| 王之信,周萍.24 h 尿蛋白、胱抑素C、D-二聚体及超敏C-反应蛋白与妊娠期高血压疾病严重程度的相关性及对不良妊娠结局的预测价值[J].安徽医药,2022,26(8):1584-1589. |
| 24 h 尿蛋白、胱抑素C、D-二聚体及超敏C-反应蛋白与妊娠期高血压疾病严重程度的相关性及对不良妊娠结局的预测价值 |
| Relationship between 24 h urinary protein, cystatin C, D-dimer and hypersensitive C-reactive protein (hs-CRP) and the severity of hypertensive disorder complicating pregnancy and the predictive value for adverse pregnancy outcomes |
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| DOI：10.3969/j.issn.1009-6469.2022.08.023 |
| 中文关键词: 高血压，妊娠性 胱抑素C D-二聚体 超敏C-反应蛋白 妊娠结局 |
| 英文关键词: Hypertension,pregnancy-induced Cystatin C D-dimer Hypersensitive C-reactive protein Pregnancy outcome |
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| 中文摘要: |
| 目的探讨24 h尿蛋白(24 h PRO)、胱抑素C(CysC)、D-二聚体(D-D)及超敏C-反应蛋白(hs-CRP)与妊娠期高血压疾病(HDP)严重程度的相关性及对不良妊娠结局的预测价值。方法选取2017年1月至2019年12月淮南市第一人民医院收治的190例HDP孕妇(其中妊娠期高血压组29例，子痫前期组96例，重度子痫前期组65例)作为HDP组，同时选取190例在淮南市第一人民医院正常产检并产生妊娠结局的孕妇作为对照组。检测两组24 h PRO、CysC、D-D、hs-CRP、血肌酐(Scr)、纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)以及尿素氮(BUN)水平，评估其与HDP严重程度的相关性，并建立预测模型评估其对不良妊娠结局的预测价值。结果HDP 组病人的24 h PRO［(1.03±0.80)g/24 h比(0.14±0.11)g/24 h］、CysC［(1.47±0.41)mg/L比(1.23±0.28)mg/L］、D-D［(760.12±275.43)μg/L比(530.98±109.20)μg/L］、hs-CRP［(7.08±3.56)mg/L比(4.01±2.02)mg/L］、Scr［(70.98±9.65)μmol/L比(69.12±8.23)μmol/L］及FIB［(4.40±0.77)g/L比(4.19±0.53)g/L］水平均高于对照组(P<0.05)，与疾病的严重程度呈正相关(rs =0.76，0.30、0.33、0.30、0.21、0.19，P<0.05)；PT［(10.05±1.09)s比(10.42±0.97)s］、APTT［(27.62±2.67)s比(28.19±2.17)s］及TT［(13.78±1.23)s比(14.08±1.26)s］水平低于对照组(P<0.05)，与病人疾病的严重程度呈负相关(rs =?0.22、?0.16、?0.17，P<0.05)。24 h PRO、CysC、D-D、hs-CRP、SCr、PT在HDP中不良妊娠结局组与正常妊娠结局组均差异有统计学意义(P<0.05)。多因素二元logistic回归分析显示24 h PRO、CysC、D-D及hs-CRP是HDP病人不良妊娠结局的独立影响因素(OR=1.98、5.38、1.00和1.28，P<0.05)。ROC曲线显示24 h PRO、CysC、D-D、hs-CRP及四项指标联合预测不良妊娠结局的曲线下面积(AUC)为72.0%、70.6%、74.6%、75.7%、86.7%。结论HDP病人24 h PRO、CysC、DD及hs-CRP水平同病情严重程度呈正相关，联合评估对于预测不良妊娠结局有一定的应用价值，临床工作中应密切监护上述指标的动态变化，评估病情进展。 |
| 英文摘要: |
| Objective To investigate the relationship between 24 h urinary protein (24 h PRO), cystatin C (CysC), D-dimer (D-D)and hypersensitive C-reactive protein (hs-CRP) and the progression of hypertensive disorder of pregnancy (HDP) and the clinical signifi?cance of evaluating pregnancy outcome.Methods A total of 190 pregnant women with HDP admitted to Huainan First People's Hospi?tal from January 2017 to December 2019 were selected as the HDP group (including 29 cases in gestational hypertension group, 96 cas?es in preeclampsia group, and 65 cases in severe preeclampsia group). Meanwhile, 190 patients with normal prenatal examination and pregnancy outcome in our hospital were selected as the control group. The 24 h PRO, CysC, D-D, hs-CRP, urea nitrogen (BUN), serum creatinine (Scr), fibrinogen (FIB), prothrombin time (PT), thrombin time (TT), activated partial prothrombin time (APTT) of all the sub?jects were tested, and their associations with the severity of hypertensive disorder complicating pregnancy,and the predictive model was established to evaluate its predictive value for adverse pregnancy outcomes were assessed.Results The levels of 24 h PRO [(1.03±0.80) g/24 h vs. (0.14±0.11) g/24 h], CysC [(1.47±0.41) mg/L vs. (1.23±0.28) mg/L], D-D [(760.12±275.43) μg/L vs. (530.98±109.20) μg/L], hs-CRP [(7.08±3.56) mg/L vs. (4.01±2.02) mg/L], Scr [(70.98±9.65) μmol/L vs. (69.12±8.23) μmol/L] and FIB [(4.40±0.77) g/L vs.(4.19±0.53) g/L] in the HDP group were higher than those in the control group (P < 0.05), which were positively correlated with the se?verity of disease (rs =0.76, 0.30, 0.33, 0.30, 0.21, 0.19, P<0.05); The levels of PT [(10.05±1.09) s vs. (10.42±0.97) s], APTT [(27.62±2.67) s vs. (28.19±2.17) s] and TT [(13.78±1.23) s vs. (14.08±1.26) s] were lower than those in the control group (P < 0.05), which were negatively correlated with the severity of disease (rs =?0.22,?0.16,?0.17,P<0.05). The 24 h PRO, CysC, D-D, hs-CRP, Scr and PT in HDP had statistically significant differences between the adverse pregnancy outcome group and the normal group (P<0.05). Multivariate binary logistic regression analysis showed that 24 h PRO, CysC, D-D and hs-CRP were independent influencing factors of adverse preg?nancy outcome in HDP group (OR=1.98, 5.38, 1.00 and 1.28, P<0.05). ROC curve analysis showed that the area under the curve (AUC)of 24 h PRO, CysC, D-D, hs-CRP and four indexes combined to predict adverse pregnancy outcome was 72.0 %, 70.6 %, 74.6 % ,75.7 % and 86.7 %.Conclusion The levels of 24 h PRO, CysC, D-D and hs-CRP in patients with HDP are positively correlated with the severity of the disease. The combined assessment has a certain application value in predicting adverse pregnancy outcomes, and the dynamic changes of the above indicators should be closely monitored in clinical work to evaluate the progress of the disease. |
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