Echocardiography combined with serum angiotensin-converting enzyme levels can be used as a potential biological indicator to evaluate cardiac function in hypertensive patients during pregnancy
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摘要:
目的 研究超声心动图联合血清血管紧张素转换酶（ACE）对妊娠期高血压（HIP）的诊断价值及与心功能的相关性。 方法 纳入2021年3月~2024年3月在我院诊治的50例HIP患者作为研究组，另选取同期在我院接受健康体检的50例健康体检者视为对照组。比较研究组与对照组HIP患者的超声心动图结果、血清ACE水平及心功能指标；采用Pearson分析超声心动图、血清ACE与心功能指标的相关性；采用ROC曲线分析超声心动图、血清ACE单独及联合诊断HIP的诊断价值。 结果 研究组ACE水平高于对照组（P < 0.05）；研究组舒张早期充盈峰速度/舒张晚期充盈峰速度（E/A）和舒张早期快速充盈分数（RFF）低于对照组（P < 0.05），左心室射血分数（LVEF）、肌钙蛋白T（cTnT）及血浆脑钠肽（BNP）水平高于对照组（P < 0.05）；Pearson分析结果显示，HIP患者E/A、RFF与cTnT、BNP呈负相关（P < 0.05），LVEF、ACE与cTnT、BNP呈正相关（P < 0.05）；ROC曲线分析显示，ACE诊断妊娠期高血压的AUC值为0.619，E/A、RFF、LVEF及四者联合诊断妊娠期高血压的AUC值分别为0.700、0.706、0.793、0.880。 结论 超声心动图联合血清ACE水平可作为评估HIP患者心功能的潜在生物学指标。 -
关键词:
- 血清血管紧张素转换酶 /
- 超声心动图 /
- 妊娠期高血压 /
- 心功能
Abstract:Objective To investigate the value of echocardiography combined with serum angiotensin-converting enzyme (ACE) in the diagnosis of gestational hypertension (HIP) and its correlation with cardiac function. Methods Fifty patients with HIP who were treated in our hospital from March 2021 to March 2024 were included as the study group, and another 50 healthy subjects who underwent physical examination in our hospital during the same period were selected as the control group. The echocardiographic results, serum ACE levels and cardiac function indexes of HIP patients in the study group and the control group were determined. The correlation between echocardiography, serum ACE and cardiac function index was analyzed by Pearson. ROC curve analysis of echocardiography, serum ACE alone and combined diagnostic value of HIP. Results The level of early diastolic filling peak velocity/late diastolic filling peak velocity (E/A) and early diastolic rapid filling fraction (RFF) in the study group were lower than those in the control group (P < 0.05), left ventricular ejection fraction (LVEF), ACE level, troponin T (cTnT) level and plasma brain natriuretic peptide (BNP) level were higher than those of control group (P < 0.05); Pearson analysis showed that E/A and RFF in HIP patients were negatively correlated with cTnT and BNP (P < 0.05), while LVEF and ACE were positively correlated with cTnT and BNP (P < 0.05). ROC curve analysis showed that the AUC value of ACE in diagnosis of gestational hypertension was 0.619, and the AUC value of E/A, RFF, LVEF and the combination of the four patients in diagnosis of gestational hypertension was 0.700, 0.706, 0.793, 0.880, respectively. Conclusion Echocardiography combined with serum ACE level can be used as a potential biological index to evaluate cardiac function in HIP patients. -
图 1 超声心动图、血清ACE单独及联合诊断HIP的ROC曲线
Figure 1. ROC curve of echocardiography and serum ACE alone and in combination for HIP diagnosis.
图 2 超声心动图、血清ACE与心功能指标的相关性
Figure 2. Correlation between echocardiography, serum ACE and cardiac function indexes; A: Correlation between E/A and cTnT; B: Correlation between RFF and cTnT; C: Correlation between LVEF and cTnT; D: Correlation between ACE and cTnT; E: Correlation between E/A and BNP; F: Correlation between RIFts and BNP; G: Correlation between LVEF and BNP; H: Correlation between ACE and BNP.
表 1 两组一般资料比较
Table 1. Comparison of general data between the two groups(n=50)
Item Research group Control group t/Z P Age (year) 27.00 (26.00, 29.00) 27.00 (26.00, 28.00) -1.162 0.245 BMI (kg/m2) 22.91±1.59 22.77±1.17 0.503 0.616 Gestational weeks 21.00 (20.25, 22.00) 22.00 (21.00, 23.00) -1.141 0.254 Diastolic blood pressure (mmHg) 95.40±12.71 83.00±6.82 6.078 ＜0.001 Systolic blood pressure (mmHg) 152.84±21.95 132.92±12.28 5.600 ＜0.001 
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表 2 两组超声心动图结果比较
Table 2. Comparison of echocardiographic results between the two groups (n=50, Mean±SD)
Group E/A RFF (%) LVEF (%) Research group 1.33±0.22 56.56±6.91 72.54±6.29 Control group 1.52±0.28 62.20±7.15 64.98±6.79 t -3.911 -4.013 5.777 P ＜0.001 ＜0.001 ＜0.001 E/A: Early diastolic filling peak velocity/late diastolic filling peak velocity; RFF: Early diastolic rapid filling score; LVEF: Left ventricular ejection fraction.
