【摘要】：目的:探討24h尿蛋白值在妊娠期高血壓疾病中的診斷價(jià)值以及重度子癇前期24h尿蛋白診斷標(biāo)準(zhǔn)與不良妊娠結(jié)局的關(guān)系,并在此基礎(chǔ)之上,進(jìn)一步尋求重度子癇前期24h尿蛋白診斷界值。方法:收集2012年12月至2013年10月期間在上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院產(chǎn)科分娩、資料齊全的65例妊娠期高血壓疾病(非慢性高血壓患者)作為病例組,并定義母兒出現(xiàn)的任何一項(xiàng)嚴(yán)重并發(fā)癥為不良妊娠結(jié)局,利用SPSS13.0軟件分析ACOG最新指南提出的子癇前期診斷標(biāo)準(zhǔn)進(jìn)行其與不良結(jié)局相關(guān)性的定性研究。然后收集2011年4月至2013年6月間在我院產(chǎn)科分娩的92例子癇前期患者的臨床資料,依據(jù)國(guó)內(nèi)外不同重度子癇前期尿蛋白的診斷標(biāo)準(zhǔn),利用SPSS13.0軟件分析母兒結(jié)局,進(jìn)行24h尿蛋白值與不良妊娠結(jié)局相關(guān)性的定量研究。最后,利用2012年12月至2013年10月期間在我院產(chǎn)科分娩的55例子癇前期患者的臨床資料,進(jìn)行定量研究結(jié)果的驗(yàn)證。結(jié)果:1、在定性研究中,65例妊娠期高血壓疾病患者中,不良妊娠結(jié)局者所占比例為63.1%(41/65),良好結(jié)局者則為36.9%(14/55)。不良結(jié)局的構(gòu)成多樣。24h尿蛋白值單獨(dú)診斷子癇前期及妊娠期高血壓患者的不良妊娠結(jié)局發(fā)生率存在顯著差異(P=0.000)。2、24h尿蛋白值是否超過(guò)0.3g與不良妊娠結(jié)局相關(guān)系數(shù)為0.557,屬于中度相關(guān),且該數(shù)值具有統(tǒng)計(jì)學(xué)意義。3、24h尿蛋白值與妊娠期高血壓疾病及子癇前期均相關(guān),且能得到logistic回歸方程。4、在定量研究中,92例子癇前期患者發(fā)生不良妊娠結(jié)局者所占比例為54%(50/92),良好結(jié)局者則為46%(42/92)。不良結(jié)局的構(gòu)成多樣。不同程度尿蛋白發(fā)生不良結(jié)局的概率均不相同,且存在顯著差異(P0.05)。5、當(dāng)24小時(shí)尿蛋白值為1g時(shí),其Youden指數(shù)最高為0.55,靈敏度及特異度相對(duì)較高。ROC曲線對(duì)應(yīng)的面積最大為0.777,最接近1。6、當(dāng)24小時(shí)尿蛋白值為3g時(shí),其陽(yáng)性預(yù)測(cè)值最高為90.32%,陽(yáng)性似然比相對(duì)應(yīng)最高位7.84。7、在驗(yàn)證研究中,55例子癇前期患者中輕度尿蛋白患者30例,重度尿蛋白患者25例。30例輕度尿蛋白患者中,不良妊娠結(jié)局者所占比例為56.7%(17/30),良好結(jié)局者則為43.3%(13/30)。25例重度子癇前期患者中,不良妊娠結(jié)局者所占比例為96%(24/25),良好結(jié)局者則為4%(1/25)。8、當(dāng)24h尿蛋白界值為3g時(shí),其所對(duì)應(yīng)的靈敏度為58.5%,特異度為92.9%,準(zhǔn)確度為67.2%,陽(yáng)性預(yù)測(cè)值為0.960,陰性預(yù)測(cè)值0.433,陽(yáng)性似然比12.949,陰性似然比0.447,診斷比值比18.353。ROC曲線下面積為0.807。結(jié)論:1、ACOG指南中子癇前期的診斷標(biāo)準(zhǔn)不適用于本研究病例,24h尿蛋白值應(yīng)作為診斷子癇前期的必要條件之一。2、24h尿蛋白值與妊娠不良結(jié)局相關(guān),可作為診斷重度子癇前期的獨(dú)立指標(biāo),且對(duì)于子癇前期不良妊娠結(jié)局的陽(yáng)性預(yù)測(cè)較高。3、建議將重度子癇前期24h尿蛋白值的診斷標(biāo)準(zhǔn)定為3g。4、若子癇前期患者24h尿蛋白值低于3g時(shí),應(yīng)結(jié)合血壓、肝腎功能等其他臟器情況進(jìn)行進(jìn)一步診治。
[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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