本文選題：妊娠期高血壓疾病 + 子癇前期��； 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：目的妊娠期高血壓疾病是一種發(fā)病機(jī)制尚不明確的妊娠期特有疾病。它是引起妊娠期婦女及胎兒病死率高的重要原因之一,給家庭與社會帶來精神傷害和經(jīng)濟(jì)損失。國內(nèi)外醫(yī)學(xué)者致力尋找能在早期預(yù)測妊娠期高血壓疾病的指標(biāo),但是目前仍然沒有一個公認(rèn)的指標(biāo)被臨床工作者所接受及廣泛使用。因此,本研究致力于在我們產(chǎn)前檢查常用的血清學(xué)指標(biāo)和孕婦一般臨床資料中尋求單個或多個早期預(yù)測指標(biāo),既不增加孕婦的經(jīng)濟(jì)負(fù)擔(dān),又能運(yùn)用于基層醫(yī)院。我們通過研究孕婦妊娠早期及妊娠中期唐氏篩查四項(xiàng)[抑制素A(INHA)、游離雌三醇(u E3)、甲胎蛋白(AFP)、血清人絨毛膜促性腺激素(β-hCG)]和血清學(xué)指標(biāo)[血常規(guī)、肝功、腎功、凝血象、甲功、空腹血糖(FPG)、糖化血紅蛋白Hb A1c]以及孕婦一般臨床資料,來評價(jià)這些指標(biāo)在早期預(yù)測妊娠期高血壓疾病發(fā)生中的意義,最終構(gòu)建妊娠期高血壓疾病早期預(yù)測模型。主要方法及結(jié)果第一部分:抑制素A與常用血清學(xué)指標(biāo)在妊娠期高血壓疾病中變化的研究方法:本研究為回顧性病例對照研究,已通過第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所倫理委員會。研究對象為2014年8月-2016年12月來我院定期規(guī)律產(chǎn)檢及分娩的所有孕婦。收集妊娠期高血壓疾病160例,其中妊娠期高血壓27例、子癇前期-子癇組133例(包括輕度子癇前期45例、重度子癇前期-子癇88例);正常對照組78例。采集孕婦分娩前7天內(nèi)、產(chǎn)后48-72小時的靜脈血留取血清于-80℃儲存,應(yīng)用化學(xué)發(fā)光法檢測血清INHA水平。并收集孕婦分娩前實(shí)驗(yàn)室常規(guī)檢驗(yàn)的血常規(guī)、肝功、腎功、FPG、HbA1c、凝血象及甲功的指標(biāo)及孕婦一般臨床資料。應(yīng)用SPSS19.0對血常規(guī)、肝功、腎功、HbA1c、凝血象及甲功及一般臨床資料指標(biāo)行單因素方差分析。結(jié)果:與正常組比較,妊娠期高血壓疾病組及子癇前期-子癇組血清學(xué)指標(biāo)中大型血小板比率P-LCR、血小板平均比積(PCT)、天門冬酸氨基轉(zhuǎn)移酶(AST)、丙氨酸氨基轉(zhuǎn)移酶(ALT)、總膽紅素(TBIL)、直接膽紅素(DBIL)、乳酸脫氫酶(LDH)、5'-核苷酸酶(5'-NT)、總膽汁酸(TBA)、腺苷脫氨酶(ADA)、前白蛋白(PA)、肌酐(CREA)、尿酸(URIC)、胱抑素C(CYC)、β_2-微球蛋白(β_2-mG)、視黃醇結(jié)合蛋白(RBP)、活化部分凝血活酶時間(APTT)、凝血酶時間(TT)、促甲狀腺素(TSH)、Hb A1c水平及孕婦一般臨床資料SBP、DBP、體重、BMI均升高(P0.05或P0.01);紅細(xì)胞平均體積(MCV)、血小板平均體積(MPV)、單核細(xì)胞百分?jǐn)?shù)(MONO%)、白蛋白(ALB)、球蛋白(GLB)、國際標(biāo)準(zhǔn)比率(PT-INR)、纖維蛋白原(FIB)、凝血酶原時間(PT-1)、游離甲狀腺素(FT4)水平在血清中下降且分娩孕周小(P0.05或P0.01)。妊娠期高血壓疾病組的INHA水平(1347.06±262.02pg/ml)和子癇前期-子癇組的INHA水平(1361.23±253.75pg/ml)均高于正常組(1152.58±310.59pg/ml)且有統(tǒng)計(jì)學(xué)意義(P0.05)。第二部分:妊娠期高血壓疾病早期預(yù)測模型的構(gòu)建方法:本研究為回顧性病例對照研究,已通過第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所倫理委員會。采集孕婦孕11-14周、孕16-20周的靜脈血留取血清于-80℃儲存,應(yīng)用化學(xué)發(fā)光法檢測唐氏篩查四項(xiàng),并收集孕11-14周、孕16-20周、孕24-28周實(shí)驗(yàn)室常規(guī)檢驗(yàn)的血常規(guī)、肝功、腎功、空腹血糖、糖化血紅蛋白、凝血象及甲功的指標(biāo)及孕婦一般臨床資料。最終孕11-14周妊娠期高血壓疾病87例[妊娠期高血壓20例、子癇前期組67例(子癇0例)],正常對照組55例;孕16-20周妊娠期高血壓疾病28例[妊娠期高血壓3例、子癇前期組25例(子癇0例)],正常對照組20例;孕24-28周妊娠期高血壓疾病90例[妊娠期高血壓17例、子癇前期組73例(子癇0例)],正常對照組67例。應(yīng)用SPSS19.0對血常規(guī)、肝功、腎功、FPG、HbA1c、凝血象及甲功血清學(xué)指標(biāo)及孕婦一般臨床資料行單因素方差分析。并結(jié)合Logistic回歸方法評價(jià)血清學(xué)指標(biāo)及孕婦一般臨床資料對妊娠期高血壓疾病的預(yù)測價(jià)值,構(gòu)建妊娠期高血壓疾病及子癇前期-子癇的早期預(yù)測模型。結(jié)果:1.孕11-14周妊娠期高血壓疾病組血清AST水平(21.77±7.88U/L)和子癇前期組血清AST水平(21.98±7.84U/L)均較正常組血清AST水平(18.40±4.93U/L)升高且有統(tǒng)計(jì)學(xué)差異(P0.05)。妊娠期高血壓疾病組血清膽堿酯酶(CHE)水平(6882.37±1339.41U/L)和子癇前期組的血清膽堿酯酶水平(6840.21±1302.51U/L)均較正常組的水平(6212.84±925.94U/L)升高且有統(tǒng)計(jì)學(xué)差異(P0.05);妊娠期高血壓疾病組血清5'-NT水平(5.73±2.82U/L)和子癇前期組血清5'-NT水平(6.03±2.94U/L)均較正常組的水平(3.77±1.86 U/L)升高有統(tǒng)計(jì)學(xué)意義(P0.01)。而且5'-NT存在子癇前期早期預(yù)測價(jià)值,5'-NT、AST及CHE存在娠期高血壓疾病早期預(yù)測價(jià)值。2.