PDF(986 KB)
PDF(986 KB)
PDF(986 KB)
测定脐血脑钠肽对血糖异常孕妇的胎儿心功能评价
Evaluation of cardiac function in fetuses from pregnant women with abnormal blood glucose levels by brain natriuretic peptide in umbilical cord blood
目的：探讨脐血脑钠肽（BNP）评价血糖异常孕妇胎儿心功能的可行性及高血糖对胎儿心功能的影响。方法：妊娠期血糖异常孕妇24例，包括妊娠期糖尿病18例和糖耐量受损6例，按分娩前血糖值的高低分为控制欠佳组（7例）和控制较好组（17例），孕末期行胎儿超声心动图测量心脏相关指标；正常妊娠孕妇25例为对照组。于胎儿分娩时留脐血，测定BNP浓度。结果：血糖异常组胎儿脐血BNP值明显高于对照组，分别为（114.0±39.0）和（80.6±13.7） pg/mL（P<0.01），其中血糖控制欠佳组高于控制较好组（142.1±44.1 pg/mL vs 102.4±31.2 pg/mL；P<0.01）。脐血BNP在妊娠期糖尿病和糖耐量受损两组间差异无显著性，与孕末期胎儿左室壁厚度呈正相关，与二尖瓣A峰、E/A比值分别呈正、负相关（r值分别为0.715，0.491和-0.507，P<0.05）。结论：妊娠期高血糖时脐血BNP水平明显升高，与孕妇血糖控制情况及胎儿心功能变化相关联，可反映胎儿心功能的潜在损害。良好血糖控制可能减轻这一影响。［中国当代儿科杂志，2009，11（10）：805-808］
OBJECTIVE: To study the feasibility of umbilical cord brain natriuretic peptide (BNP) level measurement for the evaluation of perinatal cardiac function in fetuses from pregnant women with abnormal blood glucose levels and the influence of abnormal blood glucose on fetal cardiac function. METHODS: Twenty-four mothers with gestational diabetes mellitus (n=18) or gestational impaired glucose tolerance (n=6) (diabetic group) were classified into two subgroups according to blood glucose level before delivery: good (n=17) and poor (n=7) glucose control. They underwent fetal echocardiography in their late pregnant periods and fetal cardiac sizes and function were measured. Twenty-five normal pregnant mothers served as the control group. Umbilical cord blood BNP concentrations were measured at delivery. RESULTS: The umbilical cord blood BNP concentrations in the diabetic group were significantly higher than in the control group(114.0±39.0 pg/mL vs 80.6±13.7 pg/mL; P<0.01). The poor glucose control subgroup demonstrated higher umbilical cord blood BNP concentrations than the good glucose control subgroup (142.1±44.1 pg/mL vs 102.4±31.2 pg/mL; P<0.01). No difference was found between the gestational diabetes mellitus and the impaired glucose tolerance groups. The BNP concentration was positively correlated to the thicknesses of fetal left ventricular walls and the peak velocities of mitral A wave (r＝0.715, 0.491 respectively, P<0.05), and negatively correlated to the mitral E/A ratio (r＝-0.507, P<0.05). CONCLUSIONS: The fetuses of pregnant women with abnormal blood glucose levels have an increased BNP level in umbilical cord blood. Umbilical cord BNP level is related to maternal blood glucose control and the changes in fetal cardiac function. It may reflex the latent impairments of fetal cardiac function. A good glucose control may decrease the impact of abnormal maternal blood glucose on fetal hearts. [Chin J Contemp Pediatr, 2009, 11 (10):805-808]
Brain natriuretic peptide / Gestational diabetes mellitus / Cardiac function / Fetus
［1］Yoshimura M, Yasue H, Okumura K, Ogawa H, Jougasaki M, Mukoyama M, et al. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure［J］. Circulation, 1993, 87(2):464-469.
［2］Davis GK, Bamforth F, Sarpal A, Dicke F, Rabi Y, Lyon ME. B-type natriuretic peptide in pediatrics［J］. Clin Biochem, 2006, 39(6): 600-605.
［3］Mir TS, Falkenberg J, Friedrich B, Gottschalk U, Phi Lê T, Laer S, et al. Levels of brain natriuretic peptide in children with right ventricular overload due to congenital cardiac disease［J］. Cardiol Young, 2005, 15(4):396-401.
［4］Valle R, Aspromonte N, Feola M, Milli M, Canali C, Giovinazzo P, et al. B-type natriuretic peptide can predict the medium-term risk in patients with acute heart failure and preserved systolic function［J］. J Card Fail, 2005, 11(7):498-503.
［5］Lellouche N, De Diego C, Cesario DA, Vaseghi M, Horowitz BN, Mahajan A, et al. Usefulness of preimplantation B-type natriuretic peptide level for predicting response to cardiac resynchronization therapy［J］. Am J Cardiol, 2007, 99(2):242-246.
［6］Sudoh R, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain［J］. Nature, 1988, 332(6159):78-81.
［7］Cameron VA, Ellmers LJ. Natriuretic peptides during development of the fetal heart and circulation［J］. Endocrinology, 2003, 144(6):2191-2194.
［8］Cameron VA, Scott N, Ellmers L, Lainchbury J, Maeda N, Smithies O, et al. The role of natriuretic peptides in cardiac development［J］. FASEB J, 2005, 19(4):A788.
［9］Kunii Y, Kamada M, Ohtsuki S, Araki T, Kataoka K, Kageyama M, et al. Plasma brain natriuretic peptide and the evaluation of volume overload in infants and children with congenital heart disease［J］. Acta Med Okayama, 2003, 57(4):191-197.
［10］Okumura A, Kato T, Hayakawa F, Kidokoro H, Kuno K, Watanabe K. A pilot study on umbilical venous level of natriuretic peptides in preterm infants and their relation to periventricular leukomalacia and antenatal complications［J］. Brain Devel, 2002, 24(1):30-32.
［11］Halse KG, Lindegaard ML, Goetze JP, Damm P, Mathiesen ER, Nielsen LB. Increased plasma pro-B-type natriuretic peptide in infants of women with type 1 diabetes［J］. Clin Chem, 2005, 51(12):2296-2302.
［12］Girsen A, Ala-Kopsala M, Makikallio K, Vuolteenaho O, Rasanen J. Increased fetal cardiac natriuretic peptide secretion in type-1 diabetic pregnancies［J］. Acta Obstet Gynecol Scand, 2008, 87(3):307-312.
［13］Yukawa M, Imanishi K, Oishi C, Shimajiri Y, Furuta M, Ueyama M, et al. Clinical usefulness for measurement of plasma brain natriuretic peptide in diabetic patients［J］. Rinsho Byori, 2007, 55(10):906-911.
