,其BNP浓度（1458.55±1341.77）pg/ml显著高于正常孕妇组（45.94±47.63）pg/ml,差异有统计学意义（P〈0.001）。（2）双胎组BNP浓度（356.73±415.57）pg/ml高于正常孕妇组（45.94±47.63）pg/ml,双胎并发心衰BNP的浓度（780.47±159.35）pg/ml,显著高于正常晚期妊娠孕妇（45.94±47.63）pg/ml,差异均有统计学意义（P〈0.05）。（3）BNP高水平组危险因素有血压的升高和双胎妊娠。（4）BNP高水平组胎盘早剥、心衰、产后出血及新生儿窒息发生率分别为15.4%、42.3%、23.1%及26.9%,均高于低水平组2.5%（P〈0.001）、6.9%（P〈0.001）、3.0%（P〈0.001）及12.4%（P〈0.05）,两组比较差异有统计学意义。结论重度子痫前期患者的血浆脑利钠肽浓度是反应子痫前期患者严重程度敏感指标,并能提前预测心衰的发生,同时双胎孕妇血浆脑利钠肽浓度明显升高。血压的升高和双胎妊娠是血BNP升高的危险因素;BNP水平高的妊娠不良结局升高。

Study on the correlation between the concentration of brain natriuretic peptide in serum and heart failureof pregnant women

Objective To evaluate the relationship between level of plasma brain natriuretic peptide（ BNP） and congestive heart failure in pregnant women. Methods A retrospective study was performed in 123 cases of severe Preeclampsia and 26 cases of bigeminal pregnancy who were hospitalized in Suzhou municipal hospital during September 2011 and September 2013,and datas of another 78 normal pregnancy were enrolled as control. The concentration of BNP in serum was measured by using radio- immunity method,the women were divided into high level（ 26 cases） and low group（ 202 cases） according to BNP concentration（ 500 pg / ml was the dividing crest）. Then evaluated risk factors and pregnancy outcome. Results The BNP concentrations of patients with preeclampsia（ 252. 51 ± 375. 95 pg / ml） and preeclampsia supervened heart failure（ 1458. 55 ± 1341. 77 pg /ml） were significantly higher than that of normal pregnant women（ 45. 94 ± 47. 63 pg / ml）（ P 〈0. 05） .The BNP concentrations of patients with bigeminal pregnancy（ 356. 73 ± 415. 57 pg / ml） and bigeminal pregnancy supervened heart failure（ 780. 47 ± 159. 35 pg / ml） were significantly higher than that of normal pregnant women（ P 〈0. 05） .The risk factors were blood pressure and bigeminal pregnancy. Significant differences can be found between the high level group and the low level group in placental abruption（ 15. 4% vs 2. 5%,P〈 0. 001）,congestive heart failure（ 42. 3% vs 6. 9% P〈 0. 001）,postpartum hemorrhage（ 23. 1% % vs 3. 0%,P〈 0.001） and neonatal asphyxia（ 26. 9% vs12. 4%,P〈 0. 05）. Conclusions The study revealed significant positive correlation between BNP and cardiac function in patients with preeclampsia and bigeminal pregnancy. The correlation of BNP would play a role in the grading determination and prognosis assessment in patients with preeclampsia and bigeminal pregnancy. The risk factors were blood pressure and bigeminal pregnancy. The adverse outcome was correlated to the level of BNP.