PLASMA-LEVELS OF ATRIAL-NATRIURETIC-PEPTIDE IN NORMAL AND HYPERTENSIVE PREGNANCIES - A METAANALYSIS
PLASMA-LEVELS OF ATRIAL-NATRIURETIC-PEPTIDE IN NORMAL AND HYPERTENSIVE PREGNANCIES - A METAANALYSIS
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DOI：
10.1016/0002-9378(94)90416-2
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发表时间：
1994-12-01
影响因子：
9.8
通讯作者：
GORNBEIN, J
中科院分区：
文献类型：
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作者：
CASTRO, LC;HOBEL, CJ;GORNBEIN, J
目的：我们的目标是（1）使用荟萃分析，以确定是否妊娠和产褥期是伴随着血浆心钠素水平的变化时，与非妊娠状态和（2）评估妊娠期高血压疾病对血浆心钠素levels.Study设计的额外影响：文章测量心钠素水平在怀孕期间进行了审查。从符合纳入标准的文章中提取数据，并使用Jennrich和Schluchter（Biometrics 1986;42：805-20）的最大似然法进行荟萃分析。结果：非妊娠对照组的平均心钠素水平为28.7 pg/ml（95%置信区间为22.5 - 36.7）。在妊娠晚期，平均血浆心钠素水平上升41%至40.5 pg/ml（95%置信区间31.7至51.8）（p < 0.0001）。在产后第一周，它是71.1 pg/ml（95%置信区间51.2至98.7）或148%高于平均非妊娠水平（p < 0.0001）。与怀孕对照组的水平相比，妊娠期高血压妇女血浆心钠素水平升高52%至52.1 pg/ml（95%可信区间32.9至82.5）（P < 0.005），先兆子痫妇女血浆心钠素水平升高130%至78.8 pg/ml（95%可信区间52.3至118.8）（P < 0.0001）。慢性高血压并没有显着改变心房利钠肽levels.CONCLUSIONS：41%的增加，心房利钠肽水平在第三个三个月表明，心房牵张受体的感觉扩大血容量正常适度增加。产后第一周心钠素水平的升高与已知的血流动力学变化一致，提示心钠素可能参与产后利尿。在先兆子痫中观察到的血浆心钠素水平的显著增加不太可能单独由动脉压升高引起，但可能反映了这种疾病过程特有的潜在因素。
OBJECTIVE: Our goals were (1) to use meta-analysis to determine whether pregnancy and the puerperium are accompanied by alterations in plasma atrial natriuretic peptide levels when compared with the nonpregnant state and (2) to evaluate the additional effects of hypertensive disease during pregnancy on plasma atrial natriuretic peptide levels.STUDY DESIGN: Articles measuring atrial natriuretic peptide levels during pregnancy were reviewed. Data from articles meeting inclusion criteria were abstracted, and a meta-analysis was performed with the use of the maximum likelihood methods of Jennrich and Schluchter (Biometrics 1986;42:805-20).RESULTS: The mean atrial natriuretic peptide level in nonpregnant control subjects was 28.7 pg/ml (95% confidence interval 22.5 to 36.7). The mean plasma atrial natriuretic peptide level rose 41% to 40.5 pg/ml (95% confidence interval 31.7 to 51.8) in the third trimester (p < 0.0001). It was 71.1 pg/ml (95% confidence interval 51.2 to 98.7) or 148% greater than the mean nonpregnant level during the first week post partum (p < 0.0001). Compared with levels in pregnant control subjects, plasma atrial natriuretic peptide levels increased 52% to 52.1 pg/ml (95% confidence interval 32.9 to 82.5) in women with gestational hypertension (p < 0.005) and 130% to 78.8 pg/ml (95% confidence interval 52.3 to 118.8) in women with preeclampsia (p < 0.0001). Chronic hypertension did not significantly alter atrial natriuretic peptide levels.CONCLUSIONS: The 41% increase in atrial natriuretic peptide levels in the third trimester suggests that atrial stretch receptors sense the expanded blood volume as normal to moderately increased. The rise in atrial natriuretic peptide during the first week post partum is consistent with known hemodynamic changes and suggests that atrial natriuretic peptide may be involved in the postpartum diuresis. The marked increase in plasma atrial natriuretic peptide levels observed in preeclampsia is not likely to result from elevated arterial pressures alone but may reflect underlying factors unique to this disease process.