首页|超声心动图评估妊娠期高血压患者左心室功能的价值

超声心动图评估妊娠期高血压患者左心室功能的价值

Evaluation of left ventricular function in patients with pregnancy-induced hypertension using echocardiography

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目的 观察组织多普勒成像超声心动图评价妊娠期高血压(PIH)患者左心室功能的临床价值.方法 采用病例对照研究,选取温州市中西医结合医院2019年5月至2022年5月就诊的PIH患者100例和同期健康妊娠期女性100例为研究对象,均行二维超声心动图、脉冲多普勒和组织多普勒检查,采集左心室形态和功能超声指标参数.比较不同类型PIH患者与健康受试者左心室形态和功能超声指标差异,分析不同类型PIH患者左心室功能超声指标数值与血清N-末端脑钠肽前体(NT-proBNP)含量的相关性.结果 PIH、轻度子痫前期、重度子痫前期患者与健康受试者舒张期室间隔厚度[(10.24±1.18)mm、(11.39±1.24)mm、(11.57±1.29)mm 比(8.81±0.95)mm]、左室舒张末期内径[(47.31±2.81)mm、(49.82±2.89)mm、(52.03±2.94)mm 比(46.82±2.76)mm]、左室后壁厚度[(9.73± 1.06)mm、(10.62±1.13)mm、(11.75±1.21)mm 比(8.96±0.97)mm ]、左心室内径[(32.82±2.34)mm、(35.48±2.39)mm、(36.04±2.45)mm 比(30.41±2.27)mm]和左室质量指数[(98.41±7.83)g/m2、(105.73± 8.26)g/m2、(108.63±8.57)g/m2 比(96.59±7.69)g/m2 ]差异均有统计学意义(F=13.47、12.61、16.59、13.26、19.73,均P<0.001);PIH、轻度子痫前期、重度子痫前期患者与健康受试者E峰与A峰比值(E/A)、收缩期运动幅度(S)、舒张早期与舒张晚期峰速比值(Ea/Aa)和心肌做功指数(Tei)等左心室功能性超声检测指标差异均有统计学意义(F=12.84、11.27、14.64、21.43,均P<0.001);PIH患者E/A、S和Ea/Aa与血清 NT-proBNP 含量均呈中等负相关(r=-0.56、-0.43、-0.54,P=0.029、0.042、0.031),Tei 数值与血清NT-proBNP含量呈正相关(r=0.77,P=0.003).结论 二维超声心动图、脉冲多普勒结合组织多普勒检查可有效评估不同类型PIH患者左心室结构和功能,通过组织多普勒监测Tei可更加准确有效地反映左心室损伤程度及功能变化,具有较高的临床应用价值.
Objective To investigate the clinical value of tissue Doppler echocardiography in the evaluation of left ventricular function in patients with pregnancy-induced hypertension.Methods This is a case-control study,including 100 patients with pregnancy-induced hypertension who received treatment at the Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to May 2022,and an additional 100 healthy pregnant women who underwent physical examination during the same period.All participants underwent two-dimensional echocardiography,pulsed Doppler echocardiography,and tissue Doppler echocardiography.Ultrasound parameters related to left ventricular morphology and function were collected from all participants.The ultrasound parameters related to left ventricular morphology and function between patients with different types of pregnancy-induced hypertension and healthy controls were compared.The correlation between left ventricular function ultrasound parameters and serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels was investigated.Results Patients with pregnancy-induced hypertension,patients with mild preeclampsia,patients with severe preeclampsia,and healthy controls demonstrated differences in interventricular septum thickness during diastole[(10.24±1.18)mm,(11.39±1.24)mm,(11.57± 1.29)mm,(8.81±0.95)mm],left ventricular end-diastolic diameter[(47.31±2.81)mm,(49.82± 2.89)mm,(52.03±2.94)mm,(46.82±2.76)mm],left ventricular posterior wall thickness[(9.73± 1.06)mm,(10.62±1.13)mm,(11.75±1.21)mm,(8.96±0.97)mm],left ventricular inner diameter[(32.82±2.34)mm,(35.48±2.39)mm,(36.04±2.45)mm,(30.41±2.27)mm],and left ventricular mass index[(98.41±7.83)g/m2,(105.73±8.26)g/m2,(108.63±8.57)g/m2,(96.59±7.69)g/m2].All of these parameters showed significant differences between patients with different types of pregnancy-induced hypertension and healthy controls(F=13.47,12.61,16.59,13.26,19.73,all P<0.001).Significant differences were also observed in echocardiographic indices of left ventricular function such as peak velocity ratio of E and A waves,systolic motor amplitude,early peak diastolic velocity to late peak diastolic velocity,and Tei index between patients with different types of pregnancy-induced hypertension and healthy controls(F=12.84,11.27,14.64,21.43,all P<0.001).In patients with pregnancy-induced hypertension,peak velocity ratio of E and A waves,systolic motor amplitude,and early peak diastolic velocity to late peak diastolic velocity were moderately negatively correlated with serum NT-proBNP level(r=-0.56,-0.43,-0.54,P=0.029,0.042,0.031),while Tei index showed a positive correlation with serum NT-proBNP level(r=0.77;P=0.003).Conclusion Two-dimensional echocardiography,pulsed Doppler echocardiography combined with tissue Doppler echocardiography can be used to effectively evaluate the changes in left ventricular structure and function in patients with different types of pregnancy-induced hypertension.Monitoring the Tei index using tissue Doppler echocardiography can accurately reflect myocardial injury and functional changes,which has a great clinical application value.

Echocardiography,stressUltrasonography,doppler,pulsedHypertension,pregnancy-inducedPre-eclampsiaEclampsiaVentricular function,leftNatriuretic peptide,brainEvaluation studies

叶海燕、杨建享、陈明明、赵悦子

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温州市中西医结合医院超声科,温州 325000

超声心动描记术,压力 超声检查,多普勒,脉冲 高血压,妊娠性 先兆子痫 子痫 心室功能,左 利钠肽,脑 评价研究

浙江省温州市基础性科研计划

Y20190674

2024

中国基层医药
中华医学会,安徽医科大学

中国基层医药

影响因子:1.003
ISSN:1008-6706
年,卷(期):2024.31(2)
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