重度子痫前期患者心肾功能水平与相关性变化  

Correlation betweeen changes of cardiorenal function and severe preeclampsia

作　　者：丁岚[1] 刘影[2] 白传明[3] 姚彦 DING Lan;LIU Ying;BAI Chuanming(Department of Obstetrics,Central Hospital of Cangzhou City,Hebei,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院产科,061000 [2]河北省石家庄市第四医院产科 [3]河北省沧州市中心医院心血管外科,061000 [4]河北省沧州市中心医院神经内科,061000

出　　处：《河北医药》2018年第7期1032-1035,1038,共5页Hebei Medical Journal

基　　金：沧州市科学技术研究与发展支撑计划项目(编号:162302036)

摘　　要：目的探讨重度子痫前期与轻度子痫前期患者心、肾功能改变与相关性变化。方法选择2016年3月至2017年3月诊断子痫前期患者69例,依据美国妇产科医师协会制定妊娠期高血压疾病指南(2013年版)分为轻度子痫前期组(34例)与重度子痫前期患者(35例)。入院后24 h内晨空腹采血,Elisa检测患者血清白介素-6(IL-6,ng/ml)、内皮素(ET-1,μg/L),免疫比浊法检测超敏C-反应蛋白(hs-CRP,mg/L),硝酸还原发检测一氧化氮(NO,μmol/L),电化学发光法检测血浆氨基末端脑钠肽前体水平(NT-proBNP,pg/ml),免疫投射比浊法检测24 h尿蛋白(mg/24 h),免疫投射比浊法检测血清胱抑素C(Cys-C,mg/L)。二维超声心动图心尖四腔心切面Simpson’s法估算左心室射血分数(EF),血流多普勒测量二尖瓣口舒张早期血流速度峰值(E峰),左心房舒张晚期血流速度峰值(A峰),组织多普勒测量二尖瓣环根部运动速度峰值(Ea值),计算E/A,E/Ea比值。二维斑点追踪技术测量左心室基底部、心尖部收缩期整体峰值旋转角度(BRmax,ARmax),计算左心室收缩期峰值心肌扭转角度(Twistmax)。彩色血流多普勒超声检测肾叶间动脉阻力指数(RI)、搏动指数(PI)、收缩期流速峰值(PSV)、舒张末期流速峰值(EDV),比较2组患者上述指标水平变化。Pearson相关分析E/Ea与Cys-C、NT-proBNP之间相关性。结果重度子痫前期与轻度子痫前期组患者比较,24 h尿蛋含量、血清Cys-C、NT-proBNP、IL-6、hs-CRP、ET-1水平增加,NO含量下降(P<0.05)。重度子痫前期组与轻度子痫前期组比较,E/A比值降低,E/Ea比值升高,BRmax、ARmax、Twistmax增加,双肾RI、PI增加,EDV、PSV下降,2组比较差异有统计学意义(P<0.05)。E/Ea与Cys-C、NT-proBNP呈直线正相关(r=0.824,0.845,P<0.05)。结论子痫前期患者心肾功能损伤明显,其中,以重度子痫前期患者心脏与肾脏功能减退较重,心肾功能损伤存在一定相关,监测血浆氨基末端脑钠肽前体水平�Objective To investigate the changes of cardiorenal function of patients with severe preeclampsia or mild preeclampsia.Methods A total of 69 patients with preeclampsia who were treated in our hospital from March 2016 to March 2017 were enrolled in the study.According to the American association of obstetrics and gynecology doctors’gestational hypertension disease guide(2013),these patients were divided into mild preeclampsia group(n=34)and severe preeclampsia group(n=35).The specimens of empty stomach blood were taken within 24 hours after admission,and the serum levels of interleukin 6(IL-6),endothelin(ET-1)were tested by enzyme-linked immunosorbent assay.The levels of hypersensitive C-reactive protein(hs-CRP)were detected by the immunoturbidimetry.The levels of nitric oxide(NO)were measured by nitrate reduction process.The levels of plasma amino terminal brain natriuretic peptide precursor(NT-proBNP)were tested by electrochemiluminescence method.Moreover the levels of 24h urine protein and serum inhibition C(Cys-C)were detected by immune projection turbidimetry.In addition the levels of left ventricular ejection fraction(EF)were examined by two-dimensional echocardiography,and the early diastolic blood flow velocity(E)of mitral valve and peak velocity of left atrial late diastolic blood flow(A)were detected by flow Doppler.The peak velocity of mitral annular root velocity(Ea)was measured by tissue Doppler imaging,and the ratios of E/A and E/Ea were calculated.The left ventricular base and apical peak rotation(BRmax,ARmax)were measured by two-dimensional speckle tracking imaging technique(2D-STI),and left ventricular systole Twistmax was calculated.The renal interlobular artery resistance index(RI),pulsation index(PI),systolic peak flow velocity(PSV)and end-diastolic velocity(EDV)were measured by Color Doppler ultrasound.Besides the correlation between E/Ea and Cys-C,NT-proBNP was analyzed by means of Pearson correlation analysis.Results As compared with those in mild preeclampsia group,the 24h urine protein c

关 键 词：超声心动图 氨基末端脑钠肽前体 子痫前期 相关性 

分 类 号：R714.245[医药卫生—妇产科学]