妊娠合并慢性心衰患者血清心肌标志物水平及心功能参数观察

摘要

Objective:To investigate clinical value of the change of serum cardiac markers and cardiac function parame ters of pregnant women with chronic heart failure (CHF).Methods:A total of 36 pregnant women with CHF in The First People's Hospital of Xiaoshan District from January 2010 to December 2016 were selected into CHF group,42 non-pregnant patients with CHF were in non-pregnant CHF group,50 normal pregnant women were in normal pregnancy group,and 50 healthy women for physical examination in the same period were in normal control group.Level of cardiac troponin Ⅰ (cTnⅠ) and N terminal pro brain natriuretic peptide (NT-proBNP) of women in the four groups were detected.And early diastolic left ventricular filling peak velocity (E),atrial systolic left ventricular filling peak velocity (A),E/A,left ventricular ejection fraction (LVEF),stroke volume (SV),cardiac output (CO),left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV) of women in the four groups were measured by color Doppler ultrasound.Results:Level of cTnⅠ and NT-proBNP of women in pregnant CHF group were significantly higher than those of women in non-pregnant CHF group,normal pregnancy group and normal control group (P＜ 0.05).The peak E velocity,peak A velocity,E/A,LVEF,SV and CO of women in pregnant CHF group were significantly lower than those of women in the other three groups,but LVEDV and LVESV of women in non-pregnant CHF group were significant higher (P＜ 0.05).The peak E velocity,peak A velocity,E/A,LVEF,SV and CO of women in non-pregnant CHF group were significantly lower than those of women in normal pregnancy group and nor mal control group,but LVEDV and LVESV of women in non-pregnant CHF group were significant higher (P＜0.05).LVEDV and LVESV of women in normal pregnancy group were significant higher those of women in normal control group (P＜ 0.05).Conclusion:Compared to non-pregnant women with CHF,markers of myocardial damage in pregnant women with CHF can be detected,and cardiac myocardial contractility and diastolic function in pregnant women with CHF are further decreased,so pregnant women with CHF should be paid more attention to in obstetric clinical.%目的:探讨妊娠合并慢性心力衰竭孕妇心肌损伤标志物水平及心功能参数指标变化的临床意义.方法:选取2010年1月-2016年12月本院收治的妊娠合并慢性心力衰竭孕妇36例为已孕心衰组,选取医院就诊的未孕慢性心力衰竭患者42例(未孕心衰组)和正常妊娠妇女50例(正常妊娠组),同期医院体检正常的健康女性50例(正常对照组).测定4组妇女心肌钙蛋白Ⅰ(cTnⅠ)、N端脑钠肽前体(NT-proBNP)水平;彩色多普勒超声诊断仪测定舒张压早期左室充盈峰速度(E)、心房收缩期左室充盈峰速度(A),计算E/A值、左室射血分数(LVEF)、每搏心输出量(SV)、心输出量(CO)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV).结果:cTnⅠ、NT-proBNP测定水平已孕心衰组＞未孕心衰组＞正常妊娠组＞正常对照组(P＜0.05).已孕心衰组E峰流速、A峰流速、E/A、LVEF、SV、CO均低于另外3组,LVEDV、LVESV高于另外(P＜0.05);未孕心衰组上述指标也分别低于或高于正常妊娠组、正常对照组(P＜0.05);正常妊娠组LVEDV、LVESV高于正常对照组(P＜0.05).结论:与未孕心衰女性相比,妊娠合并慢性心衰孕妇的心肌损伤标志物发生异常,心肌收缩、舒张功能进一步下降,在产科临床应引起注意予以检测和观察.