朱彥霏　王毅　江金香

[摘要] 目的 探究妊娠期婦女血清NT-proBNP水平在伴發(fā)心功能損害中的監(jiān)測價值。 方法 選取2013年6月～2015年11月我院收治的82例妊娠合并心臟病患者作為觀察組，另選取在我院同期進(jìn)行檢查的正常妊娠者80例作為對照組，采用電化學(xué)免疫發(fā)光法檢測兩組研究對象血清NT-proBNP水平，彩色多普勒超聲心動儀檢測二尖瓣血流舒張早期以及晚期充盈峰（E峰及A峰）、E/A、左室射血分?jǐn)?shù)（LVEF）及左室舒張末徑（LVEDD）。 結(jié)果 觀察組NT-proBNP以及心功能相關(guān)指標(biāo)LVEDD均明顯高于對照組（P<0.05）。隨著心功能分級增加，NT-proBNP、LVEDD、A值逐漸增加（P<0.05），LVEF、E、E/A值逐漸降低（P<0.05）。NT-proBNP與心功能分級、LVEDD呈正相關(guān)（r=0.672，P=0.017；r=0.297，P=0.056）；NT-proBNP與LVEF、E/A呈負(fù)相關(guān)（r=0.324，P=0.045；r=0.472，P=0.061）。 結(jié)論 妊娠期心功能損害者NT-proBNP水平明顯升高，與心功能指標(biāo)LVEF、E/A呈負(fù)相關(guān)，與心功能分級呈正相關(guān)，對臨床監(jiān)測心功能狀況以及治療、預(yù)后具有參考價值。

[關(guān)鍵詞] 妊娠期；心功能損害；N端腦鈉肽前體；監(jiān)測價值

[中圖分類號] R541.6；R714.2 [文獻(xiàn)標(biāo)識碼] B [文章編號] 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損是產(chǎn)科常見并發(fā)癥之一，在孕婦中發(fā)病率為0.5%～3%，嚴(yán)重者能夠?qū)е聡a(chǎn)期母嬰死亡，亦占據(jù)非直接產(chǎn)科死亡的首位，由于患者早期發(fā)病無明顯癥狀，因此診斷較困難[1]。相關(guān)研究表明心臟心室分泌的N末端B型鈉尿肽原（N-terminal pro-B-type natriuretic pep-tide，NT-proBNP）穩(wěn)定性好、半衰期較長，在心臟受損時期其表達(dá)量升高，是檢測評價心臟功能可靠迅速的標(biāo)志物之一[2，3]。本研究選取我院的妊娠合并心臟病者作為研究對象并進(jìn)行回顧分析，通過測定血清NT-proBNP水平以及心功能相關(guān)指標(biāo)水平，來探究其在妊娠伴發(fā)心功能損害中的監(jiān)測價值，現(xiàn)將結(jié)果報道如下。