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

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