心肌做功参数评估重度子痫前期孕妇子代新生儿期心肌损伤的前瞻性研究

陈慧赟; 潘涛; 李洪; 徐秋琴; 孙芳璨; 韩冰; 顾欣贤

doi:10.7499/j.issn.1008-8830.2110052

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中国当代儿科杂志 ›› 2022, Vol. 24 ›› Issue (2) : 155-161. DOI: 10.7499/j.issn.1008-8830.2110052

论著·临床研究

心肌做功参数评估重度子痫前期孕妇子代新生儿期心肌损伤的前瞻性研究

陈慧赟¹, 潘涛², 李洪², 徐秋琴³, 孙芳璨¹, 韩冰¹, 顾欣贤⁴

作者信息 +

Assessment of myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices: a prospective study

CHEN Hui-Yun, PAN Tao, LI Hong, XU Qiu-Qin, SUN Fang-Can, HAN Bing, GU Xin-Xian

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摘要

目的应用心肌做功参数评估重度子痫前期孕妇子代新生儿期心肌损伤。方法前瞻性收集2020年6月至2021年4月重度子痫前期孕妇分娩的早产儿25例作为重度子痫前期组，同时收集无严重妊娠期并发症孕妇分娩的早产儿25例作为对照组，分别于出生后24 h内、48~72 h及14~28 d应用超声心动图检查测量常规参数，应用二维斑点追踪成像技术通过心肌二维应变联合无创测得的左室收缩压构建无创性左室压力-应变环计算心肌做功参数。结果与对照组相比，重度子痫前期组在出生后24 h内左室整体做功指数和整体有用功降低（P<0.05）；在出生后48~72 h左室整体做功效率降低，左室整体无用功增加（P<0.05）；在出生后14~28 d左室整体做功效率仍降低（P<0.05）。结论重度子痫前期孕妇分娩的早产儿在新生儿期持续存在亚临床心肌损伤。

Abstract

Objectives To evaluate myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices. Methods A prospective cohort study was performed on 25 preterm infants born to the pregnant women with severe preeclampsia from June 2020 to April 2021 (severe preeclampsia group), and 25 preterm infants born to the pregnant women without severe complications in pregnancy were enrolled as the control group. Echocardiography was performed within 24 hours and at 48-72 hours and 14-28 days after birth to measure conventional parameters. Two-dimensional speckle-tracking echocardiography was performed to construct a noninvasive left ventricular pressure-strain loop based on two-dimensional myocardial strain and left ventricular systolic pressure noninvasively measured, so as to calculate myocardial work indices. Results Compared with the control group, the severe preeclampsia group had significant reductions in left ventricular global work index and global constructive work within 24 hours after birth (P<0.05), a significant reduction in left ventricular global work efficiency and a significant increase in global waste work at 48-72 hours after birth (P<0.05), and a significant reduction in left ventricular global work efficiency at 14-28 days after birth (P<0.05). Conclusions Subclinical myocardial injury persists in the neonatal period in preterm infants born to pregnant women with severe preeclampsia.

导出引用

陈慧赟, 潘涛, 李洪, 徐秋琴, 孙芳璨, 韩冰, 顾欣贤. 心肌做功参数评估重度子痫前期孕妇子代新生儿期心肌损伤的前瞻性研究[J]. 中国当代儿科杂志. 2022, 24(2): 155-161 https://doi.org/10.7499/j.issn.1008-8830.2110052

CHEN Hui-Yun, PAN Tao, LI Hong, XU Qiu-Qin, SUN Fang-Can, HAN Bing, GU Xin-Xian. Assessment of myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices: a prospective study[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(2): 155-161 https://doi.org/10.7499/j.issn.1008-8830.2110052