孕16-20周妊娠期高血壓疾病組血清INHA水平(329.08±88.03pg/ml)和子癇前期組血清INHA水平(337.03±101.26pg/ml)均較正常組的水平(232.74±82.77pg/ml)升高(P0.01)。妊娠期高血壓疾病組的基礎(chǔ)舒張壓(DBP(73.80±8.00mm Hg)和子癇前期組的基礎(chǔ)舒張壓(DBP)(74.17±8.12mm Hg)均較正常組的水平(66.83±8.25mm Hg)增高(P0.01)。妊娠期高血壓疾病組的孕前BMI值(23.41±5.81Kg/m~2)和子癇前期組的孕前BMI值(23.72±4.37Kg/m~2)均較正常組的值(20.57±2.73Kg/m~2)增高(P0.05)。而且血清INHA、基礎(chǔ)DBP及孕前BMI存在子癇前期早期預(yù)測價(jià)值,血清INHA存在娠期高血壓疾病早期預(yù)測價(jià)值。3.孕24-28周妊娠期高血壓疾病FPG水平(4.93±0.53umol/L)和子癇前期組FPG水平(4.95±0.55umol/L)較正常組水平(4.67±0.35umol/L)升高且均有統(tǒng)計(jì)學(xué)差異(P0.01)。妊娠期高血壓疾病基礎(chǔ)收縮壓(SBP)水平(116.51±10.15mmHg)和子癇前期組基礎(chǔ)收縮壓水平(116.18±10.07mmHg)較正常組的值(106.18±11.95mmHg)升高且有統(tǒng)計(jì)學(xué)差異(P0.01),而且FPG結(jié)合基礎(chǔ)SBP有妊娠期高血壓疾病和子癇前期早期預(yù)測價(jià)值。4.經(jīng)Logistics回歸分析得到孕11-14周有妊娠期高血壓疾病預(yù)測價(jià)值的指標(biāo)是5'-NT、AST及CHE,有子癇前期預(yù)測價(jià)值的指標(biāo)是5'-NT;最終構(gòu)建妊娠期高血壓疾病預(yù)測模型如下:Y=0.512(AST)+0.510(5'-NT)+0.482(CHE)-3.667,準(zhǔn)確率67.5%;子癇前期預(yù)測模型:Y=0.624(5'-NT)-1.785,準(zhǔn)確率63.5%。孕16-20周有妊娠期高血壓疾病預(yù)測價(jià)值的指標(biāo)是INHA,有子癇前期預(yù)測價(jià)值的指標(biāo)是INHA、孕前BMI及基礎(chǔ)DBP;最終構(gòu)建妊娠期高血壓疾病預(yù)測模型:Y=1.162(INHA)-3.327,準(zhǔn)確率79.3%;子癇前期預(yù)測模型如下:Y=1.164(INHA)+1.804(基礎(chǔ)DBP)+1.695(孕前BMI)-12.967,準(zhǔn)確率84.6%。孕24-28周對妊娠期高血壓疾病、子癇前期預(yù)測價(jià)值的指標(biāo)均是FPG及基礎(chǔ)SBP;最終構(gòu)建妊娠期高血壓疾病預(yù)測模型如下:Y=0.443(FPG)+0.767(基礎(chǔ)SBP)-2.7,準(zhǔn)確率71.2%;子癇前期預(yù)測模型:Y=0.375(FPG)+0.739(基礎(chǔ)SBP)-2.676,準(zhǔn)確率71.2%。結(jié)論1、系統(tǒng)地研究了孕婦一般臨床資料和臨床常用的血清學(xué)指標(biāo)(血常規(guī)、肝功、腎功、凝血象、甲功、空腹血糖、糖化血紅蛋白)及抑制素A在妊娠期高血壓疾病孕婦血清中的變化;篩查出了差異有統(tǒng)計(jì)學(xué)意義的指標(biāo)如下:INHA、血常規(guī)中P-LCR、PCT、MONO%、MPV,肝功中AST、ALT、TBI、LDH、5'-NT、TBA、ADA、PA、ALB、GLB,腎功中CREA、URIC、CYC、β2-m G、RBP,凝血象中APTT、TT、PT-INR、FIB、PT-1,甲功中TSH、FT4,HbA1c及孕婦一般臨床資料中的基礎(chǔ)收縮壓SBP、基礎(chǔ)舒張壓DBP、體重、BMI、分娩孕周。2、系列序貫研究了孕11-14周、孕16-20周、孕24-28周孕婦一般臨床資料和臨床常用的血清學(xué)指標(biāo)及唐氏篩查四項(xiàng)(抑制素A、血清人絨毛膜促性腺激素、游離雌三醇、甲胎蛋白)在妊娠期高血壓疾病孕婦血清中的變化,篩查出了差異有統(tǒng)計(jì)學(xué)意義的指標(biāo)如下:抑制素A、血常規(guī)中的PLT、PCT,肝功中AST、ALT、5'-NT、GGT、CHE,腎功中的URIC,FPG以及孕婦一般臨床資料中的基礎(chǔ)收縮壓、基礎(chǔ)舒張壓、孕前BMI。這些指標(biāo)可能對妊娠期高血壓疾病有早期預(yù)測價(jià)值。3、通過Logistic回歸分析建立了不同孕周的妊娠期高血壓疾病及子癇前期的早期預(yù)測模型:孕11-14周妊娠期高血壓疾病早期預(yù)測模型:Y=0.512(AST)+0.510(5'-NT)+0.482(CHE)-3.667,準(zhǔn)確率67.5%;子癇前期早期預(yù)測模型:Y=0.624(5'-NT)-1.785,準(zhǔn)確率分別為63.5%;孕16-20周妊娠期高血壓疾病早期預(yù)測模型:Y=1.162(INHA)-3.327,準(zhǔn)確率為79.3%;子癇前期早期預(yù)測模型:Y=1.164(INHA)+1.804(基礎(chǔ)DBP)+1.695(孕前BMI)-12.967,準(zhǔn)確率為84.6%;孕24-28周妊娠期高血壓疾病早期預(yù)測模型:Y=0.443(FPG)+0.767(基礎(chǔ)SBP)-2.7,子癇前期早期預(yù)測模型:Y=0.375(FPG)+0.739(基礎(chǔ)SBP)-2.676,準(zhǔn)確率均為71.2%。其中孕16-20周血清抑制素A、基礎(chǔ)DBP、孕前BMI聯(lián)合預(yù)測模型準(zhǔn)確率最高(84.6%),該早期預(yù)測模型將應(yīng)用于臨床進(jìn)一步驗(yàn)證,有望成為一種經(jīng)濟(jì)、有效、可廣泛應(yīng)用于基層醫(yī)院的子癇前期早期預(yù)測方法,以達(dá)到早發(fā)現(xiàn)、早預(yù)防、早監(jiān)管、早治療,最終降低妊娠期高血壓疾病在孕產(chǎn)婦中發(fā)病率和死亡率的目的。
