妊娠期合并先天性心脏病患者超声影像学指标与血清脑钠肽和母婴结局的关系分析

Analysis of the relationship between ultrasonographic indices, serum brain natriuretic peptide levels, and maternal and neonatal outcomes in pregnant women with congenital heart disease

摘要:

目的 探究妊娠期合并先天性心脏病患者超声影像学指标与血清脑钠肽（BNP）水平的关系，以及这些指标对母婴结局的预测价值。方法 回顾性分析2020年1月—2023年12月西北妇女儿童医院收治的248例妊娠期合并先天性心脏病患者的临床资料。根据母婴结局分为结局良好组162例和结局不良组86例。采用超声心动图评估心脏结构和功能；比较两组的超声指标、血清BNP水平及美国纽约心脏病协会（NYHA）心功能分级；采用Spearman法分析超声指标、血清BNP水平与NYHA分级的相关性；采用多因素一般Logistic回归模型分析影响母婴结局的危险因素，并绘制受试者工作特征（ROC）曲线评估该模型对母婴结局的预测效能。结果 结局不良组患者的心输出量（CO）、左室射血分数（LVEF）水平均低于结局良好组（P <0.05），结局不良组患者的心脏指数（CI）、二尖瓣舒张早期与晚期血流峰值速度比值（E/A）和BNP均高于结局良好组（P <0.05）。结局良好组患者NYHA分级优于结局不良组（P <0.05）。Spearman相关性分析结果显示，NYHA分级与CO水平（r_s =-0.210，P =0.001）、LVEF水平（r_s =-0.193，P =0.002）呈负相关，与CI水平（r_s =0.172，P =0.007）、E/A水平（r_s =0.173，P =0.006）和BNP水平（r_s =0.184，P =0.004）呈正相关。多因素一般Logistic回归分析结果显示：CO水平低［O^R =0.612（95% CI：0.430，0.873）］、CI水平高［O^R =2.129（95% CI：1.361，3.331）］、E/A水平高［O^R =4.368（95% CI：1.726，11.053）］、LVEF水平低［O^R =0.928（95% CI：0.890，0.969）］、BNP水平高［O^R =1.099（95% CI：1.064，1.136）］均为妊娠期合并先天性心脏病患者母婴结局不良的危险因素（P <0.05）。多因素一般Logistic回归模型预测妊娠期合并先天性心脏病患者母婴结局不良的敏感性为67.9%（95% CI：0.565，0.772）、特异性为94.2%（95% CI：0.897，0.974）、准确性为85.1%（95% CI：0.782，0.903）。结论 超声影像学指标与血清BNP水平与妊娠期合并先天性心脏病患者的母婴结局有关，可作为评估病情严重程度和预测母婴结局的有效生物标志物。

Abstract:

Objective This study aims to explore the relationship between ultrasonographic indices and serum brain natriuretic peptide (BNP) levels in pregnant women with congenital heart disease, and to assess the predictive value of these indices for maternal and infant maternal and neonatal outcome.Methods A total of 248 pregnant patients with congenital heart disease admitted to Northwest Women's and Children's Hospital from January 2020 to December 2023 were selected as the study subjects. Based on maternal and neonatal outcome, they were divided into a good prognosis group (n = 162) and a poor prognosis group (n = 86). Echocardiography was used to evaluate cardiac structure and function, and differences in ultrasound indices, serum BNP levels, and NYHA classifications between the groups were analyzed. The correlations between ultrasound indices, serum BNP levels, and NYHA classification were assessed using Spearman's correlation analysis. Multivariate regression analysis was employed to identify risk factors affecting maternal and neonatal outcome, and the value of ultrasound indices and BNP in predicting maternal and neonatal outcome was evaluated using ROC curves.Results The poor-outcome group exhibited significantly lower cardiac output (CO) and left ventricular ejection fraction (LVEF) but higher cardiac index (CI), E/A ratio, and BNP levels compared to the favorable-outcome group (P < 0.05). The NYHA classification was worse in the poor-outcome group (P < 0.05). Spearman correlation analysis revealed that NYHA classification was negatively correlated with CO (r_s = -0.210, P = 0.001) and LVEF (r_s = -0.193, P = 0.002) but positively correlated with CI (r_s = 0.172, P = 0.007), E/A ratio (r_s = 0.173, P = 0.006), and BNP levels (r_s = 0.184, P = 0.004). Multivariate logistic regression identified low CO [O^R = 0.612 (95% CI: 0.430, 0.873) ], high CI [O^R = 2.129 (95% CI: 1.361, 3.331) ], high E/A ratio [O^R = 4.368 (95% CI: 1.726, 11.053) ], low LVEF [O^R = 0.928 (95% CI: 0.890, 0.969) ], and elevated BNP [O^R = 1.099 (95% CI: 1.064, 1.136) ] as independent risk factors for adverse maternal and neonatal outcome. The model demonstrated a sensitivity of 67.9% (95% CI: 0.565, 0.772), specificity of 94.2% (95% CI: 0.897, 0.974), and accuracy of 85.1% (95% CI: 0.782, 0.903) in predicting adverse outcomes.Conclusion Abnormalities in ultrasonographic indices and serum BNP levels are closely related to maternal and neonatal outcome in pregnant women with congenital heart disease and can serve as effective biomarkers for assessing disease severity and predicting maternal and neonatal outcome.