Girsen A, Ala-Kopsala M, Mäkikallio K, Vuolteenaho O, Räsänen J
Department of Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Ultrasound Obstet Gynecol. 2007 Mar;29(3):296-303. doi: 10.1002/uog.3934.
To test our hypothesis that human fetal N-terminal peptide of proB-type natriuretic peptide (NT-proBNP) secretion is increased in proportion to the severity of fetal cardiovascular compromise in intrauterine growth restriction.
This prospective cross-sectional study consisted of 42 growth-restricted fetuses who underwent Doppler ultrasonographic examination of cardiovascular hemodynamics within 7 days before delivery. Group 1 fetuses (n = 13) had normal umbilical artery (UA) velocimetry. Group 2 fetuses (n = 15) had abnormal UA and normal ductus venosus (DV) velocimetry. In Group 3 fetuses (n = 14), both UA and DV velocimetries were abnormal. At delivery, an UA blood sample was obtained for assessment of NT-proBNP. Normal values for UA NT-proBNP were determined in 49 neonates (control group) with uncomplicated pregnancy and delivery.
Group 3 fetuses demonstrated greater (P < 0.05) UA and descending aorta pulsatility indices (PIs) and greater DV, left hepatic vein (LHV) and inferior vena cava PIs for veins (PIVs) than fetuses in Groups 1 and 2. Weight-indexed cardiac outputs and ventricular ejection forces were similar among the groups. Group 3 fetuses had higher (P < 0.05) UA NT-proBNP concentration than fetuses in Groups 1 and 2. In the control group, the 95(th) percentile value of UA NT-proBNP was 518 pmol/L. In Group 3, 13/14 neonates demonstrated abnormal UA NT-proBNP levels. The corresponding incidences were 4/13 and 7/15 in Groups 1 and 2. Significant positive correlations were found between UA, DV and LHV PIVs and UA NT-proBNP concentrations.
In human fetal growth restriction, increased cardiac afterload and pulsatility in DV blood velocity waveform pattern are associated with elevated UA NT-proBNP concentrations.
验证我们的假设，即胎儿生长受限（FGR）时，随着胎儿心血管功能损害严重程度的增加，人胎儿B型利钠肽原N端肽（NT-proBNP）的分泌也相应增加。
这项前瞻性横断面研究纳入了42例生长受限胎儿，在分娩前7天内对其进行心血管血流动力学的多普勒超声检查。第1组胎儿（n = 13）脐动脉（UA）血流速度测定正常。第2组胎儿（n = 15）脐动脉异常但静脉导管（DV）血流速度测定正常。第3组胎儿（n = 14）脐动脉和静脉导管血流速度测定均异常。分娩时，采集脐动脉血样以评估NT-proBNP。在49例妊娠和分娩无并发症的新生儿（对照组）中确定脐动脉NT-proBNP的正常值。
与第1组和第2组胎儿相比，第3组胎儿的脐动脉和降主动脉搏动指数（PI）更高（P < 0.05），静脉导管、左肝静脉（LHV）和下腔静脉的静脉搏动指数（PIV）更高（P < 0.05）。各组间体重指数心输出量和心室射血力相似。第3组胎儿的脐动脉NT-proBNP浓度高于第1组和第2组胎儿（P < 0.05）。在对照组中，脐动脉NT-proBNP的第95百分位数为518 pmol/L。在第3组中，14例新生儿中有13例脐动脉NT-proBNP水平异常。第1组和第2组的相应发生率分别为4/13和7/15。脐动脉、静脉导管和左肝静脉的静脉搏动指数与脐动脉NT-proBNP浓度之间存在显著正相关。
在胎儿生长受限中，心脏后负荷增加和静脉导管血流速度波形模式的搏动性增加与脐动脉NT-proBNP浓度升高有关。
