中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2009年
10期
731-735
,共5页
妊娠并发症%心血管%心脏病%基质金属蛋白酶1%金属蛋白酶1组织抑制剂%心室重构
妊娠併髮癥%心血管%心髒病%基質金屬蛋白酶1%金屬蛋白酶1組織抑製劑%心室重構
임신병발증%심혈관%심장병%기질금속단백매1%금속단백매1조직억제제%심실중구
Pregnancy complications%cardiovascular%Heart diseases%Matrix metalloproteinase 1%Tissue inhibitor of metalloproteinase-1%Ventricular remodeling
目的 探讨妊娠合并心脏病患者左心室结构及功能与血清基质金属蛋白酶1(MMP-1)及其组织抑制物1(TIMP-1)水平的相关性,评价MMP-1及TIMP-1在妊娠合并心脏病患者心脏重新构建过程中的临床价值.方法 收集2007年10月至2008年7月上海交通大学医学院附属仁济医院产科收治的孕晚期妊娠合并心脏病孕妇58例,根据左心室肥大和肺动脉高压情况分为:A组:有心慌、胸闷等临床症状,但无左心室肥大者17例;B组:有心慌、胸闷等临床症状及左心室肥大,但无肺动脉高压者15例;C组:有心慌、胸闷等临床症状及左心室肥大,且有肺动脉高压者26例,其中C组患者根据肺动脉压情况又分为轻度[肺动脉压30～49 mm Hg(1 mm Hg=0.133 kPa)]11例,中度(肺动脉压50-79 mm Hg)9例,重度(肺动脉压≥80 mm Hg)6例.另选同期正常妊娠妇女15例作为对照组.采用多普勒彩色超声心动仪分别测定各组孕妇妊娠晚期的左心室结构和功能指标,包括左心窒重量指数(LVMI)、舒张未期内径(LVEDd)、左心室射血分数(EF)、二尖瓣舒张早期充盈峰(E峰)、舒张晚期充盈峰(A峰)及其比值(E/A);采用酶联免疫法测定各组孕妇血清MMP-1和TIMP-1水平.结果 (1)C组孕妇LVMI为(148±7)g/m~2、LVEDd为(58.9±3.5)mm,E峰为(50±10)cm/s,明显高于对照组及A组、B组(P＜0.01);EF为(51.0±4.4)%,E/A比值为(0.6±0.3),与对照组及A组、B组比较,均显著降低(P＜0.01).(2)C组重度肺动脉高压孕妇LVMI为(150±7)g/m~2、LVEDd为(69.7±3.4)mm,均明显高于轻度及中度孕妇(P＜0.01),A峰[(86±8)cm/s]升高(P＜0.05);E峰[(44±9)cm/s]下降(P＜0.05),EF为(45.6±2.6)%,E/A比值为(0.52±0.17),均明显低于轻度及中度孕妇(P＜0.01).(3)C组孕妇血清MMP-1[(41±10)μg/L]及TIMP-1[(393±37)μg/L]水平与对照组、A组和B组比较,显著升高(P均＜0.01).(4)C组重度肺动脉高压孕妇血清MMP-1[(42±27)μg点/L]及TIMP-1[(411±31)μg又/L]水平较轻度孕妇显著升高(P＜0.01).(5)相关性分析显示,A组、B组及C组孕妇血清MMP-1水平与TIMP-1呈正相关(r=0.587,P＜0.01);MMP-1水平与LVMI、LVEDd呈正相关(r=0.782,P＜0.01;,=0.648,P＜0.01);与EF旱负相关(r=-0.587,P＜0.01).(6)C组重度肺动脉高压孕妇中有3例发生心功能衰竭,其血清MMP-1水平均＞50μg/L,血清TIMP-1水平均＞450μg/L.结论 (1)妊娠合并心脏病孕妇妊娠晚期存在心脏重新构建的特点,并且随着左心室肥大和肺动脉高压严重程度的加重而明显化.(2)血清MMP-1和TIMP-1水平变化与妊娠合并心脏病孕妇的左心室结构、功能及临床症状的严重程度密切相关,并对妊娠合并心脏病孕妇心功能衰竭发生可能有预测价值.
