在临床实践中,最终发展为先兆子痫(PE)的女性常发生异常生化变化.该研究旨在探讨孕早期孕妇血清生化指标是否可以预测PE和新生儿出生体重。
对287名随后发展为PE的女性(轻度=139;重度=148)和143名健康女性进行了回顾性病例对照研究。在妊娠早期(28.49±1.63周)抽取所有孕妇的空腹静脉血样本进行常规生化指标筛查。选择合适的统计学方法,用SPSS软件进行分析。
(1)血浆甘油三酯(TG)的浓度,低密度脂蛋白胆固醇(LDL),与正常妊娠组的相应水平相比,PE组的重度和轻度亚组的尿酸(UA)显着升高(3.90vs.4.03vs.3.14mmol/L;3.41vs.3.33vs.2.89mmol/L;365.42vs.318.91vs.284.69μmol/L;p<0.0001)。PE组血清钙水平显著低于对照组(2.10vs.2.18vs.2.22mmol/L;p<0.0001)。(2)利用受试者工作特性曲线估计各标志物筛查PE的诊断率,最高的灵敏度出现在TG的组合,总胆固醇(TC),LDL,高密度脂蛋白胆固醇(HDL),LDL/HDL,UA,Ca2+,和高半胱氨酸(HCY)(79%)。UA的曲线下面积(AUC)为0.70,在这8个标记中最高,但8-标记组合模型的AUC(0.85)具有更好的诊断指征.(3)在体育,最大收缩压/舒张压与血清UA呈正相关(r=0.212/0.205,p<0.0001),与血清总钙呈负相关(r=-0.193/-0.196,p=0.001)。PE组新生儿出生体重与血清TG水平(r=0.141,p=0.017)和血清总钙水平(r=0.221,p<0.0001)呈正相关,与UA水平呈负相关(r=-0.265,p<0.0001)。
个体标记在预测PE方面确实表现得很糟糕。这些参数的联合监测和评估可以提高筛查效率,以早期预测PE和胎儿生长不良。
In clinical practice, abnormal biochemical changes often occur in women who eventually develop preeclampsia (PE). The study aims to investigate whether maternal serum biochemical markers in the early third trimester can predict PE and neonatal birth weight.
A retrospective
case-control study was performed on 287 women who subsequently developed PE (mild = 139; severe = 148) and 143 healthy women. Fasting venous blood samples of all gravidas were drawn for routine biochemical markers screening in the early third trimester (28.49 ± 1.63 weeks). Appropriate statistical methods were selected for analysis with SPSS software.
(1) The concentrations of plasma triglyceride (TG), low-density lipoprotein cholesterol (LDL), and uric acid (UA) in the severe and mild subgroups of the PE group were significantly higher compared with the respective levels in the normal pregnancy groups (3.90 vs. 4.03 vs. 3.14 mmol/L; 3.41 vs. 3.33 vs. 2.89 mmol/L; 365.42 vs. 318.91 vs. 284.69 μmol/L; p < 0.0001). Serum calcium levels in PE group were significantly lower than those in control group (2.10 vs. 2.18 vs. 2.22 mmol/L; p < 0.0001). (2) By using the receiver operating characteristic curve to estimate the diagnosis rate of screening for PE of each marker, the highest sensitivity appeared by the combination of TG, total cholesterol (TC), LDL, high-density lipoprotein cholesterol (HDL), LDL/HDL, UA, Ca2+, and homocysteine (HCY) (79%). The area under curve (AUC) of UA was 0.70, which was the highest among these eight markers, but the AUC of an eight-marker combination model (0.85) had a better diagnostic indication. (3) In PE, the maximum systolic/diastolic blood pressure was significantly positively correlated with serum UA (r = 0.212/0.205, p < 0.0001); and negatively correlated with serum total calcium (r = -0.193/-0.196, p = 0.001). The neonatal birth weight of PE group had a positive correlation with serum TG levels (r = 0.141, p = 0.017) and serum total calcium levels (r = 0.221, p < 0.0001), and a negative correlation with UA levels (r = -0.265, p < 0.0001).
The individual marker really performs terrible in predicting PE. Joint monitoring and evaluation of these parameters may improve the screening efficiency for the prediction of PE and poor fetal growth early.