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中华妇幼临床医学杂志(电子版) ›› 2021, Vol. 17 ›› Issue (06) : 709 -714. doi: 10.3877/cma.j.issn.1673-5250.2021.06.013

论著

血清氨基末端脑钠肽前体水平与重度子痫前期孕妇妊娠结局的关系
刘夕珑1,1, 荣茜1,1, 邢悦2,2, 潘碧琼2,2, 卢丹1,2,†,1,2()   
  • 收稿日期:2021-04-18 修回日期:2021-11-07 出版日期:2021-12-01
  • 通信作者: 卢丹

Correlation study between serum N-terminal pro-brain natriuretic peptide levels and pregnancy outcomes of pregnant women with severe preeclampsia

Xilong Liu1,1, Qian Rong1,1, Yue Xing2,2, Biqiong Pan2,2, Dan Lu1,2,1,2,†()   

  • Received:2021-04-18 Revised:2021-11-07 Published:2021-12-01
  • Corresponding author: Dan Lu
  • Supported by:
    National Natural Science Foundation of China(82072088)
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引用本文：

刘夕珑, 荣茜, 邢悦, 潘碧琼, 卢丹. 血清氨基末端脑钠肽前体水平与重度子痫前期孕妇妊娠结局的关系[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(06): 709-714.

Xilong Liu, Qian Rong, Yue Xing, Biqiong Pan, Dan Lu. Correlation study between serum N-terminal pro-brain natriuretic peptide levels and pregnancy outcomes of pregnant women with severe preeclampsia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(06): 709-714.

目的

探讨血清氨基末端脑钠肽前体(NT-proBNP)水平与重度子痫前期(SPE)孕妇妊娠结局的关系。

方法

选择2019年1月至2021年1月，于江苏省苏北人民医院妇产科住院治疗的76例SPE孕妇为研究对象。按照血清NT-proBNP水平，将其分为研究组(n＝45，血清NT-proBNP水平升高者)和对照组(n＝31，血清NT-proBNP正常者)。采用成组t检验，对2组SPE孕妇年龄、人体质量指数(BMI)、孕次、产次、收缩压、舒张压、分娩孕龄等进行分析；采用Mann-Whitney U检验，对其天冬氨酸氨基转移酶(AST)，丙氨酸转氨酶(ALT)，总胆汁酸(TBA)、D-二聚体，以及分娩新生儿生后1 min Apgar评分等进行分析；采用χ2检验、连续性校正χ2检验、Fisher确切概率法，对SPE孕妇低白蛋白血症、脐血流异常、妊娠期肝内胆汁淤积症(ICP)、肝功能异常，以及其胎儿宫内生长受限(FGR)、视网膜病变(ROP)、肺动脉高压(PAH)发生率等进行统计学分析。本研究遵循的程序符合江苏省苏北人民医院伦理委员会规定，并获得该伦理委员会批准(审批文号：YXYLL-2020-134)，所有受试者均签署临床研究知情同意书。

结果

①2组SPE孕妇年龄、BMI、孕次、产次、收缩压、舒张压、脐血流S/D比较，差异均无统计学意义(P>0.05)。2组孕妇分娩孕龄、24 h尿蛋白定量比较，差异有统计学意义(P<0.05)。②研究组SPE孕妇血清白蛋白、Ca2+水平低于对照组，而血清肌酐、尿酸、D-二聚体水平高于对照组，并且差异均有统计学意义(P<0.05)。2组孕妇血清球蛋白、AST、ALT、TBA、Na+、K+、Cl—水平比较，差异无统计学意义(P>0.05)。③2组SPE孕妇发生低白蛋白血症，脐血流异常，ICP，肝功能异常，剖宫产率，胸、腹水，以及FGR、ROP、PAH发生率比较，差异均无统计学意义(P>0.05)。④研究组SPE孕妇所分娩新生儿的出生体重、胎龄、生后1 min Apgar评分低于对照组，而研究组孕妇分娩早产儿所占比例高于对照组，并且差异均有统计学意义(P<0.05)。

结论

血清NT-proBNP水平可能成为预测SPE孕妇的有效预测因子，对临床管理SPE孕妇具有一定的指导意义。

关键词: 先兆子痫, 重度子痫前期, 脑钠肽, 血清, 妊娠并发症, 妊娠结局, 围生儿结局, 孕妇
Objective

To investigate the correlation between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and pregnancy outcomes of pregnant women with severe pre-eclampsia (SPE).

Methods

From January 2019 to January 2021, a total of 76 pregnant women with SPE admitted to the Department of Obstetrics and Gynecology, Northern Jiangsu People′s Hospital were selected into this study. According to their serum NT-proBNP levels, they were divided into study group (n=45, with elevated serum NT-proBNP levels) and control group (n=31, with normal serum NT-proBNP levels). Among pregnant women with SPE, their age, body mass index (BMI), gravidity, parity, systolic blood pressure, diastolic blood pressure, gestational age were observed and compared by independent-samples t test between two groups. Besides, aspartate aminotransferase (AST), alanine transaminase (ALT), total bile acid (TBA), D-dimer, and 1 min Apgar score after birth were analyed by Mann-Whitney U test. The incidence of hypoalbuminemia, abnormal umbilical blood flow, intrahepatic cholestasis of pregnancy (ICP), abnormal liver function of pregnant women with SPE, and intrauterine growth restriction (FGR), retinopathy (ROP) and pulmonary hypertension (PAH) of fetal were statistically analyzed by using chi-square test, continuity correction of chi-square test, and Fisher′s exact test. The procedure followed in this study was in accordance with regulations of the Ethics Committee of Northern Jiangsu People′s Hospital, and was approved by the ethics Committee (Approval No. YXYLL-2020-134). Informed consent was obtained from each participate.

