不同类型妊娠期高血压疾病孕妇的心脏结构和功能改变及其影响因素分析  

Changes of cardiac structure and function in pregnant women with different types of hypertensive disorders in pregnancy and their influencing factors

作　　者：李丹[1] 尹韶华 李昭屏[1] 林春忠 魏媛[3] 赵扬玉[3] Li Dan;Yin Shaohua;Li Zhaoping;Lin Chunzhong;Wei Yuan;Zhao Yangyu(Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,State Key Laboratory of Vascular Homeostasis and Remodeling,National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191,China;Department of Medical Engineering,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院心内科血管医学研究所、血管稳态与重构全国重点实验室、国家卫生健康委心血管分子生物学与调节肽重点实验室心、血管受体研究北京市重点实验室,北京100191 [2]北京大学第三医院医学工程处,北京100191 [3]北京大学第三医院妇产科,北京100191

出　　处：《中华妇产科杂志》2024年第8期600-607,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家卫生健康委生育健康重点实验室开放基金(202308010731)。

摘　　要：目的分析不同类型妊娠期高血压疾病(HDP)孕妇的心脏结构和功能的改变, 并探讨其影响因素。方法纳入2014年1月1日至2022年4月15日于北京大学第三医院分娩并确诊为HDP的孕妇共1 967例为观察对象, 根据HDP的具体诊断分为妊娠期高血压506例(25.7%), 子痫前期589例(29.9%), 妊娠合并慢性高血压332例(16.9%), 慢性高血压伴发子痫前期540例(27.5%), 回顾性分析4种类型HDP孕妇心脏结构和功能指标的差异, 心脏结构指标包括左心房前后径(LAD)、左心房面积(LAA)、右心房面积(RAA)、舒张末期左心室内径(LVEDD)、舒张末期室间隔厚度(IVST)、舒张末期左心室后壁厚度(LVPWT), 收缩功能指标包括左心室射血分数(LVEF)、左心室侧壁收缩期二尖瓣环运动速度(Sm), 舒张功能指标包括二尖瓣舒张早期峰值血流速度(E)/二尖瓣舒张晚期峰值血流速度(A)、E/左心室侧壁舒张早期二尖瓣环运动速度(Em)。采用多因素广义线性回归方法分析影响心脏结构和功能的因素。结果 (1)一般临床资料:不同类型HDP孕妇的年龄、分娩孕周、血压、合并糖尿病占比、住院天数分别比较, 差异均有统计学意义(P均<0.05)。(2)与妊娠合并慢性高血压、子痫前期及妊娠期高血压孕妇相比, 慢性高血压伴发子痫前期孕妇的LAD、LAA、RAA和LVEDD更大(P均<0.001), IVST和LVPWT更厚(P均<0.001), 左心室舒张功能指标(E/A、侧壁Em、E/Em)和收缩功能指标Sm下降(P均<0.001), 妊娠期高血压孕妇的心脏结构和功能相对较好。与子痫前期孕妇相比, 妊娠合并慢性高血压孕妇的RAA更小(P<0.001), E/A更低(P<0.001), 其余指标在两者间比较, 差异均无统计学意义(P均>0.05)。(3)慢性高血压伴发子痫前期、妊娠合并慢性高血压及子痫前期的发生与较大的LAD、LAA、LVEDD相关, 与较小的Em相关(P均<0.05)。结论不同类型HDP孕妇的心脏结构和功能改变不同, 其中慢性高血压伴发子�Objective:To analyze the changes in cardiac structure and function in women with different types of hypertensive disorders in pregnancy(HDP)and explore their influencing factors.Methods:A total of 1967 pregnant women diagnosed with HDP who delivered at Peking University Third Hospital from January 1,2014 to April 15,2022 were included in the study.They were categorized into four groups based on specific HDP diagnoses:gestational hypertension(506 cases,25.7%),pre-eclampsia(589 cases,29.9%),pregnancy complicated with chronic hypertension(332 cases,16.9%)and chronic hypertension with pre-eclampsia(540 cases,27.5%).Differences in cardiac structure and function among four groups were retrospectively analyzed.Cardiac structure indicators included left atrial diameter(LAD),left atrial area(LAA),right atrial area(RAA),left ventricular end-diastolic diameter(LVEDD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),systolic function indicators included left ventricular ejection fraction(LVEF),lateral systolic mitral annular velocity(Sm),diastolic function indicators included peak early diastolic mitral in flow velocity(E)/peak late diastolic mitral in flow velocity(A),and E/peak early diastolic myocardial velocity of the lateral mitral annulus early diastolic velocity(Em).Influencing factors on cardiac structure and function were analyzed using generalized linear regression.Influencing factors were assessed by generalized linear regression.Results:(1)General clinical data:the differences in age,gestational week at delivery,blood pressure,proportion of diabetes,and length of hospital stay were statistically significant among four different HDP types(all P<0.05).(2)Compared with pregnant women with pregnancy complicated with chronic hypertension,pre-eclampsia,and gestational hypertension,those with chronic hypertension with pre-eclampsia had larger LAD,LAA,RAA and LVEDD(all P<0.001),thicker IVST and LVPWT(all P<0.001),and reduced left ventricular diastolic function(E/A,lateral Em,E/Em)a

关 键 词：高血压 妊娠性 子痫前期 心房 心室功能 左 影响因素分析 

分 类 号：R714.246[医药卫生—妇产科学]