目的 探討妊娠閤併心髒病患者左心室結構及功能與血清基質金屬蛋白酶1(MMP-1)及其組織抑製物1(TIMP-1)水平的相關性,評價MMP-1及TIMP-1在妊娠閤併心髒病患者心髒重新構建過程中的臨床價值.方法 收集2007年10月至2008年7月上海交通大學醫學院附屬仁濟醫院產科收治的孕晚期妊娠閤併心髒病孕婦58例,根據左心室肥大和肺動脈高壓情況分為:A組:有心慌、胸悶等臨床癥狀,但無左心室肥大者17例;B組:有心慌、胸悶等臨床癥狀及左心室肥大,但無肺動脈高壓者15例;C組:有心慌、胸悶等臨床癥狀及左心室肥大,且有肺動脈高壓者26例,其中C組患者根據肺動脈壓情況又分為輕度[肺動脈壓30～49 mm Hg(1 mm Hg=0.133 kPa)]11例,中度(肺動脈壓50-79 mm Hg)9例,重度(肺動脈壓≥80 mm Hg)6例.另選同期正常妊娠婦女15例作為對照組.採用多普勒綵色超聲心動儀分彆測定各組孕婦妊娠晚期的左心室結構和功能指標,包括左心窒重量指數(LVMI)、舒張未期內徑(LVEDd)、左心室射血分數(EF)、二尖瓣舒張早期充盈峰(E峰)、舒張晚期充盈峰(A峰)及其比值(E/A);採用酶聯免疫法測定各組孕婦血清MMP-1和TIMP-1水平.結果 (1)C組孕婦LVMI為(148±7)g/m~2、LVEDd為(58.9±3.5)mm,E峰為(50±10)cm/s,明顯高于對照組及A組、B組(P＜0.01);EF為(51.0±4.4)%,E/A比值為(0.6±0.3),與對照組及A組、B組比較,均顯著降低(P＜0.01).(2)C組重度肺動脈高壓孕婦LVMI為(150±7)g/m~2、LVEDd為(69.7±3.4)mm,均明顯高于輕度及中度孕婦(P＜0.01),A峰[(86±8)cm/s]升高(P＜0.05);E峰[(44±9)cm/s]下降(P＜0.05),EF為(45.6±2.6)%,E/A比值為(0.52±0.17),均明顯低于輕度及中度孕婦(P＜0.01).(3)C組孕婦血清MMP-1[(41±10)μg/L]及TIMP-1[(393±37)μg/L]水平與對照組、A組和B組比較,顯著升高(P均＜0.01).(4)C組重度肺動脈高壓孕婦血清MMP-1[(42±27)μg點/L]及TIMP-1[(411±31)μg又/L]水平較輕度孕婦顯著升高(P＜0.01).(5)相關性分析顯示,A組、B組及C組孕婦血清MMP-1水平與TIMP-1呈正相關(r=0.587,P＜0.01);MMP-1水平與LVMI、LVEDd呈正相關(r=0.782,P＜0.01;,=0.648,P＜0.01);與EF旱負相關(r=-0.587,P＜0.01).(6)C組重度肺動脈高壓孕婦中有3例髮生心功能衰竭,其血清MMP-1水平均＞50μg/L,血清TIMP-1水平均＞450μg/L.結論 (1)妊娠閤併心髒病孕婦妊娠晚期存在心髒重新構建的特點,併且隨著左心室肥大和肺動脈高壓嚴重程度的加重而明顯化.(2)血清MMP-1和TIMP-1水平變化與妊娠閤併心髒病孕婦的左心室結構、功能及臨床癥狀的嚴重程度密切相關,併對妊娠閤併心髒病孕婦心功能衰竭髮生可能有預測價值.
목적 탐토임신합병심장병환자좌심실결구급공능여혈청기질금속단백매1(MMP-1)급기조직억제물1(TIMP-1)수평적상관성,평개MMP-1급TIMP-1재임신합병심장병환자심장중신구건과정중적림상개치.방법 수집2007년10월지2008년7월상해교통대학의학원부속인제의원산과수치적잉만기임신합병심장병잉부58례,근거좌심실비대화폐동맥고압정황분위:A조:유심황、흉민등림상증상,단무좌심실비대자17례;B조:유심황、흉민등림상증상급좌심실비대,단무폐동맥고압자15례;C조:유심황、흉민등림상증상급좌심실비대,차유폐동맥고압자26례,기중C조환자근거폐동맥압정황우분위경도[폐동맥압30～49 mm Hg(1 mm Hg=0.133 kPa)]11례,중도(폐동맥압50-79 mm Hg)9례,중도(폐동맥압≥80 mm Hg)6례.령선동기정상임신부녀15례작위대조조.채용다보륵채색초성심동의분별측정각조잉부임신만기적좌심실결구화공능지표,포괄좌심질중량지수(LVMI)、서장미기내경(LVEDd)、좌심실사혈분수(EF)、이첨판서장조기충영봉(E봉)、서장만기충영봉(A봉)급기비치(E/A);채용매련면역법측정각조잉부혈청MMP-1화TIMP-1수평.결과 (1)C조잉부LVMI위(148±7)g/m~2、LVEDd위(58.9±3.5)mm,E봉위(50±10)cm/s,명현고우대조조급A조、B조(P＜0.01);EF위(51.0±4.4)%,E/A비치위(0.6±0.3),여대조조급A조、B조비교,균현저강저(P＜0.01).(2)C조중도폐동맥고압잉부LVMI위(150±7)g/m~2、LVEDd위(69.7±3.4)mm,균명현고우경도급중도잉부(P＜0.01),A봉[(86±8)cm/s]승고(P＜0.05);E봉[(44±9)cm/s]하강(P＜0.05),EF위(45.6±2.6)%,E/A비치위(0.52±0.17),균명현저우경도급중도잉부(P＜0.01).(3)C조잉부혈청MMP-1[(41±10)μg/L]급TIMP-1[(393±37)μg/L]수평여대조조、A조화B조비교,현저승고(P균＜0.01).(4)C조중도폐동맥고압잉부혈청MMP-1[(42±27)μg점/L]급TIMP-1[(411±31)μg우/L]수평교경도잉부현저승고(P＜0.01).(5)상관성분석현시,A조、B조급C조잉부혈청MMP-1수평여TIMP-1정정상관(r=0.587,P＜0.01);MMP-1수평여LVMI、LVEDd정정상관(r=0.782,P＜0.01;,=0.648,P＜0.01);여EF한부상관(r=-0.587,P＜0.01).(6)C조중도폐동맥고압잉부중유3례발생심공능쇠갈,기혈청MMP-1수평균＞50μg/L,혈청TIMP-1수평균＞450μg/L.결론 (1)임신합병심장병잉부임신만기존재심장중신구건적특점,병차수착좌심실비대화폐동맥고압엄중정도적가중이명현화.(2)혈청MMP-1화TIMP-1수평변화여임신합병심장병잉부적좌심실결구、공능급림상증상적엄중정도밀절상관,병대임신합병심장병잉부심공능쇠갈발생가능유예측개치.