[Abstract]:Objective pregnancy induced hypertension (gestation) is an unambiguous pregnancy specific disease. It is one of the important causes of high mortality in pregnant women and fetus. It brings mental and economic damage to family and society. There is still no recognized indicator accepted and widely used by clinical workers. Therefore, this study seeks to seek individual or multiple early predictors in the common serological indicators and general clinical data of pregnant women for prenatal examination. It does not increase the economic burden of pregnant women, but also can be used in grass-roots hospitals. To evaluate four items [inhibin A (INHA), free female three alcohol (U E3), alpha fetoprotein (AFP), serum human chorionic gonadotropin (beta -hCG)] and serological indexes [blood routine, liver function, renal function, renal function, thyroid function, FPG, FPG), glycosylated hemoglobin Hb A1c], and general clinical data of pregnant women, were evaluated. The significance of these indicators in the early prediction of pregnancy induced hypertension and the construction of an early prediction model of pregnancy induced hypertension. Main methods and results: the study method of inhibin A and common serological indexes in pregnancy induced hypertension: This study was a retrospective case control study, which had passed through The ethics committee of the Department of field surgery research, Daping Hospital of the Third Army Medical University, was studied in all pregnant women of regular regular production and childbirth in our hospital in December -2016 August 2014. 160 cases of pregnancy induced hypertension were collected, including 27 cases of pregnancy induced hypertension and 133 cases of preeclampsia - eclampsia (45 cases of mild preeclampsia, severe preeclampsia) 88 cases of eclampsia, 78 cases of normal control group, were collected in 7 days before childbirth and 48-72 hours after delivery, the serum was stored at -80 C, and the serum INHA level was detected by chemiluminescence. The blood routine test, liver function, kidney work, FPG, HbA1c, coagulation hematogram and thyroid function and general clinical capital of pregnant women before delivery were collected. Material. Single factor variance analysis was performed on blood routine, liver function, renal function, HbA1c, hemogram and thyroid function and general clinical data. Results: compared with the normal group, the large platelet ratio in the pregnancy induced hypertension group and the preeclampsia and eclampsia group was P-LCR, the average platelet ratio (PCT), and aspartate aminotransferase (SPSS19.0). AST) alanine aminotransferase (ALT), total bilirubin (TBIL), direct bilirubin (DBIL), lactate dehydrogenase (LDH), 5'- nucleotidase (5'-NT), total bile acid (TBA), adenosine deaminase (ADA), prealbumin (PA), creatinine (CREA), uric acid (URIC), cystatin, retinol binding protein, retinol binding protein, activated partial thromboplastin APTT, thrombin time (TT), thyrotropin (TSH), Hb A1c level and general clinical data of pregnant women, SBP, DBP, weight, BMI (P0.05 or P0.01); average volume of red blood cells (MCV), average volume of platelets (MPV), percentage of mononuclear cells, albumin, globulin, international standard ratio, fibrinogen, coagulation The level of plasma protin (PT-1) and free thyroxine (FT4) decreased in serum and was small (P0.05 or P0.01). The level of INHA (1347.06 + 262.02pg/ml) and the INHA level (1361.23 + 253.75pg/ml) in the group of preeclampsia and eclampsia (1361.23 + 253.75pg/ml) were higher than those of the normal group (1152.58 + 310.59pg/ml) and were statistically significant (P0.05). The two part: the construction method of the early prediction model of pregnancy induced hypertension: This study is a retrospective case control study, which has passed the ethics committee of the Department of field surgery research in Daping Hospital of Third Military Medical University. To collect pregnant women for 11-14 weeks and 16-20 weeks of pregnancy, the blood serum was stored at -80 C, and down screening was detected by chemiluminescence. Four items, including 11-14 weeks of pregnancy, 16-20 weeks of pregnancy, 24-28 weeks of pregnancy, routine laboratory test, liver function, renal function, fasting blood glucose, glycosylated hemoglobin, hemogram and thyroid function and general clinical data of pregnant women. 87 cases of pregnancy induced hypertension in 11-14 weeks of pregnancy [20 cases of pregnancy hypertension, 67 cases of preeclampsia (0 cases)] were normal. There were 55 cases in the control group; 28 cases of pregnancy induced hypertension (3 cases of pregnancy hypertension, 25 cases of preeclampsia group (0 cases of eclampsia)], 20 cases of normal control group, 90 pregnant 24-28 weeks pregnancy hypertension disease [17 cases of pregnancy hypertension, 73 cases of preeclampsia (eclampsia 0 cases)], 28 cases in normal control group. The application of SPSS19.0 to blood routine, liver work, renal work, FPG, HbA1c, a single factor variance analysis of the hemogram and the serological indexes of the thyroid function and the general clinical data of pregnant women. Combined with the Logistic regression method, the predictive value of the serological index and the general clinical data of pregnant women on hypertensive disorders in pregnancy was evaluated, and the early prediction model of pregnancy induced hypertension and preeclampsia and eclampsia was constructed. Results: 1. pregnancy 11 Serum levels of AST (21.77 + 7.88U/L) and serum AST level (21.98 + 7.84U/L) in the group of -14 weeks pregnancy induced hypertension were higher than those of normal group (18.40 + 4.93U/L) and there were statistically significant differences (P0.05). Serum cholinesterase (CHE) level (6882.37 + 1339.41U/L) and serum of preeclampsia group in the group of hypertensive patients