应用氨基末端B型利钠肽前体评估孕产妇心功能的临床价值

目的探讨应用氨基末端B型利钠肽前体（NT-proBNP）对有呼吸困难症状的孕产妇评估心功能的作用。方法回顾性分析本院2009年1月1日至2009年12月30日有呼吸困难症状的孕产妇共42例,其中子痫前期18例,心脏病7例,甲亢4例,双胎妊娠先兆早产用宫缩抑制剂安胎5例,三胎妊娠2例,卵巢过度刺激综合征5例,产后出血1例。每例病人均测定血清NT-proBNP值并按标准诊断程序检测,并规范治疗。结果本组42例中12例（双胎妊娠先兆早产用宫缩抑制剂安胎5例,三胎妊娠1例,卵巢过度刺激综合征5例,妊娠合并甲亢1例）NT-proBNP〈500pg/ml,临床排除心衰;余下30例（子痫前期18例,妊娠合并心脏病7例,妊娠合并甲亢3例,三胎妊娠1例,产后出血1例）均NT-proBNP〉500pg/ml,行胸片示双肺肺水肿,经临床证实为妊娠合并急性心衰。NT-proBNP〉3000pg/ml者7例,临床治疗困难,心衰反复发作,1例孕产妇死亡。NT-proBNP 1000～3000pg/ml者21例,经积极治疗病情好转。NT-proBNP 500～1000pg/ml者2例,症状轻,治疗康复快。此外,其中2例患者治疗过程复查NT-proBNP下降,临床体现病情好转;1例NT-proBNP值增高,病情加重。结论对有呼吸困难症状的孕产妇NT-proBNP值〉500pg/ml可早期诊断心力衰竭并评估预后,NT-proBNP的改变较临床症状出现早,其值越高,心衰临床表现越明显,预后越差。

Diagnostic Value of N-Terminal Pro-Brain Natriuretic Peptide in the Evaluation of Ventricular Function in Obstetric Patients

Objective To evaluate the role of N-Terminal Pro-Brain Natriuretic Peptide（NT-proBNP） in clinical diagnosis and management options of early heart failure in obstetric patients with acute dyspnea.Methods NT-proBNP and clinical manifestation of 42 patients between Jan 2009 to Dec 2009 in our hospital were analyzed.Eighteen patients had preeclampsia,7 had cardiac and/or pulmonary disease,5 patients with twin pregnancy had preterm labor tocolysis,2 patients with triplet pregnancy,4 had hyperthyroidism and 1 had postpartum hemorrhage.Each of these patients was presented with signs and symptoms consistent with acute dyspnea.Results The levels of NT-proBNP of 12 patients（5 twins had preterm labor tocolysis,1 was triplet,5 had ovarian hyperstimulation syndrome,1 had hyperthyroidism） were no more than 500 pg /ml.They were not found to have significant left ventricular dysfunction.The levels of NTproBNP of others 30 cases（18 patients had preeclampsia,7 had cardiac and /or pulmonary disease,1 was triplet,3 had hyperthyroidism,1 had postpartum hemorrhage） were more than 500 pg /ml.They were found to have significant left ventricular dysfunction that was respond to standard clinical evaluation.Seven of them the levels of NT-proBNP were more than 3 000 pg /ml and had more serious cardiac dysfunction,and one was dead.Twenty-one of them the levels of NT-proBNP were 1 000～3 000 pg /ml and were difficult to manage.Two of them the levels of NT-proBNP were 500～1 000 pg /ml and were regularly managed.The changing of levels of NT-proBNP in 3 cases could predict the outcome,one was worse,while two were improved.Conclusion N-terminal pro-BNP can be used in the clinical evaluation and management of obstetric patients with acute dyspnea,especially for the patients with a level of NTproBNP more than 500 pg /ml.