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胎儿 NT-proBNP 水平及其在宫内治疗严重贫血期间的变化。

Fetal NT-proBNP levels and their course in severe anemia during intrauterine treatment.

机构信息

Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.

Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany.

出版信息

Arch Gynecol Obstet. 2024 Apr;309(4):1341-1351. doi: 10.1007/s00404-023-07006-8. Epub 2023 Mar 26.

DOI:10.1007/s00404-023-07006-8
PMID:36966429
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10894143/
Abstract

PURPOSE

In adults and fetuses, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac failure and myocardial remodelling. We examined the effect of anemia and intrauterine transfusion (IUT) on NT-proBNP concentrations in fetuses with anemia and established gestational age-dependent reference values of a control group.

METHODS

We analyzed NT-proBNP levels in anemic fetuses that underwent serial intrauterine transfusions (IUT), focusing on different causes and severity of anemia and comparing the results to a non-anemic control group.

RESULTS

In the control group, the average NT-proBNP concentration was 1339 ± 639 pg/ml, decreasing significantly with increasing gestational age (R = - 74.04, T = - 3.65, p = 0.001). Subjects had significantly higher NT-proBNP concentrations before initiation of IUT therapy (p < 0.001), showing fetuses with parvovirus B19 (PVB19) infection having the highest concentrations. Hydropic fetuses also showed an increased NT-proBNP concentration compared to non-hydropic fetuses (p < 0.001). During the course of therapy, NT-proBNP concentration before subsequent IUT decreased significantly from pathologically high levels, while MoM-Hb and MoM-MCA-PSV remained pathological.

CONCLUSION

NT-pro BNP levels in non-anemic fetuses are higher than in postnatal life, decreasing with ongoing pregnancy. Anemia is a hyperdynamic state and its severity correlates with circulating NT-proBNP levels. Highest concentrations occur in fetuses with hydrops and with PVB19 infection, respectively. Treatment by IUT leads to a normalisation of NT-proBNP concentrations, so the measurement of its levels may be useful in therapy monitoring.

摘要

目的

在成人和胎儿中，N 端脑利钠肽前体（NT-proBNP）是心力衰竭和心肌重构的标志物。我们研究了贫血和宫内输血（IUT）对贫血胎儿 NT-proBNP 浓度的影响，并建立了一个对照组的与胎龄相关的参考值。

方法

我们分析了接受连续宫内输血（IUT）的贫血胎儿的 NT-proBNP 水平，重点关注不同原因和严重程度的贫血，并将结果与非贫血对照组进行比较。

结果

在对照组中，平均 NT-proBNP 浓度为 1339±639pg/ml，随着胎龄的增加而显著降低（R=-74.04，T=-3.65，p=0.001）。在开始 IUT 治疗之前，受试者的 NT-proBNP 浓度显著升高（p<0.001），其中 B19 病毒感染的胎儿浓度最高。水肿胎儿的 NT-proBNP 浓度也高于非水肿胎儿（p<0.001）。在治疗过程中，与后续 IUT 前相比，NT-proBNP 浓度显著降低，而 MoM-Hb 和 MoM-MCA-PSV 仍处于病理状态。

结论

非贫血胎儿的 NT-proBNP 水平高于产后，随着妊娠的进行而降低。贫血是一种高动力状态，其严重程度与循环 NT-proBNP 水平相关。在水肿胎儿和 B19 病毒感染胎儿中，浓度最高。IUT 治疗导致 NT-proBNP 浓度正常化，因此其水平的测量可能对治疗监测有用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/613954f4dab0/404_2023_7006_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/8e3dd83ba652/404_2023_7006_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/e7f7b7c20293/404_2023_7006_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/613954f4dab0/404_2023_7006_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/8e3dd83ba652/404_2023_7006_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/58c20d1db83d/404_2023_7006_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/6f86cf777763/404_2023_7006_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/e7f7b7c20293/404_2023_7006_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d613/10894143/613954f4dab0/404_2023_7006_Fig5_HTML.jpg

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