超声评估妊娠期高血压疾病患者心功能早期变化  

Early Changes in Cardiac Function in Patients with Hypertensive Disorders in Pregnancy Assessed by Echocardiography

作　　者：王秀娟[1] 陈玲玲 洪铭锾 孔令云 向伟 付丽 刘芳[1] Wang Xiujuan;Chen Lingling;Hong Minghuan;Kong Lingyun;Xiang Wei;Fu Li;Liu Fang(Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院,清华大学临床医学院,北京市102218

出　　处：《中国超声医学杂志》2024年第7期753-757,共5页Chinese Journal of Ultrasound in Medicine

基　　金：北京市医院管理中心“青苗”计划专项经费资助(No.12022B4009);北京清华长庚医院青年启动基金(No.12021C1004)。

摘　　要：目的探索超声评估妊娠期高血压疾病患者心功能早期变化的价值。方法随机选取妊娠期高血压疾病(A组)、健康妊娠(B组)、健康未孕对照(C组)女性各81例。应用组织多普勒及应变评估心功能变化,测量P波到a′波峰值的时间间隔(PA-TDI)及左心室整体纵向应变(LV-GLS)。统计学方法采用方差分析及Kruskal-Wallis H检验。结果(1)A组孕前体质量、体质量指数、体表面积较B组和C组增高(P<0.05)。(2)A组LAD、LVMI、RWT、IVSd和LVPWd较B组和C组增大(P<0.05),LVIDd、LVIDs较C组增大(P<0.05)。(3)A组E/A、室间隔和左心室侧壁e′较C组减低,E/e′较C组增大(P<0.05)。A组PA-TDI较C组延长(P<0.05)。A组LV-GLS较B组和C组减低(P<0.05),B组LV-GLS较C组减低(P<0.05)。而3组间LVEF差异无统计学意义。结论妊娠期高血压疾病患者的心脏结构发生了一定程度的重构,其心功能呈减退趋势。PA-TDI、LV-GLS可早期评估妊娠期高血压疾病患者心功能变化。Objective To explore the value of echocardiography in assessing early changes in cardiac function in patients with hypertensive disorders in pregnancy.Methods A total of 81 female diagnosed with hypertensive disorders of pregnancy(group A)were prospectively enrolled as the case group,81 pregnancy-matched healthy pregnancy(group B),and 81 healthy nonpregnant subjects(group C)were enrolled as the control groups.Tissue Doppler and strain analysis were applied to assess changes in cardiac function.The echocardiographic parameters total atrial conduction time(PA-TDI)was calculated as the electrocardiographic P-wave to a′duration on tissue Doppler imaging and LV-GLS was measured using 2-dimensional speckle tracking echocardiography.Difference among the three groups was analyzed.Results(1)Pre-pregnancy weight,BMI and BSA of group A were increased compared to group B and C(P<0.05).(2)LAD,LVMI,RWT,IVSd and LVPWd were increased in group A compared to group B and C(P<0.05),and LVIDd,LVIDs were increased in group A compared to group C(P<0.05).(3)E/A ratio,interventricular septum thickness and left ventricular lateral wall e′velocity were attenuated in group A compared to group C,and E/e′was enlarged in group A compared with group C(P<0.05).PA-TDI was prolonged in group A compared with group C(P<0.05).LV-GLS was attenuated in group A compared with groups B and C(P<0.05),and LV-GLS was attenuated in group B compared with group C(P<0.05).And there was no statistically significant difference in LVEF among the three groups.Conclusions The cardiac structure of patients with hypertensive disorders during pregnancy undergoes a certain degree of remodeling,and their cardiac function tends to be reduced.PA-TDI and LV-GLS can be used for early assessment of changes in cardiac function in patients with hypertensive disorders during pregnancy.

关 键 词：妊娠期高血压疾病 心功能 心房总传导时间 应变 超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R714.246[医药卫生—内科学]