Sadlecki Pawel, Grabiec Marek, Walentowicz-Sadlecka Malgorzata
Department of Obstetrics and Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, Torun, Poland.
PLoS One. 2016 Sep 29;11(9):e0162957. doi: 10.1371/journal.pone.0162957. eCollection 2016.
Common complications of pregnancy include preeclampsia (PE), gestational hypertension (GH) and gestational diabetes mellitus (GDM). Hypertensive disorders (PE/GH) and GDM may result in greater maternal, fetal and neonatal morbidity and mortality. Women with PE/GH, one of the most common causes of heart burden in an obstetrical setting, present with elevated serum levels of BNP and NT-proBNP. The aim of this study was to shed more light on the role of NT-proBNP in pathophysiology of PE, GH and GDM. The study included 156 pregnant women with singleton pregnancies. A total of 26 women developed arterial hypertension during pregnancy, 14 were diagnosed with PE, and GDM was detected in 81 patients. The control group included 35 women with uncomplicated pregnancies, normal arterial blood pressure and normal glucose concentrations. Patients with GH presented with significantly higher serum concentrations of NT-proBNPthan normotensive women (65.5 vs. 37.4 pg/ml; p = 0.0136). Serum levels of NT-proBNP in patients with PE were the highest of all the analyzed subsets, being significantly higher than in women without this condition (89.00 vs. 37.4pg/ml,p = 0,0136). However, women with and without GDM did not differ significantly in terms of their serum NT-proBNPconcentrations. Serum NT-proBNP (pg/ml) (p = 0.0001) and BMI (p<0.0001) turned out to be independent predictors of GH on multivariate logistic regression analysis.Moreover, serum NT-proBNP (pg/ml) was identified as an independent indicator of PE (p = 0.0016). A significant inverse correlation was found between birth weight and maternal serum NT-proBNP concentrations. In our opinion, NT-proBNP can be a useful clinical marker of GH and PE. Determination of NT-proBNP levels may be helpful in identification of patients with PE and GH and in their qualification for intensive treatment; this in turn, may be reflected by better neonatal outcomes.
妊娠常见并发症包括子痫前期（PE）、妊娠期高血压（GH）和妊娠期糖尿病（GDM）。高血压疾病（PE/GH）和GDM可能导致更高的孕产妇、胎儿及新生儿发病率和死亡率。PE/GH是产科环境中最常见的心脏负担原因之一，此类孕妇血清BNP和NT-proBNP水平升高。本研究的目的是进一步阐明NT-proBNP在PE、GH和GDM病理生理学中的作用。该研究纳入了156名单胎妊娠孕妇。共有26名女性在孕期出现动脉高血压，14名被诊断为PE，81名患者检测出GDM。对照组包括35名妊娠情况正常、动脉血压正常且血糖浓度正常的女性。GH患者的血清NT-proBNP浓度显著高于血压正常的女性（65.5对37.4 pg/ml；p = 0.0136）。PE患者的血清NT-proBNP水平在所有分析亚组中最高，显著高于未患该病的女性（89.00对37.4 pg/ml，p = 0.0136）。然而，患GDM和未患GDM的女性在血清NT-proBNP浓度方面无显著差异。多因素逻辑回归分析结果显示，血清NT-proBNP（pg/ml）（p = 0.0001）和BMI（p<0.0001）是GH的独立预测因素。此外，血清NT-proBNP（pg/ml）被确定为PE的独立指标（p = 0.0016）。出生体重与母体血清NT-proBNP浓度之间存在显著负相关。我们认为，NT-proBNP可能是GH和PE的有用临床标志物。测定NT-proBNP水平可能有助于识别PE和GH患者并确定其强化治疗资格；这反过来可能表现为更好的新生儿结局。
