子痫前期患者24h尿蛋白值与不良结局的相关性

发布时间：2019-06-13 13:24

【摘要】：目的:探讨24h尿蛋白值在妊娠期高血压疾病中的诊断价值以及重度子痫前期24h尿蛋白诊断标准与不良妊娠结局的关系,并在此基础之上,进一步寻求重度子痫前期24h尿蛋白诊断界值。方法:收集2012年12月至2013年10月期间在上海交通大学医学院附属仁济医院产科分娩、资料齐全的65例妊娠期高血压疾病(非慢性高血压患者)作为病例组,并定义母儿出现的任何一项严重并发症为不良妊娠结局,利用SPSS13.0软件分析ACOG最新指南提出的子痫前期诊断标准进行其与不良结局相关性的定性研究。然后收集2011年4月至2013年6月间在我院产科分娩的92例子痫前期患者的临床资料,依据国内外不同重度子痫前期尿蛋白的诊断标准,利用SPSS13.0软件分析母儿结局,进行24h尿蛋白值与不良妊娠结局相关性的定量研究。最后,利用2012年12月至2013年10月期间在我院产科分娩的55例子痫前期患者的临床资料,进行定量研究结果的验证。结果:1、在定性研究中,65例妊娠期高血压疾病患者中,不良妊娠结局者所占比例为63.1%(41/65),良好结局者则为36.9%(14/55)。不良结局的构成多样。24h尿蛋白值单独诊断子痫前期及妊娠期高血压患者的不良妊娠结局发生率存在显著差异(P=0.000)。2、24h尿蛋白值是否超过0.3g与不良妊娠结局相关系数为0.557,属于中度相关,且该数值具有统计学意义。3、24h尿蛋白值与妊娠期高血压疾病及子痫前期均相关,且能得到logistic回归方程。4、在定量研究中,92例子痫前期患者发生不良妊娠结局者所占比例为54%(50/92),良好结局者则为46%(42/92)。不良结局的构成多样。不同程度尿蛋白发生不良结局的概率均不相同,且存在显著差异(P0.05)。5、当24小时尿蛋白值为1g时,其Youden指数最高为0.55,灵敏度及特异度相对较高。ROC曲线对应的面积最大为0.777,最接近1。6、当24小时尿蛋白值为3g时,其阳性预测值最高为90.32%,阳性似然比相对应最高位7.84。7、在验证研究中,55例子痫前期患者中轻度尿蛋白患者30例,重度尿蛋白患者25例。30例轻度尿蛋白患者中,不良妊娠结局者所占比例为56.7%(17/30),良好结局者则为43.3%(13/30)。25例重度子痫前期患者中,不良妊娠结局者所占比例为96%(24/25),良好结局者则为4%(1/25)。8、当24h尿蛋白界值为3g时,其所对应的灵敏度为58.5%,特异度为92.9%,准确度为67.2%,阳性预测值为0.960,阴性预测值0.433,阳性似然比12.949,阴性似然比0.447,诊断比值比18.353。ROC曲线下面积为0.807。结论:1、ACOG指南中子痫前期的诊断标准不适用于本研究病例,24h尿蛋白值应作为诊断子痫前期的必要条件之一。2、24h尿蛋白值与妊娠不良结局相关,可作为诊断重度子痫前期的独立指标,且对于子痫前期不良妊娠结局的阳性预测较高。3、建议将重度子痫前期24h尿蛋白值的诊断标准定为3g。4、若子痫前期患者24h尿蛋白值低于3g时,应结合血压、肝肾功能等其他脏器情况进行进一步诊治。
[Abstract]:Objective: to investigate the diagnostic value of 24 h urinary egg white value in hypertensive disorder complicating pregnancy and the relationship between 24 h urinary protein diagnostic criteria and adverse pregnancy outcome in severe preeclampsia, and to further seek the diagnostic threshold of 24 h urinary protein in severe preeclampsia. Methods: from December 2012 to October 2013, 65 cases of hypertensive disorder complicating pregnancy (non-chronic hypertension) were collected and delivered in Renji Hospital, Medical College of Shanghai Jiaotong University, and any serious complications occurred between mother and child were defined as adverse pregnancy outcomes. The diagnostic criteria of preeclampsia proposed by the latest guidelines of ACOG were analyzed by SPSS13.0 software to qualitatively study the correlation between preeclampsia and adverse outcomes. Then the clinical data of 92 patients with preeclampsia delivered in our hospital from April 2011 to June 2013 were collected. According to the diagnostic criteria of different severe preeclampsia protein at home and abroad, the maternal and infant outcomes were analyzed by SPSS13.0 software, and the correlation between 24 h urinary egg white value and adverse pregnancy outcome was quantitatively studied. Finally, the clinical data of 55 patients with preeclampsia delivered in our hospital from December 2012 to October 2013 were used to verify the results of quantitative study. Results: 1. In the qualitative study, the proportion of 65 patients with hypertensive disorder complicating pregnancy was 63.1% (41 鈮，

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