舒张早期左心室内血流传播速度评价妊娠期高血压患者左心室舒张功能的临床意义  

Evaluation of left ventricular diastolic function with early diastolic left ventricular flow propagation velocity in pregnant women with hypertension

作　　者：寿列军[1] 解左平[1] 金社红[1] 谭乳燕[1] 谢乐燕 袁华[1] SHOU Liejun;XIE Zuoping;JIN Shehong(Department of Ultrasonography,Shaoxing Women and Children’s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市妇幼保健院超声科,312000

出　　处：《浙江医学》2020年第4期343-348,I0003,共7页Zhejiang Medical Journal

基　　金：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)。

摘　　要：目的探讨彩色M型多普勒测量舒张早期左心室内血流传播速度(FPV)评价妊娠期高血压患者左心室舒张功能异常的临床意义。方法选取25例妊娠期高血压患者、25例轻度子痫前期患者、31例重度子痫前期患者(早发型12例,晚发型19例)和29例血压正常孕妇(对照组)。运用超声心动图测量左心室功能参数,包括左心室射血分数(LVEF)、二尖瓣瓣口舒张早期E波峰值流速(VE)、舒张晚期A波峰值流速(VA)、E波与A波峰值流速比值(VE/VA);舒张早期心肌运动峰值速度(Ea)、舒张晚期心肌运动峰值速度(Aa)、舒张早期与晚期心肌运动峰值速度比值(Ea/Aa)和FPV。同时检测血N-端脑利钠肽前体(NT-proBNP)水平。结果与对照组比较,轻度子痫前期组和重度子痫前期组Ea、Ea/Aa和FPV减低,NT-proBNP升高,差异均有统计学意义(均P<0.05);重度子痫前期组Aa增高,差异有统计学意义(P<0.05)。相关性分析显示:FPV和与自然对数转换后的NT-proBNP(Ln NT-proBNP)水平呈负相关(r=-0.601,P<0.05)。多元线性逐步回归分析显示:FPV为Ln NT-proBNP独立影响因素。与晚发型组比较,早发型组Ln NT-proBNP升高,FPV减低,差异均有统计学意义(均P<0.01)。结论FPV可作为评价妊娠期高血压左心室舒张功能的早期敏感指标。Objective To investigate the clinical value of early diastolic left ventricular flow propagation velocity(FPV)measured by color M-mode Doppler in evaluation of left ventricular diastolic function in pregnant women with hypertension.Methods The study included 25 women with gestational hypertension,25 pregnant women with mild preeclampsia,31 pregnant women with severe preeclampsia and 29 normotensive pregnant women(control group).The severe preeclampsia group were further divided into early-onset subgroup(n=12)and late subgroup(n=19).The parameters of left ventricular function were measured by echocardiography,including left ventricular ejection fraction(LVEF),E wave peak velocity of mitral valvular flow(VE),A wave peak velocity of mitral valvular flow(VA),VE/VA,myocardial motion peak velocity of mitral annulus in early diastole(Ea),myocardial motion peak velocity of mitral annulus in late diastole(Aa),Ea/Aa,left ventricular flow propagation velocity in early diastole(FPV).Meanwhile,serum N-terminal brain natriuretic peptide precursor(NT-proBNP)levels were measured.Results Compared with the control group,in mild preeclampsia group and severe preeclampsia group the Ea,Ea/Aa and FPV decreased,NT-proBNP levels increased(P<0.05);the Aa in severe preeclampsia group increased(P<0.05).Correlation analysis showed that FPV was negatively correlated with the natural logarithmic transformation of NT-proBNP(Ln NT-proBNP)(r=-0.601,P<0.05).Multiple linear stepwise regression analysis showed that FPV was an independent influencing factor of Ln NT-proBNP.Compared with the late-onset severe preeclampsia subgroup,in the early-onset subgroup NT-proBNP increased,FPV decreased(P<0.05).Conclusion FPV can be used as early sensitive indicators to evaluate diastolic function of left ventricle in hypertensive disorder complicating pregnancy.

关 键 词：超声心动图 彩色M型多普勒 血流传播速度 妊娠期高血压疾病 左心室功能 

分 类 号：R714.246[医药卫生—妇产科学]