with pregnancy The level of cholinesterase (6840.21 + 1302.51U/L) was higher than that of the normal group (6212.84 + 925.94U/L) and had statistical difference (P0.05). The serum level of 5'-NT (5.73 + 2.82U/L) and the serum 5'-NT level (6.03 + 2.94U/L) in the preeclampsia group were significantly higher than those of the normal group (3.77 + 1.86 U/L) (P0.01). And 5'-NT had early predictive value for preeclampsia, 5'-NT, AST and CHE had early predictive value for hypertensive disease in pregnancy. The serum INHA level (329.08 + 88.03pg/ml) and serum INHA level (337.03 + 101.26pg/ml) in the group of pregnancy induced hypertension in 16-20 weeks and preeclampsia group were higher than those of normal group (232.74 + 82.77pg/ml) (P0.01). Basic diastolic pressure (DBP (73.80 + 8.00mm Hg) and basic diastolic pressure (DBP) (74.17 + 8.12mm Hg) in preeclampsia group were higher than that of normal group (66.83 + 8.25mm Hg) (P0.01). The pre pregnancy BMI value (23.41 + 5.81Kg/m~2) and pre pregnancy BMI value (23.72 +)) of preeclampsia group were all (23.72 +). The value of (20.57 + 2.73Kg/m~2) was higher than that of the normal group (P0.05). Moreover, serum INHA, basal DBP and pre pregnancy BMI had early predictive value for preeclampsia, serum INHA had early predictive value for hypertensive disease of pregnancy, FPG level of.3. pregnancy (4.93 + 0.53umol/L) and FPG level (4.95 + 0.55umol/L) in pre eclampsia group (4.95 + 0.55umol/L) were more positive. The level of normal group (4.67 + 0.35umol/L) increased and had statistical difference (P0.01). The level of basal systolic pressure (SBP) of pregnancy induced hypertension (116.51 + 10.15mmHg) and basic systolic pressure in preeclampsia group (116.18 + 10.07mmHg) were higher than those of normal group (106.18 + 11.95mmHg) and had statistical difference (P0.01), and FPG combined basis SBP had pregnancy induced pregnancy. The predictive value of hypertensive disease and preeclampsia at the early stage of pregnancy.4. was analyzed by Logistics regression analysis to predict the value of pregnancy induced hypertension by 11-14 weeks of pregnancy, 5'-NT, AST and CHE, and the index of preeclampsia predictive value was 5'-NT; the final pretest model for pregnancy induced hypertension was as follows: Y=0.512 (AST) +0.510 (5'-NT) +0.482 (CH) E) -3.667, accuracy rate 67.5%; preeclampsia prediction model: Y=0.624 (5'-NT) -1.785, accurate rate of 63.5%. pregnancy for pregnancy induced hypertension, the predictive value of pregnancy is INHA. The index of predictive value for preeclampsia is INHA, pre pregnancy BMI and basic DBP; finally, the prediction model of hypertensive disorder in pregnancy: Y=1.162 (INHA), accuracy rate 79. 