血清脑钠肽、肌钙蛋白Ⅰ水平对妊娠合并心脏病患者母婴不良结局的预测价值

目的:探讨血清脑钠肽(BNP)、肌钙蛋白I(cTnI)水平对妊娠合并心脏病患者不良母婴结局的预测价值。方法:根据母婴结局的不同回顾性将64例妊娠合并心脏病患者分为结局良好组(34例)和结局不良组(30例)。在孕晚期(孕28周、孕32周)对两组孕妇各进行1次血清BNP、cTnI水平检测,对比两组血清BNP、cTnI水平及终止妊娠前心功能分级情况。结果:与孕28周相比,两组孕32周时血清BNP、cTnI水平均升高,且结局良好组BNP、cTnI水平及升高值均低于结局不良组(P<0.05)。结局良好组心功能分级为Ⅰ级、Ⅱ级占比高于结局不良组,Ⅲ级、Ⅳ级占比低于结局不良组(P<0.05)。相关分析显示,两组血清BNP及cTnI升高值与NYHA分级均呈正相关(r=0.910、0.895,P均<0.05)。对不良母婴结局的诊断敏感性、特异性、准确性,血清BNP或cTnI单独检测比较无差异(P>0.05),二者联合检测AUC值(0.841)、诊断敏感性(94.6%)、特异性(98.2%)、准确性(96.4%)高于单独检测(P<0.05)。结论:妊娠合并心脏病患者孕晚期血清BNP、cTnI水平升高与不良母婴结局密切相关,血清BNP、cTnI水平联合检测,对预测不良母婴结局有较高效能。

The value of serum brain natriuretic peptide and troponin I levels for predicting adverse maternal and infant outcomes of pregnant women with heart disease

Objective:To explore the value of serum brain natriuretic peptide(BNP)and troponin I(cTnI)levels for predicting adverse maternal and infant outcomes of pregnant women with heart disease.Methods:64 pregnant women with heart disease were divided into group A(34 women with good pregnancy outcomes)and group B(30 women with adverse pregnancy outcomes).Serum BNP and cTnI levels of all women were measured during the third trimester of pregnancy(28 and 32 gestational weeks).The serum BNP and cTnI levels and cardiac function grading before delivery of women were compared between the two groups.Results:Compared with those of women during 28 gestational weeks in the two groups,the levels of serum BNP and cTnI were significant higher during 32 gestational weeks.The levels of serum BNP and cTnI of women in the group A during 32 gestational weeks were significant lower than those of women in group B(P<0.05).The proportion of grade I and II of women in group A was significant higher than that of women in group B,but the proportion of grade III and IV of women in group A was significant lower(P<0.05).The values increased of serum BNP and cTnI levels of pregnant women in both groups were positively correlated with their NYHA grade(r=0.910,0.895,P<0.05).There was no significant difference in diagnostic sensitivity,specificity and accuracy for predicting adverse maternal and infant outcomes between serum BNP level and serum cTnI level(P>0.05).The AUC value,the sensitivity,the specificity,and the accuracy of the BNP level combined with the cTnI level detection were 0.841,94.6%,98.2%and 96.4%,respectively,which were significant higher than those of detection of serum BNP level or cTnI level alone(P<0.05).Conclusion:The levels of serum BNP and cTnI of pregnant women with heart disease increase during the third trimester of pregnancy,which is closely related to their adverse maternal and infant outcomes.Monitoring serum BNP and cTnI levels of pregnant women can predict effectively the occurrence of adverse maternal and infant outcomes.