参考文献

1 Barker DJ. The fetal and infant origins of adult disease[J]. BMJ, 1990, 301(6761): 1111. PMID: 2252919. PMCID: PMC1664286. DOI: 10.1136/bmj.301.6761.1111.
2 Armstrong DWJ, Tse MY, Wong PG, et al. Gestational hypertension and the developmental origins of cardiac hypertrophy and diastolic dysfunction[J]. Mol Cell Biochem, 2014, 391(1-2): 201-209. PMID: 24718734. DOI: 10.1007/s11010-014-2003-9.
3 Peixoto AB, Rolo LC, Nardozza LMM, et al. Epigenetics and preeclampsia: programming of future outcomes[J]. Methods Mol Biol, 2018, 1710: 73-83. PMID: 29196995. DOI: 10.1007/978-1-4939-7498-6_6.
4 Russell K, Eriksen M, Aaberge L, et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work[J]. Eur Heart J, 2012, 33(6): 724-733. PMID: 22315346. PMCID: PMC3303715. DOI: 10.1093/eurheartj/ehs016.
5 Chan J, Edwards NFA, Khandheria BK, et al. A new approach to assess myocardial work by non-invasive left ventricular pressure-strain relations in hypertension and dilated cardiomyopathy[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 31-39. PMID: 30247622. DOI: 10.1093/ehjci/jey131.
6 Edwards NFA, Scalia GM, Shiino K, et al. Global myocardial work is superior to global longitudinal strain to predict significant coronary artery disease in patients with normal left ventricular function and wall motion[J]. J Am Soc Echocardiogr, 2019, 32(8): 947-957. PMID: 31043359. DOI: 10.1016/j.echo.2019.02.014.
7 Vecera J, Penicka M, Eriksen M, et al. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy[J]. Eur Heart J Cardiovasc Imaging, 2016, 17(6): 624-632. PMID: 26921169. PMCID: PMC4871236. DOI: 10.1093/ehjci/jew019.
8 Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916[J]. Nutrition, 1989, 5(5): 303-311; discussion 312-313. PMID: 2520314.
9 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J]. 中华妇产科杂志, 2020, 55(4): 227-238. PMID: 32375429. DOI: 10.3760/cma.j.cn112141-20200114-00039.
10 刘宏程, 罗招平, 王彦飞. 一种改善新生儿无创血压测量准确性方法的研究应用[J]. 中国医学装备, 2020, 17(9): 48-51. DOI: 10.3969/J.ISSN.1672-8270.2020.09.011.
11 Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council[J]. J Am Soc Echocardiogr, 2010, 23(5): 465-495. PMID: 20451803. DOI: 10.1016/j.echo.2010.03.019.
12 Tsutsumi T, Ishii M, Eto G, et al. Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index[J]. Pediatr Int, 1999, 41(6): 722-727. PMID: 10618901. DOI: 10.1046/j.1442-200x.1999.01155.x.
13 Youssef L, Miranda J, Paules C, et al. Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction[J]. Am J Obstet Gynecol, 2020, 222(1): 79.e1-79.e9. PMID: 31336074. DOI: 10.1016/j.ajog.2019.07.025.
14 何才通, 李基增, 罗宇迪, 等. HDCP对胎儿心脏发育、子宫动脉血流参数的影响[J]. 解放军预防医学杂志, 2019, 37(2): 157-158. DOI: 10.13704/j.cnki.jyyx.2019.02.059.
15 Mutlu K, Karadas U, Yozgat Y, et al. Echocardiographic evaluation of cardiac functions in newborns of mildly preeclamptic pregnant women within postnatal 24-48 hours[J]. J Obstet Gynaecol, 2018, 38(1): 16-21. PMID: 28631496. DOI: 10.1080/01443615.2017.1322564.
16 Tang YH, Ye WF, Liu X, et al. VEGF and sFLT-1 in serum of PIH patients and effects on the foetus[J]. Exp Ther Med, 2019, 17(3): 2123-2128. PMID: 30867699. PMCID: PMC6396009. DOI: 10.3892/etm.2019.7184.
17 Lewandowski AJ, Augustine D, Lamata P, et al. Preterm heart in adult life: cardiovascular magnetic resonance reveals distinct differences in left ventricular mass, geometry, and function[J]. Circulation, 2013, 127(2): 197-206. PMID: 23224059. DOI: 10.1161/CIRCULATIONAHA.112.126920.