妊娠中期心血管超声参数与肝功能的相关性及对不良妊娠结局的预测价值

doi:10.3877/cma.j.issn.2095-2015.2023.06.028

目的

探讨妊娠中期心血管超声参数与肝功能的相关性，以及两者对孕妇不良妊娠结局的预测价值。

方法

回顾性分析2021年1月至2023年1月于上海市闵行区中心医院定期产前检查并生产的200名产妇，根据其妊娠结局分为非不良妊娠结局组(n＝108)和不良妊娠结局组(n＝92)。对比两组妊娠中期的基线资料、孕期心血管超声参数[左心室后壁厚度(LVPWd)、左心室收缩末期内径(LVESd)、左心室舒张末期内径(LVEDd)和室间隔厚度(IVSd)、左心室射血分数(LVEF)、左心房直径(LAD)、二尖瓣口舒张早期血流峰值速度/二尖瓣口舒张晚期血流峰值速度(E/A)、E/二尖瓣环室间隔侧和侧壁舒张期早期峰值速度平均值(e′)]及肝功能指标[谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)]。Pearson相关分析评估妊娠中期心血管超声参数与肝功能指标间的相关性，ROC分析评估妊娠中期心血管超声参数与肝功能对孕妇不良妊娠结局的预测价值。

结果

不良妊娠结局组孕妇妊娠中期的收缩压、舒张压显著高于非不良妊娠结局组(P<0.05)，出现轻度高血压的孕妇的比例显著高于非不良妊娠结局组的孕妇(P<0.05)，分娩时的胎龄和新生儿体重均显著低于非不良妊娠结局组(P<0.05)。不良妊娠结局组的LVPWd、LVESd、LVEDd、IVSd、LVEF、LAD及E/e′均显著高于非不良妊娠结局组，E/A显著低于对照组(P<0.05)。不良妊娠结局组较非不良妊娠结局组肝功能指标显著升高(P<0.05)。Pearson相关分析表明，不良妊娠结局组孕妇的心血管超声参数与肝功能指标之间均呈显著正相关。ROC曲线分析显示，妊娠中期心血管超声参数与肝功能指标对孕妇不良妊娠结局具有较高的预测价值。

结论

妊娠中期心血管超声参数与肝功能指标显著正相关，对孕妇不良妊娠结局具有较高的预测价值。

关键词: 妊娠中期, 不良妊娠结局, 心血管超声, 肝功能, 相关性, 预测价值

Objective

To explore the correlation between echocardiography parameters and liver function during the second trimester of pregnancy, and their predictive value for adverse pregnancy outcomes.

Methods

A retrospective analysis was conducted on 200 pregnant women who underwent regular prenatal examinations and gave birth between January 2021 and January 2023 at Minhang Central Hospital.These women were divided into two groups based on their pregnancy outcomes: the non-adverse pregnancy outcome group(n=108)and the adverse pregnancy outcome group(n=92). The baseline data, echocardiography parameters during the second trimester [left ventricular posterior wall thickness in diastole(LVPWd), left ventricular end-systolic diameter, (LVESd), left ventricular end-diastolic diameter(LVEDd), interventricular septal thickness in diastole(IVSd), left ventricular ejection fraction(LVEF), left atrial diameter(LAD), peak blood flow velocity in early mitral orifice diastole/peak blood flow velocity in late mitral orifice diastole(E/A), E/mitral ring early peak diastolic velocity on the interventricular septal side and lateral wall(e′)], and liver function indicators [aspartate aminotransferase(AST), alanine aminotransferase(ALT), total bilirubin(TBIL). Pearson correlation analysis was used to assess the relationship between echocardiography parameters and liver function indicators during the second trimester, and ROC analysis was conducted to evaluate their predictive value for adverse pregnancy outcomes.

Results

The adverse pregnancy outcome group had significantly higher systolic blood pressure and diastolic blood pressure during the second trimester compared to the non-adverse outcome group(P<0.05), with a higher proportion of mild hypertension(P<0.05). The gestational age at delivery and birth weight of infants were also significantly lower in the adverse outcome group than those in the non-adverse outcome group(P<0.05). In terms of echocardiography parameters, the adverse pregnancy outcome group showed significantly higher values in LVPWd, LVESd, LVEDd, IVSd, LVEF, LAD, and E/e′ ratio, while the E/A ratio was significantly lower than that in the control group(P<0.05). Liver function indicators also showed significant elevations in the adverse outcome group(P<0.05). Pearson correlation analysis indicated a significant positive correlation between echocardiography parameters and liver function indicators in the adverse pregnancy outcome group.ROC analysis confirmed that echocardiography parameters and liver function indicators during the second trimester had a high predictive value for adverse pregnancy outcomes.