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表 3 超声心动图、血清ACE单独及联合诊断HIP的ROC曲线
Table 3. ROC curve of echocardiography, serum ACE alone and combined diagnosis of HIP
Index AUC 95% CI P Optimum cutoff Sensitivity Specificity E/A 0.700 0.597-0.803 ＜0.001 1.455 0.780 0.580 RFF 0.706 0.604-0.807 ＜0.001 57.500 0.580 0.760 LVEF 0.793 0.706-0.880 ＜0.001 66.500 0.900 0.620 ACE 0.619 0.509-0.729 0.041 419.785 0.400 0.820 Combined detection 0.880 0.816-0.944 ＜0.001 0.384 0.880 0.740
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表 4 两组心功能指标比较
Table 4. Comparison of cardiac function indexes between the two groups (n=50, Mean±SD)
Group cTnT (μg/L) BNP (pg/mL) Research group 0.24±0.09 274.31±48.75 Control group 0.10±0.03 74.62±11.35 t 9.864 28.209 P ＜0.001 ＜0.001 cTnT: Troponin T; BNP: Plasma brain natriuretic peptide.
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表 5 超声心动图、血清ACE与心功能指标的相关性
Table 5. Correlation between echocardiography, serum ACE and cardiac function indexes
Index cTnT (μg/L) BNP (pg/mL) rs P rs P E/A -0.210 0.036 -0.266 0.008 RFF (%) -0.218 0.030 -0.329 ＜0.001 LVEF (%) 0.372 ＜0.001 0.480 ＜0.001 ACE (U/mL) 0.443 ＜0.001 0.349 ＜0.001
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[1] 应微微. 妊娠期高血压疾病孕妇血清ACE和NEFA水平与心功能和妊娠结局的相关性[J]. 中国妇幼保健, 2021, 36(14): 3228-30. [2] 惠玉洁, 尉艳芹, 赵雪燕, 等. 超声追踪技术联合超声心动图在妊娠期高血压孕妇心功能中的应用价值[J]. 临床和实验医学杂志, 2021, 20 (6): 664-6. doi: 10.3969/j.issn.1671-4695.2021.06.029 [3] Jin Y, Jia TT, Wu XL, et al. The predictive value of microRNA in early hypertensive disorder complicating pregnancy (HDCP)[J]. Am J Transl Res, 2021, 13(6): 7288-93. [4] Sinkey RG, Battarbee AN, Bello NA, et al. Prevention, diagnosis, and management of hypertensive disorders of pregnancy: a comparison of international guidelines[J]. Curr Hypertens Rep, 2020, 22(9): 66. doi: 10.1007/s11906-020-01082-w [5] 胡文静, 顾欣贤. 超声心动图评价妊娠期高血压孕妇胎儿心脏功能的研究进展[J]. 中华医学超声杂志电子版, 2024, 21(1): 99-101. [6] 钱警语, 陈先侠, 郑晨旻, 等. 血清和肽素、半乳糖凝集素-3与妊娠期高血压疾病左心室功能下降的相关性[J]. 中国计划生育学杂志, 2021, 29(12): 2561-6. [7] 何丽珍, 钱丽. 妊娠期高血压疾病妇女妊娠晚期心脏形态和心功能变化的超声心动图观察[J]. 影像研究与医学应用, 2021, 5(1): 217-8. doi: 10.3969/j.issn.2096-3807.2021.01.108 [8] 唐红, 谭静. 左室收缩功能评估的超声新方法: 心肌做功[J]. 西部医学, 2024, 36(4): 469-72. doi: 10.3969/j.issn.1672-3511.2024.04.001 [9] 张俊. 超声心动图联合外周血管超声对早期诊断高血压性心脏病的效果探讨[J]. 影像研究与医学应用, 2023, 7(23): 173-5. doi: 10.3969/j.issn.2096-3807.2023.23.057 [10] 朱萍, 沈萍. VEGF、ESM-1、ACE及Vaspin在妊娠高血压患者血清及胎盘中的表达水平研究[J]. 河北医药, 2020, 42(15): 2268-72. doi: 10.3969/j.issn.1002-7386.2020.15.006 [11] 解静, 牛美芝, 张蕊. T2DM合并高血压病人NAGL、sfrp5、ACE水平变化及与左心室重构的关系探讨[J]. 