Abnormal pressure-wave reflection in pregnant women with chronic hypertension: association with maternal and fetal outcomes
Abnormal pressure-wave reflection in pregnant women with chronic hypertension: association with maternal and fetal outcomes
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DOI：
10.1038/hr.2014.109
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发表时间：
2014-11-01
影响因子：
5.4
通讯作者：
Kimura, Tadashi
中科院分区：
文献类型：
--
作者：
Tomimatsu, Takuji;Fujime, Mika;Kimura, Tadashi
目前的研究测试了这样的假设：异常压力波反射可能在识别患有慢性高血压的孕妇中发挥重要作用，这些孕妇可能会患上先兆子痫（PE）和/或胎儿生长受限。对 41 名患有慢性高血压的女性进行脉搏波分析，以评估妊娠 26-32 周期间母体动脉僵硬度。我们使用自动压平眼压计系统，利用桡动脉的脉搏波形，无创地测量了中心收缩压 (CSP) 和增强指数 (AIx)。在将 AIx-75（心率为每分钟 75 次时的 AIx）、肱动脉收缩压、母亲身高、吸烟状况、测试时孕龄以及测试时是否接受抗高血压治疗作为独立决定因素的多元回归分析中，AIx-75 是出生体重的唯一显着决定因素，而肱动脉收缩压则不是。在随后出现叠加性PE和胎儿生长受限的慢性高血压孕妇中，CSP、AIx、AIx-75以及肱动脉收缩压和脉压均显着高于未叠加PE或小于胎龄的孕妇。相比之下，AIx-75 是胎儿生长受限但未合并 PE 的患者中唯一显着升高的血流动力学参数。此外，CSP 是出现叠加 PE 但未出现胎儿生长受限的患者中唯一显着升高的血流动力学参数。与传统的肱动脉血压相比，妊娠 26-32 周期间异常的压力波反射与出生体重的相关性更强。我们的研究结果可能为胎儿生长受限的病理生理学以及妊娠合并慢性高血压的叠加 PE 提供新的见解。
The current study tested the hypothesis that abnormal pressure-wave reflection may have an important role in identifying pregnant women with chronic hypertension who might develop pre-eclampsia (PE) and/or fetal growth restriction. Pulse-wave analyses were performed to assess maternal arterial stiffness during 26-32 weeks of gestation in 41 women with chronic hypertension. We measured the central systolic pressure (CSP) and augmentation index (AIx) noninvasively using pulse waveforms of the radial artery with an automated applanation tonometric system. In a multiple regression analysis that included AIx-75 (AIx at a heart rate of 75 beats per minute), brachial systolic pressure, maternal height, smoking status, gestational age at testing and the presence of antihypertensive treatment at testing as independent determinants, AIx-75 was the only significant determinant of birth weight, whereas the brachial systolic pressure was not. In pregnant women with chronic hypertension who subsequently developed both superimposed PE and fetal growth restriction, CSP, AIx, AIx-75, and the brachial systolic and pulse pressures were all significantly higher than those who did not develop superimposed PE nor small for gestational age. In contrast, AIx-75 was the only significantly elevated hemodynamic parameter in patients who developed fetal growth restriction but not superimposed PE. In addition, CSP was the only significantly elevated hemodynamic parameter in patients who developed superimposed PE but not fetal growth restriction. Abnormal pressure-wave reflection during 26-32 weeks of gestation showed a stronger correlation with birth weight than conventional brachial blood pressure. Our findings might provide new insight into the pathophysiology of fetal growth restriction as well as superimposed PE in pregnancies complicated with chronic hypertension.