Conclusion

There is a significant positive correlation between echocardiography parameters and liver function indicators during the second trimester of pregnancy, and they have substantial predictive value for adverse pregnancy outcomes.

Key words: Second trimester of pregnancy, Adverse pregnancy outcomes, Echocardiography, Liver function, Correlation, Predictive value

表1 两组一般基线资料对比

组别	例数	孕妇一般基线资料						分娩信息
组别	例数	年龄(岁，±s)	孕周(周，max-min)	体重指数(kg/m²，±s)	孕次(次，max-min)	收缩压(mmHg，±s)	舒张压(mmHg，±s)	新生儿出生体重(g，±s)	胎龄(周，max-min)
非不良妊娠结局组	108	29.35±2.14	21.00(14.00~28.00)	26.80±1.73	2.00(1.00~3.00)	118.30±7.12	75.36±6.37	3265.31±402.60	38.50(37.00~40.00)
不良妊娠结局组	92	28.92±2.32	21.00(14.00~28.00)	27.25±1.86	2.00(1.00~3.00)	136.39±9.61	88.27±8.01	2818.20±528.20	37.50(35.00~40.00)
t		1.362	0.494	1.771	0.171	15.26	12.69	6.784	2.308
P		0.175	0.621	0.078	0.864	<0.001	<0.001	<0.001	0.023

表1 两组一般基线资料对比

组别	例数	孕妇一般基线资料						分娩信息
组别	例数	年龄(岁，±s)	孕周(周，max-min)	体重指数(kg/m²，±s)	孕次(次，max-min)	收缩压(mmHg，±s)	舒张压(mmHg，±s)	新生儿出生体重(g，±s)	胎龄(周，max-min)
非不良妊娠结局组	108	29.35±2.14	21.00(14.00~28.00)	26.80±1.73	2.00(1.00~3.00)	118.30±7.12	75.36±6.37	3265.31±402.60	38.50(37.00~40.00)
不良妊娠结局组	92	28.92±2.32	21.00(14.00~28.00)	27.25±1.86	2.00(1.00~3.00)	136.39±9.61	88.27±8.01	2818.20±528.20	37.50(35.00~40.00)
t		1.362	0.494	1.771	0.171	15.26	12.69	6.784	2.308
P		0.175	0.621	0.078	0.864	<0.001	<0.001	<0.001	0.023

表2 两组孕妇心血管超声参数对比(±s)

组别	例数	LVPWd(mm)	LVESd(mm)	LVEDd(mm)	IVSd(mm)	LVEF(%)
非不良妊娠结局组	108	8.74±1.22	28.94±1.15	45.16±1.25	8.52±0.79	60.72±3.81
不良妊娠结局组	92	9.80±1.78	31.45±1.92	51.25±3.71	9.92±1.38	57.31±4.45
t/χ²		4.97	11.40	16.03	8.96	5.84
P		<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	LAD(mm)	E/A	E/e′	e′(cm/s)	左心室肥厚[例(%)]
非不良妊娠结局组	108	30.25±1.66	1.38±0.25	6.26±0.80	10.02±1.55	0
不良妊娠结局组	92	38.12±2.40	1.02±0.35	10.32±2.07	8.68±1.56	31(33.70)
t/χ²		27.27	8.46	18.81	6.08	43.07
P		<0.001	<0.001	<0.001	<0.001	<0.001

表2 两组孕妇心血管超声参数对比(±s)

组别	例数	LVPWd(mm)	LVESd(mm)	LVEDd(mm)	IVSd(mm)	LVEF(%)
非不良妊娠结局组	108	8.74±1.22	28.94±1.15	45.16±1.25	8.52±0.79	60.72±3.81
不良妊娠结局组	92	9.80±1.78	31.45±1.92	51.25±3.71	9.92±1.38	57.31±4.45
t/χ²		4.97	11.40	16.03	8.96	5.84
P		<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	LAD(mm)	E/A	E/e′	e′(cm/s)	左心室肥厚[例(%)]
非不良妊娠结局组	108	30.25±1.66	1.38±0.25	6.26±0.80	10.02±1.55	0
不良妊娠结局组	92	38.12±2.40	1.02±0.35	10.32±2.07	8.68±1.56	31(33.70)
t/χ²		27.27	8.46	18.81	6.08	43.07
P		<0.001	<0.001	<0.001	<0.001	<0.001