Objective To analyse the relationship between the left ventricular(LV)structure,function and changes of concentration of serum matrix metalloproteinase-1(MMP-1),tissue inhibitor of matrix metalloproteinase-1(TIMP-1),and evaluate the value of the change of serum MMP-1 and serum TIMP-1 in ventrieular remodeling of pregnant women complicating cardiac disease.Methods Fifty-eight cases of pregnant women with cardiac disease divided into three groups[group A had 17 cases who had clinical manifestations and no left ventricular hypertrophy(LVH)],group B had 15 cases who had clinical manifestations and LVH but no palmonaly hypertension(PH),group C had 26 cases who had clinical manifestations,LVH and PH which divided into three groups again:11 cases of slight group[PH from 30-49 mm Hg(1 mm Hg=0.133 kPa)],9 cases of moderate group(PH from 50-79 mm Hg)and 6 cases of severe group(PH≥80 mm Hg).Fifteen healthy pregnant women acted as control group.The left ventricular structure and function[(left ventrieular nlasS index(LVMI),left ventricular end-diastolic diameter(INEDd),Ejection fraction(EF),E peak(E),A peak(A)and E/A],pulmonary pressure and plasma MMP-1,TIMP-1 values were determined in the third trimester of pregnancy.Results(1)LVMI (148±7)g/m~2 and LVEDd(58.9±3.5)mm in group C increased significantly(totally P＜0.01),EF (51.0±4.4)% decreased significantly(P＜0.01),E(50±10)cm/s decreased significantly(P＜0.01),A(81±13)cm/s increased(P＜0.05)and E/A(0.6±0.3)decreased significantly(P＜0.01)compared with normal subjects,group A and group B.(2)LVMI(150±7)g/m~2,LVEDd(69.7±3.4)mm in severe pulmonary hypertension group increased significantly(P＜0.01),EF(45.6±2.6)% decreased significantly(P＜0.01),E(44±9)cm/s decreased(P＜0.05),A(86±8)cm/s increased(P＜0.05)and E/A(0.52±0.17)decreased significantly(P＜0.01)compared with slight and moderate pulmonary hypertension group.(3)Plasma MMP-1(41±10)μg/L and TIMP-1(393±37)μg/L values in group C increased significantly compared with normal subjects,group A and group B(P＜0.01).(4)Plasma MMP-1(42±7)μg/L and TIMP-1(411±31)μg/L values of severe pulmonary hypertension group increased significantly compared with slight pulmonary hypertension group(P＜0.05,P＜0.01).(5)The correlation analysis indicated that:There was positive correlation between the serum concentration of MMP-1 and TIMP-1(r=0.587.P＜0.01).The serum concentration of MMP-1 was positively correlated with LVMI and LVEDd significantly(r=0.782,P＜0.001;r=0.648,P＜0.01)and was negatively correlated with EF significantly(r:-0.587,P＜0.01).(6)Plasma MMP-1 values＞50μg/L and plasma TIMP-1 values ＞450μg/L in 3 cardiac disease failure cases.Conclusions (1)The ventricular remodeling can be found in the third trimester of pregnancy of women complicating cardiac disease,and the more serious the left ventricular hypertrophy and PH,the more obvious the ventricular remodeling.(2)The changes in the plasma MMP-1/TIMP-1 values and MMP-1/TIMP-1 balance may play an important role in the left ventrieular structural.functional,and clinical manifestations of pregnant women complicating cardiac disease.(3)An increased MMP-1 and TIMP-1 level maybe can predict the presence of cardiac disease failure.
