摘要
目的研究高龄孕妇妊娠期心血管功能异常与妊娠结局的关系。方法选取2018年9月-2020年3月河北北方学院附属第二医院高龄孕妇146例,根据妊娠结局分为不良妊娠结局组(包括剖宫产、产后出血、低体重儿、早产、流产、死胎,n=52)和正常妊娠结局组(n=94)。均采用超声心动图、血管壁回声跟踪技术(E-Tracking)检查,分析心血管功能指标与高龄孕妇妊娠结局的关系及对妊娠结局的预测价值。结果不良妊娠结局组左心室射血分数(left ventricular ejection fraction,LVEF)低于正常妊娠结局组[(55.49±7.24)%vs(67.83±6.50)%,P<0.001]、室间隔舒张末期厚度(interventricular septum end-diastolic thickness,IVSTd)[(10.93±1.77)mm vs(8.74±1.57)mm]、左心房收缩末期内径(left atrial end-systolic diameter,LAD)[(34.73±3.15)mm vs(30.27±3.39)mm]、左心室重量指数(left ventricular mass index,LVMI)[(105.47±13.38)g/m2 vs(95.69±16.48)g/m2]、血管硬化度(vascular stiffness,β)[(31.11±3.60)vs(21.92±2.46)]、脉搏波传导速度(higher pulse wave velocity,PWVβ)[(12.27±1.22)m/s vs(9.03±2.25)m/s]、血管压力-应变弹性系数(vascular pressure-strain elastic coefficient,Eρ)[(316.37±34.86)kPa vs(252.66±38.15)kPa]均高于正常妊娠结局组(P均<0.05)。LVEF(OR=0.474)、IVSTd(OR=2.165)、LVMI(OR=4.064)、PWVβ(OR=3.130)、Eρ(OR=3.152)、主动脉顺应性(OR=0.414)为高龄孕妇发生不良妊娠结局的影响因素(P均<0.05)。IVSTd、LVMI、PWVβ、Eρ预测高龄孕妇妊娠结局的AUC分别为0.824、0.809、0.817、0.815,提示上述指标对高龄孕妇妊娠结局具有良好预测价值。结论心血管功能异常是高龄孕妇发生不良妊娠结局的主要影响因素。
Objective To investigate the association between abnormal cardiovascular function during pregnancy and pregnancy outcome in women of advanced reproductive age.Methods A total of 146 women of advanced reproductive age who were hospitalized in the Second Affiliated Hospital of Hebei North University from September 2018 to March 2020 were enrolled,and according to pregnancy outcome,they were divided into adverse pregnancy outcome group(52 women,including cesarean section,postpartum hemorrhage,low birth weight,premature delivery,abortion,and stillbirth)and normal pregnancy outcome group with 94 women.All women underwent echocardiography examination and vascular wall echo-tracking to analyze the association between cardiovascular function parameters and pregnancy outcome in women of advanced reproductive age and their value in predicting pregnancy outcome.Results Compared with the normal pregnancy outcome group,the adverse pregnancy outcome group had a significantly lower left ventricular ejection fraction(LVEF)(55.49%±7.24%vs 67.83%±6.50%)and significantly higher interventricular septum end-diastolic thickness(IVSTd)([10.93±1.77]mm vs[8.74±1.57]mm),higher left atrial end-systolic diameter(LADs)([34.73±3.15]mm vs[30.27±3.39]mm),higher left ventricular mass index(LVMI)([105.47±13.38]g/m2 vs[95.69±16.48]g/m2),higher degree of vascular stiffness(β)(31.11±3.60 vs 21.92±2.46),higher pulse wave velocity(PWVβ)([12.27±1.22]m/s vs[9.03±2.25]m/s),and higher vascular pressure-strain elastic coefficient(Eρ)([316.37±34.86]kPa vs[252.66±38.15]kPa)(all P<0.05).Logistic regression analysis showed LVEF(odds ratio[OR]=0.474),IVSTd(OR=2.165),LVMI(OR=4.064),PWVβ(OR=3.130),Eρ(OR=3.152),and arterial compliance(OR=0.414)were influencing factors for adverse pregnancy outcome in women of advanced reproductive age(all P<0.05).IVSTd,LVMI,PWVβ,and Eρhad an area under the ROC curve of 0.824,0.809,0.817,and 0.815,respectively,in predicting pregnancy outcome in women of advanced reproductive age,suggesting that the above indica
作者
刁云云
郝文斌
田秀娟
闫利荣
王贝
郑卫
DIAO Yunyun;HAO Wenbin;TIAN Xiujuan;YAN Lirong;WANG Bei;ZHENG Wei(Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei Province,China;Department of Obstetrics and Gynecology,Yanqing Hospital,the Third Hospital of Peking University,Beijing 102100,China;Electrocardiogram Room,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,Hebei Province,China)
出处
《解放军医学院学报》
CAS
2020年第11期1058-1063,1067,共7页
Academic Journal of Chinese PLA Medical School
基金
张家口市重点研发计划项目(1921016D)。
关键词
高龄
妊娠期
心血管功能
左心室重量指数
脉搏波传导速度
妊娠结局
advanced age
pregnancy
cardiovascular function
left ventricular mass index
pulse wave velocity
pregnancy outcome