表3 两组孕妇肝功能指标对比

组别	例数	谷草转氨酶(U/L，±s)	谷丙转氨酶(U/L，±s)	总胆红素(μmol/L，±s)	肝功能指标异常[例(%)]
非不良妊娠结局组	108	29.18±4.46	36.35±6.10	17.45±1.12	10(9.26)
不良妊娠结局组	92	38.30±6.84	45.45±8.73	20.45±3.80	43(46.73)
t/χ²		11.32	8.638	7.82	35.83
P		<0.001	<0.001	<0.001	<0.001

表3 两组孕妇肝功能指标对比

组别	例数	谷草转氨酶(U/L，±s)	谷丙转氨酶(U/L，±s)	总胆红素(μmol/L，±s)	肝功能指标异常[例(%)]
非不良妊娠结局组	108	29.18±4.46	36.35±6.10	17.45±1.12	10(9.26)
不良妊娠结局组	92	38.30±6.84	45.45±8.73	20.45±3.80	43(46.73)
t/χ²		11.32	8.638	7.82	35.83
P		<0.001	<0.001	<0.001	<0.001

表4 不良妊娠结局组孕妇妊娠中期心血管超声参数与肝功能的相关性

心血管超声	肝功能
心血管超声	谷草转氨酶	谷丙转氨酶	总胆红素
LVPWd	r＝0.218^*	r＝0.322^*	r＝0.408^**
LVESd	r＝0.365^*	r＝0.412^**	r＝0.331^*
LVEDd	r＝0.320^*	r＝0.369^*	r＝0.401^**
IVSd	r＝0.224^*	r＝0.256^*	r＝0.297^*
LVEF	r＝0.248^*	r＝0.406^**	r＝0.355^*
LAD	r＝0.265^*	r＝0.307^*	r＝0.218^*
E/e′	r＝0.318^*	r＝0.405^**	r＝0.266^*
E/A	r＝0.245^*	r＝0.211^*	r＝0.410^**

表4 不良妊娠结局组孕妇妊娠中期心血管超声参数与肝功能的相关性

心血管超声	肝功能
心血管超声	谷草转氨酶	谷丙转氨酶	总胆红素
LVPWd	r＝0.218^*	r＝0.322^*	r＝0.408^**
LVESd	r＝0.365^*	r＝0.412^**	r＝0.331^*
LVEDd	r＝0.320^*	r＝0.369^*	r＝0.401^**
IVSd	r＝0.224^*	r＝0.256^*	r＝0.297^*
LVEF	r＝0.248^*	r＝0.406^**	r＝0.355^*
LAD	r＝0.265^*	r＝0.307^*	r＝0.218^*
E/e′	r＝0.318^*	r＝0.405^**	r＝0.266^*
E/A	r＝0.245^*	r＝0.211^*	r＝0.410^**

表5 心血管超声参数与肝功能的ROC曲线结果

指标	AUC	最佳截点值	灵敏度(%)	特异度(%)
LVPWd	0.764	9.56	71.65	82.59
LVESd	0.829	31.22	77.00	87.45
LVEDd	0.852	50.48	84.11	88.05
IVSd	0.809	9.58	72.87	83.59
LVEF	0.828	56.49	82.79	89.08
LAD	0.840	37.87	85.21	83.25
E/e′	0.791	14.70	75.92	80.58
E/A	0.815	0.95	73.16	89.66
谷草转氨酶	0.876	37.55	85.96	90.59
谷丙转氨酶	0.846	44.42	72.83	90.59
总胆红素	0.778	19.56	68.04	93.52

表5 心血管超声参数与肝功能的ROC曲线结果

指标	AUC	最佳截点值	灵敏度(%)	特异度(%)
LVPWd	0.764	9.56	71.65	82.59
LVESd	0.829	31.22	77.00	87.45
LVEDd	0.852	50.48	84.11	88.05
IVSd	0.809	9.58	72.87	83.59
LVEF	0.828	56.49	82.79	89.08
LAD	0.840	37.87	85.21	83.25
E/e′	0.791	14.70	75.92	80.58
E/A	0.815	0.95	73.16	89.66
谷草转氨酶	0.876	37.55	85.96	90.59
谷丙转氨酶	0.846	44.42	72.83	90.59
总胆红素	0.778	19.56	68.04	93.52

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Relationship between echocardiography parameters and liver function during the second trimester of pregnancy and their predictive value for adverse pregnancy outcomes

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Relationship between echocardiography parameters and liver function during the second trimester of pregnancy and their predictive value for adverse pregnancy outcomes