中西医结合心脑血管病杂志, 2020, 18(8): 1270-2. [12] 乐杰. 妇产科学[M]. 7版. 北京: 人民卫生出版社, 2008: 94-105. [13] 沈艳, 骆志玲, 王奖, 等. 二维斑点追踪技术评价冠状动脉慢性完全性闭塞患者PCI后左心室应变情况的效果分析[J]. 中国循证心血管医学杂志, 2019, 11(9): 1062-5, 1068. doi: 10.3969/j.issn.1674-4055.2019.09.08 [14] 王秀娟, 陈玲玲, 洪铭锾, 等. 超声评估妊娠期高血压疾病患者心功能早期变化[J]. 中国超声医学杂志, 2024, 40(7): 753-7. [15] 孙瑜婧. 艾司洛尔治疗脓毒症相关心肌损害患者的临床研究[J]. 中国临床药理学杂志, 2024, 40(19): 2811-6. [16] 陈吉, 杨超, 周峥. 心脏病患者围生期心脏不良事件的发生状况及影响因素分析[J]. 中国妇幼保健, 2020, 35(20): 3861-4. [17] 魏昭, 王雁丽, 侯成文, 等. 超声心动图指标与血清心肌酶水平改变对妊娠期高血压的评估价值[J]. 心血管康复医学杂志, 2019, 28(4): 454-7. doi: 10.3969/j.issn.1008－0074.2019.04.16 [18] 孙黄辉. 心脏功能参数和心电图表现与妊娠期高血压疾病患者病情程度的关系[J]. 中国妇幼保健, 2021, 36(11): 2512-5. [19] 张鑫, 吴文谦, 谢明星. 多模态影像在肥厚型梗阻性心肌病室间隔心肌切除术中的应用价值[J]. 临床心血管病杂志, 2023, 39(12): 935-40. [20] 陈迎春, 李莉锦, 尹静, 等. 实时三维超声心动图联合二维斑点追踪技术对青年男性力量型运动员右室收缩功能的研究[J]. 实用医学杂志, 2019, 35(22): 3531-4, 3539. doi: 10.3969/j.issn.1006-5725.2019.22.022 [21] 陈斯亮, 刘梦鸽, 史晋宁, 等. 阿魏酸治疗阿尔茨海默病的潜在靶点预测及验证[J]. 药学研究, 2024, 43(5): 428-34. [22] 周田田, 程伟, 孙运奇, 等. 牡蛎肽的提取纯化及生物活性研究进展[J]. 食品科技, 2021, 46(7): 150-4. [23] 闫昌誉, 李怡芳, 李晓敏, 等. 玉米肽的研究与应用进展[J]. 今日药学, 2021, 31(5): 321-33, 338. [24] Jiang CH, Zhu F, Qin TT. Relationships between chronic diseases and depression among middle-aged and elderly people in China: a prospective study from CHARLS[J]. Curr Med Sci, 2020, 40(5): 858-70. doi: 10.1007/s11596-020-2270-5 [25] 宋惠杰, 李阳, 肖方喜, 等. ACE、APN及baPWV预测糖尿病合并高血压发生心脑血管事件的价值[J]. 西部医学, 2024, 36(2): 274-8. doi: 10.3969/j.issn.1672-3511.2024.02.022 [26] Guo HJ, Jiang F, Chen C, et al. Plasma brain natriuretic peptide, platelet parameters, and cardiopulmonary function in chronic obstructive pulmonary disease[J]. World J Clin Cases, 2021, 9(36): 11165-72. doi: 10.12998/wjcc.v9.i36.11165 [27] Shen XZ, Gong C, Liu MQ, et al. Effect of sacubitril/valsartan on brain natriuretic peptide level and prognosis of acute cerebral infarction[J]. PLoS One, 2023, 18(9): e0291754. doi: 10.1371/journal.pone.0291754 [28] 高美景, 孟文超, 王立羽. 高龄射血分数保留心衰患者血NT-proBNP、cTnT、LP(a)的变化及与心功能的关系[J]. 中国循证心血管医学杂志, 2022, 14(5): 595-7, 601. doi: 10.3969/j.issn.1674-4055.2022.05.20 [29] Kavsak PA, Jaffe AS. Troponin T levels and when to peek using CMR in patients with MINOCA[J]. Can J Cardiol, 2023, 39(7): 945-6. doi: 10.1016/j.cjca.2023.05.006 [30] 罗玉清, 蒋靖波, 李金轶, 等. 急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后左心室血栓的危险因素分析[J]. 临床内科杂志, 2024, 41(3): 165-9. doi: 10.3969/j.issn.1001-9057.2024.03.006 -
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