Results

① There were no significant differences in age, BMI, gravidity, parity, systolic blood pressure, diastolic blood pressure and umbilical blood flow S/D of pregnant women with SPE between two groups (P>0.05). There were statistically significant differences between two groups in terms of gestational age and 24 h urinary protein quantification of pregnant women with SPE (P<0.05). ②Among pregnant women with SPE, levels of serum albumin and Ca2+ in study group were lower than those in control group, while the levels of serum creatinine, uric acid and D-dimer were higher than those in control group, and differences between two groups were statistically significant (P<0.05). there were no significant differences in serum globulin, AST, ALT, TBA, Na+ , K+ and Cl- levels between two groups of pregnant women with SPE (P>0.05). ③ There were no significant differences in incidence of hypoalbuminemia, abnormal umbilical blood flow, ICP, abnormal liver function, cesarean section rate of pregnant women with SPE, and FGR, ROP, PAH of fetal between two groups (P>0.05). ④ The birth weight, gestational age and 1 min Apgar score after birth of newborns delivered by SPE pregnant women in study group were lower than those in control group, while the proportion of premature babies delivered by pregnant women in study group was higher than that in control group, and the differences were statistically significant (P<0.05).

Conclusions

Levels of serum NT-proBNP may become an effective predictor of SPE patients, which has certain guiding significance for clinical management of SPE patients.

Key words: Pre-eclampsia, Severe pre-eclampsia, Brain natriuretic peptide, Serum, Pregnancy complications, Pregnancy outcome, Perinatal outcome, Pregnant Women
表1 2组SPE孕妇一般临床资料比较
组别 例数 年龄(岁，±s) BMI(kg /m2，±s) 孕次[次，M(P25~P75)] 产次[次，M(P25~P75)] 收缩压(mmHg，±s)
研究组 45 31.0±5.7 29.8±4.5 3(1~4) 1(1~2) 170.9±15.2
对照组 31 31.6±5.6 31.5±4.0 2(1~3) 2(1~2) 168.3±14.9
检验值   t＝—0.423 t＝—1.681 Z＝0.983 Z＝1.203 t＝0.753
P值   0.673 0.050 0.329 0.233 0.454
组别 例数 舒张压(mmHg，±s) 脐血流S/D(±s) 分娩孕龄(周，±s) 24 h尿蛋白定量[g/24 h，M(P25P75)]
研究组 45 109.7±11.5 2.5±0.5 34.5±3.8 3.86(1.90~13.91)
对照组 31 110.0±13.7 2.5±0.8 36.3±2.2 1.10(0.39~3.58)
检验值   t＝-0.126 t＝0.242 t＝-2.386 Z＝2.732
P值   0.900 0.810 0.020 0.006
表2 2组SPE孕妇入院时实验室检查结果比较
组别 例数 白蛋白(g/L，±s) 球蛋白(g/L，±s) AST[U/L，M(P25~P75)] ALT[U/L，M(P25~P75)] TBA[μmol/L，M(P25~P75)] 肌酐(μmol/L，±s)
研究组 45 30.7±3.5 27.2±4.3 25(21~43) 24(16~44) 3.6(1.4~5.2) 64.9±22.4
对照组 31 33.6±4.7 27.2±4.6 21(17~32) 22(14~28) 3.5(1.7~7.0) 53.7±12.5
检验值   t＝-3.035 t＝-0.046 Z＝1.091 Z＝1.071 Z＝0.650 t＝2.542
P值   0.003 0.963 0.274 0.281 0.516 0.013
组别 例数 尿酸(μmol/L，±s) Na+(mmol/L，±s) Ca2+(mmol/L，±s) K+(mmol/L，±s) Cl—(mmol/L，±s) D-二聚体[mg/L，M(P25~P75)]
研究组 45 422.5±101.3 136.2±8.2 2.0±0.3 4.2±0.8 105.2±3.0 3.13(1.33~4.46)
对照组 31 365.9±101.5 136.6±3.3 2.2±0.1 4.2±0.4 105.2±3.2 1.58(0.91~2.15)
检验值   t＝2.395 t＝-0.228 t＝-2.716 t＝-0.554 t＝-0.084 Z＝3.742
P值   0.019 0.820 0.008 0.581 0.933 <0.001
表3 2组SPE孕妇妊娠并发症及结局比较[例数(%)]
组别 例数 低白蛋白血症 脐血流异常 ICP 肝功能异常 FGR ROP 胸、腹水 PAH 剖宫产
研究组 45 17(37.8) 3(6.7) 5(11.1) 4(8.9) 8(17.8) 2(4.4) 5(11.1) 2(4.4) 44(97.8)
对照组 31 8(25.8) 3(9.7) 2(6.5) 1(3.2) 5(16.1) 0(0) 0(0) 0(0) 30(96.8)
χ2值   1.192 0.002a 0.082a 0.258a 0.035 — 2.101a — —
P值   0.275 0.964 0.774 0.612 0.851 0.511 0.147 0.511 1.000
表4 2组SPE孕妇分娩新生儿一般情况比较
组别 例数 出生体重(g，±s) 胎龄(周，±s) 生后1 min Apgar评分[分，M(P25~P75)] 早产儿[例数(%)] 死亡[例数(%)]
研究组 45 2 166.7±1 005.1 34.5±3.8 10(7~10) 38(84.4) 0(0)
对照组 31 2 796.3±1 129.7 36.3±2.2 10(10~10) 15(48.4) 1(3.2)
检验值   t＝-2.529 t＝-2.386 Z＝2.457 χ2＝11.308 —
P值   0.014 0.020 0.014 0.001 0.408
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