妊娠期妇女血清NT—proBNP水平变化在伴发心功能损害中的监测价值

朱彦霏　王毅　江金香

[摘要] 目的 探究妊娠期妇女血清NT-proBNP水平在伴发心功能损害中的监测价值。 方法 选取2013年6月～2015年11月我院收治的82例妊娠合并心脏病患者作为观察组，另选取在我院同期进行检查的正常妊娠者80例作为对照组，采用电化学免疫发光法检测两组研究对象血清NT-proBNP水平，彩色多普勒超声心动仪检测二尖瓣血流舒张早期以及晚期充盈峰（E峰及A峰）、E/A、左室射血分数（LVEF）及左室舒张末径（LVEDD）。 结果 观察组NT-proBNP以及心功能相关指标LVEDD均明显高于对照组（P<0.05）。随着心功能分级增加，NT-proBNP、LVEDD、A值逐渐增加（P<0.05），LVEF、E、E/A值逐渐降低（P<0.05）。NT-proBNP与心功能分级、LVEDD呈正相关（r=0.672，P=0.017；r=0.297，P=0.056）；NT-proBNP与LVEF、E/A呈负相关（r=0.324，P=0.045；r=0.472，P=0.061）。 结论 妊娠期心功能损害者NT-proBNP水平明显升高，与心功能指标LVEF、E/A呈负相关，与心功能分级呈正相关，对临床监测心功能状况以及治疗、预后具有参考价值。

[关键词] 妊娠期；心功能损害；N端脑钠肽前体；监测价值

[中图分类号] R541.6；R714.2 [文献标识码] B [文章编号] 1673-9701（2016）36-0077-04

[Abstract] Objective To investigate monitoring value of serum NT-proBNP level changes in pregnant women with concomitant cardiac dysfunction. Methods A total of 82 pregnant women with heart disease in our hospital from June 2013 to November 2015 were enrolled as the observation group.And 80 patients with normal pregnancy who were examined in the same period were selected as the control group.Serum NT-proBNP levels in the two groups were measured by electrochemical immunofluorescence assay. The filling peak（E peak and A peak） of mitral valve blood flow velocity in early and late diastole， E/A， Left ventricular ejection fraction（LVEF）， and left ventricular end diastolic diameter （LVEDD） were detected by color Doppler echocardiography. Results The levels of NT-proBNP and LVEDD in the observation group were significantly higher than those in the control group（P<0.05）. With the increase in cardiac function grading，the values of NT-proBNP， LVEDD and A were gradually increased（P<0.05）， and the LVEF， E， E/A values decreased gradually（P<0.05）. NT-proBNP was positively correlated with cardiac function grade and LVEDD（r=0.672， P=0.017； r=0.297， P=0.056）. NT-proBNP was negatively correlated with LVEF， E/A（r=0.324， P=0.045； r=0.472， P=0.061）. Conclusion The level of NT-proBNP in pregnant women with heart failure was significantly significantly increased，which was negatively correlated with in LVEF and E/A and positively correlated with cardiac function grade，and had a reference value for clinical monitoring of cardiac function， treatment and prognosis.

[Key words] Pregnancy； Cardiac dysfunction； N-terminal pro-brain natriuretic peptide； Monitoring value

妊娠期合并心臟功能受损是产科常见并发症之一，在孕妇中发病率为0.5%～3%，严重者能够导致围产期母婴死亡，亦占据非直接产科死亡的首位，由于患者早期发病无明显症状，因此诊断较困难[1]。相关研究表明心脏心室分泌的N末端B型钠尿肽原（N-terminal pro-B-type natriuretic pep-tide，NT-proBNP）稳定性好、半衰期较长，在心脏受损时期其表达量升高，是检测评价心脏功能可靠迅速的标志物之一[2，3]。本研究选取我院的妊娠合并心脏病者作为研究对象并进行回顾分析，通过测定血清NT-proBNP水平以及心功能相关指标水平，来探究其在妊娠伴发心功能损害中的监测价值，现将结果报道如下。