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

doi:10.3877/cma.j.issn.1673-5250.2021.06.013

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	0.002^a	0.082^a	0.258^a	0.035	—	2.101^a	—	—
P值		0.275	0.964	0.774	0.612	0.851	0.511	0.147	0.511	1.000

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	0.002^a	0.082^a	0.258^a	0.035	—	2.101^a	—	—
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

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

[1]	Liu Y, Huang J, Yu N, et al. Involvement of WNT2 in trophoblast cell behavior in preeclampsia development[J]. Cell Cycle, 2020, 19(17): 2207-2215. DOI: 10.1080/15384101.2020.1802913.
[2]	李璐，田叶，谢媛媛. 孕妇血清维生素D、叶酸及血脂水平与子痫前期的关系[J/CD]. 中华妇幼临床医学杂志(电子版), 2020, 16(5): 607-614. DOI: 10.3877/cma.j.issn.1673-5250.2020.05.016.
[3]	陈秋和，单丹，陈倩，等. 妊娠期糖尿病高龄孕妇并发子痫前期的相关因素分析[J/CD]. 中华妇幼临床医学杂志(电子版), 2020, 16(5): 574-583. DOI: 10.3877/cma.j.issn.1673-5250.2020.05.011.
[4]	Li XL, Guo PL, Xue Y, et al. An analysis of the differences between early and late preeclampsia with severe hypertension[J]. Pregnancy Hypertens, 2016, 6(1): 47-52. DOI: 10.1016/j.preghy.2015.12.003.
[5]	Barton JR, Woelkers DA, Newman RB, et al. Placental growth factor predicts time to delivery in women with signs or symptoms of early preterm preeclampsia: a prospective multicenter study[J]. Am J Obstet Gynecol, 2020, 222(3): 259.e1-259.e11. DOI: 10.1016/j.ajog.2019.09.003.
[6]	Roberge S, Nicolaides K, Demers S, et al. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and Meta-analysis[J]. Am J Obstet Gynecol, 2017, 216(2): 110-120.e6. DOI: 10.1016/j.ajog.2016.09.076.
[7]	Shah DA, Khalil RA. Bioactive factors in uteroplacental and systemic circulation link placental ischemia to generalized vascular dysfunction in hypertensive pregnancy and preeclampsia[J]. Biochem Pharmacol, 2015, 95(4): 211-226. DOI: 10.1016/j.bcp.2015.04.012.
[8]	Pourghassem Gargari B, Pourteymour Fard Tabrizi F, Sadien B, et al. Vitamin D status is related to oxidative stress but not high-sensitive C-reactive protein in women with pre-eclampsia[J]. Gynecol Obstet Invest, 2016, 81(4): 308-314. DOI: 10.1159/000441781.
[9]	Lewis RA, Durrington C, Condliffe R, et al. BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing？[J]. Eur Respir Rev, 2020, 29(156): 200009. DOI: 10.1183/16000617.0009-2020.
[10]	Asferg CL, Andersen UB, Linneberg A, et al. Serum B-type natriuretic peptide does not increase with higher systolic blood pressure in obese men despite evidence of blood pressure-related increases in left ventricular mass and filling pressure[J]. Peptides, 2020, 134: 170390. DOI: 10.1016/j.peptides.2020.170390.
[11]	谢幸，孔北华. 妇产科学[M]. 9版. 北京：人民卫生出版社，2018: 154-155.
[12]	Peterson JA, Sandgren K, Levine LD. Severe preterm preeclampsia: an examination of outcomes by race[J]. Am J Obstet Gynecol MFM, 2020, 2(4): 100181. DOI: 10.1016/j.ajogmf.2020.100181.
[13]	Mirkovic L, Tulic I, Stankovic S, et al. Prediction of adverse maternal outcomes of early severe preeclampsia[J]. Pregnancy Hypertens, 2020, 22: 144-150. DOI: 10.1016/j.preghy.2020.09.009.
[14]	Myatt L. The prediction of preeclampsia: the way forward[J]. Am J Obstet Gynecol, 2020, S0002-9378(20)31277-1. DOI: 10.1016/j.ajog.2020.10.047.
[15]	Rana S, Burke SD, Karumanchi SA. Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders[J]. Am J Obstet Gynecol, 2020, S0002-9378(20)31196-0. DOI: 10.1016/j.ajog.2020.10.022. Epub ahead of print. PMID: 33096092.
[16]	Afshani N, Moustaqim-Barrette A, Biccard BM, et al. Utility of B-type natriuretic peptides in preeclampsia: a systematic review[J]. Int J Obstet Anesth, 2013, 22(2): 96-103. DOI: 10.1016/j.ijoa.2012.11.001.
[17]	Borges V, Zanati SG, Peraçoli M，et al. Maternal left ventricular hypertrophy and diastolic dysfunction and brain natriuretic peptide concentration in early- and late-onset pre-eclampsia[J]. Ultrasound Obstet Gynecol, 2018, 51(4): 519-523. DOI: 10.1002/uog.17495.
[18]	Macheret F, Heublein D, Costello-Boerrigter LC, et al. Human hypertension is characterized by a lack of activation of the antihypertensive cardiac hormones ANP and BNP[J]. J Am Coll Cardiol, 2012, 60(16): 1558-1565. DOI: 10.1016/j.jacc.2012.05.049.
[19]	Clerico A, Giannoni A, Vittorini S, et al. Thirty years of the heart as an endocrine organ: physiological role and clinical utility of cardiac natriuretic hormones[J]. Am J Physiol Heart Circ Physiol, 2011, 301(1): H12-H20. DOI: 10.1152/ajpheart.00226.2011.
[20]	Kuhn M. Molecular physiology of membrane guanylyl cyclase receptors[J]. Physiol Rev, 2016, 96(2): 751-804. DOI: 10.1152/physrev.00022.2015.
[21]	Kato J. Natriuretic peptides and neprilysin inhibition in hypertension and hypertensive organ damage[J]. Peptides, 2020, 132: 170352. DOI: 10.1016/j.peptides.2020.170352.
[22]	Tsuruda T, Boerrigter G, Huntley BK, et al. Brain natriuretic peptide is produced in cardiac fibroblasts and induces matrix metalloproteinases[J]. Circ Res, 2002, 91(12): 1127-1134. DOI: 10.1161/01.res.0000046234.73401.70.
[23]	Kuwahara K. The natriuretic peptide system in heart failure: diagnostic and therapeutic implications[J]. Pharmacol Ther, 2021, 227: 107863. DOI: 10.1016/j.pharmthera.2021.107863.
[24]	Kumari M, Kovach T, Sheehy B, et al. Circulating NT-proBNP but not soluble corin levels were associated with preeclampsia in pregnancy-associated hypertension[J]. Clin Biochem, 2019, 67: 12-15. DOI: 10.1016/j.clinbiochem.2019.03.005.
[25]	Sandrim VC, Palei AC, Sertório JT, et al. Alterations in cyclic GMP levels in preeclampsia may reflect increased B-type natriuretic peptide levels and not impaired nitric oxide activity[J]. Clin Biochem, 2011, 44(12): 1012-1014. DOI: 10.1016/j.clinbiochem.2011.05.026.
[26]	李德新，贾慧敏，王清涛. BNP的测定和临床应用的研究进展[J]．现代生物医学进展，2006, 6(10): 139-142. DOI: 10.3969/j.issn.1673-6273.2006.10.047.
[27]	王际军. 血清BNP、CTnI水平与老年冠心病心力衰竭患者心肌能量消耗的相关性[J]．中国老年学杂志，2020, 40(15): 3147-3150. DOI: 10.3969/j.issn.1005-9202.2020.15.004.
[28]	Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure[J]. N Engl J Med, 2002, 347(3): 161-167. DOI: 10.1056/NEJMoa020233.