3%, the preeclampsia prediction model is as follows: Y=1.164 (INHA) +1.804 (base DBP) +1.695 (pre pregnancy BMI) -12.967, accurate rate of 24-28 weeks of pregnancy with pregnancy induced hypertension, the predictive value of preeclampsia are all FPG and basic SBP; finally, the prediction model for pregnancy induced hypertension is as follows: Y=0.443 (FPG), accuracy rate 71. 2%; preeclampsia prediction model: Y=0.375 (FPG) +0.739 (base SBP) -2.676, accurate rate 71.2%. conclusion 1, systematically study the changes of pregnant women's general clinical data and clinical common serological indexes (blood routine, liver function, kidney work, hemogram, thyroid function, fasting blood glucose, glycated hemoglobin) and inhibin A in pregnant women with hypertension. INHA, P-LCR, PCT, MONO%, MPV, AST, ALT, TBI, LDH, 5'-NT, TBA, ALT, 5'-NT, TBA. DBP, weight, BMI, and birth week.2. A series of sequential studies were carried out in the series of 11-14 weeks of pregnancy, 16-20 weeks of pregnancy, and 24-28 weeks of pregnant women's general clinical data and clinical routine serological indexes and four down screening (inhibin A, serum human chorionic gonadotropin, free female three alcohol, alpha fetoprotein) in pregnant women with hypertensive disorder complicating pregnancy. The results are as follows: inhibin A, PLT in blood routine, PCT, AST, ALT, 5'-NT, GGT, CHE, URIC, FPG, and basic systolic blood pressure in general clinical data of pregnant women, basic diastolic pressure, and pre pregnancy BMI., which can have an early predictive value for pregnancy induced hypertension. Regression analysis established an early prediction model of pregnancy induced hypertension and preeclampsia: early prediction model of pregnancy induced hypertension at 11-14 weeks of pregnancy: Y=0.512 (AST) +0.510 (5'-NT) +0.482 (CHE) -3.667, accuracy rate 67.5%; early preeclampsia prediction model: Y=0.624 (5'-NT) -1.785, 63.5%, respectively; pregnancy 16-20 weeks of pregnancy. Early prediction model of hypertensive disease of pregnancy: Y=1.162 (INHA) -3.327, accuracy rate 79.3%; early preeclampsia prediction model: Y=1.164 (INHA) +1.804 (basal DBP) +1.695 (pre pregnancy BMI) -12.967, accuracy rate 84.6%; early pregnancy model of pregnancy induced hypertension disease: Y=0.443 (FPG), early prediction model for preeclampsia Type: Y=0.375 (FPG) +0.739 (base SBP) -2.676, the accuracy rate is 71.2%. 16-20 weeks serum inhibin A, basic DBP, pre pregnancy BMI joint prediction model is the highest (84.6%), the early prediction model will be applied to clinical further validation, it is expected to be a kind of economic, effective, and can be widely used in primary pre eclampsia prediction in grass-roots hospitals. Methods: to achieve early detection, early prevention, early supervision, early treatment, and ultimately reduce the incidence and mortality of hypertensive disorder complicating pregnancy in pregnant women.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.246

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