[1]	Haoyuan Yang, Jie Gong, Qingwei Zou, Hang Ruan. Current research status on adverse pregnancy outcomes of maternal and infant in pregnant women with asthma[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 522-529.
[2]	Tiantian Chen, Xiaodong Wang, Haiyan Yu. Pregnancy outcome of twin pregnancy with Gitelman syndrome: a case report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 559-568.
[3]	Xiaoqing Ju, Yunjie Jin, Xiaoyan Wang. Influencing factors of uterine rupture during vaginal delivery in patients with scarred uterus after cesarean section[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 575-581.
[4]	Juan Gu, Qingqing Sun, Fangfang Hu, Yijuan Cao, Yujuan Qi. Clinical application of endometrial receptivity array to improve pregnancy outcomes in women with repeated embryo implantation failure[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 582-587.
[5]	Beibei Wang, Qixiu Dong, Hongyan Xi, Qingyun Yu, Lijun Zhang, Guang Shi. Analysis of influencing factors of medical abortion failure of pregnant women in early pregnancy and construction of related prediction model and its predictive value for medical abortion success[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 588-594.
[6]	Xu Chen, Yuru Zhan, Chunhua Wang. Clinical value of ABO blood group combined with thyroid function in prediction of gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 604-610.
[7]	Mengling Zhou, Zhiwei Xue, Shu Zhou. Changes in size of uterine myoma during pregnancy and its association with adverse pregnancy outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 611-615.
[8]	Chenxi Ran, Rufei Shen, Mingyu Liao, Qian Liao, Ling Zhou, Yuling Zhang, Min Long. Treatment and management of pituitary tumor during pregnancy[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 487-491.
[9]	Chenglu Huang, Fei Liao, Xianping Liu, Zhiqiang Wang. Relationship between overexpression of serum exosomal has_circ_0060937 and metastasis and poor prognosis of NSCLC[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(04): 490-494.
[10]	Li Cheng, Xiaoliang Zhang. Relationship between serum uric acid combining cystatin C and diabetic kidney disease in patients with diabetic retinopathy and influencing factors[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 194-199.
[11]	Yuyan Zhang, Bin Hu, Weihong Zhang, Mei Xu, Hui Zhu, Xinyue Yang, Hailing Liu. Relationship between echocardiography parameters and liver function during the second trimester of pregnancy and their predictive value for adverse pregnancy outcomes[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 499-504.
[12]	Shaohong Zhuo, Xiuling Lin, Cuimei Zhou, Weilian Xiong, Xingzao Ma. Application value of CD64 index combined with serum SAA/CRP and PCT in the diagnosis of children with infectious gastrointestinal diseases[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 505-509.
[13]	Lifang Wang, Wu Ning, Yan Ding, Yanxia Zhang, Doudou Ma, Zhemin Lu, Peng Han, Chaoran Li, Kuanting Wang. Association between serum uric acid and serum 25(OH)D3 levels in middle school students in Shijingshan District, Beijing[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 865-869.
[14]	Rui Tan, Jing Wang, Jiangquan Yu, Ruiqiang Zheng. Progress in understanding of role of high density lipoprotein, apolipoprotein A-I, and serum amyloid A in sepsis[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 749-753.
[15]	Xin Wang, Lin Liu, Zhejia Wen, Chunling Liu, Hong Zhang, Fang Lyu. Effect of stress exposure before pregnancy on subsequent pregnancy outcomes in mice[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 431-437.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export