摘要
目的筛选血常规、肝肾功能、凝血功能及血脂检测中可用于辅助诊断子痫前期严重程度的指标并探讨其价值。方法选取2016年1月至2020年9月在广西壮族自治区河池市人民医院住院分娩的393例孕妇为研究对象,其中子痫前期组185例、重度子痫前期组208例,回顾性分析两组孕妇的一般临床资料及实验室检测指标,比较两组孕妇的差异性。采用Logistic回归筛选出重度子痫前期的独立影响指标,并用诊断试验与受试者工作特征曲线(ROC)分析血尿素氮(BUN)、D-二聚体(D-D)、胆固醇(CHOL)对子痫前期严重程度的辅助诊断价值。结果两组孕妇外周血血红蛋白、碱性磷酸酶、纤维蛋白原、活化部分凝血活酶时间比较差异均无统计学意义(P>0.05);重度子痫前期组孕妇的血小板计数、总蛋白、白蛋白、估算的肾小球滤过率、血钙水平分别为198.68(149.75,248.00)×10^(9)/L、(54.68±7.64)g/L、(30.49±5.15)g/L、(105.93±29.16)mL/(min·1.73 m^(2))、(2.05±0.27)mmol/L,明显低于子痫前期组的220.68(175.00,260.00)×10^(9)/L、(59.44±6.08)g/L、(33.88±4.01)g/L、(121.94±29.50)mL/(min·1.73 m^(2))、(2.16±0.23)mmol/L,而白细胞、谷草转氨酶、谷丙转氨酶、BUN、血肌酐、尿酸、乳酸脱氢酶、D-D、甘油三酯、CHOL水平分别为11.54(8.76,13.79)×10^(9)/L、62.78(19.00,41.00)U/L、41.26(12.00,32.25)U/L、5.05(3.54,5.92)mmol/L、71.58(52.75,81.25)μmol/L、(439.46±107.56)μmol/L、357.13(210.00,358.00)U/L、3.32(1.25,3.64)μg/mL、4.40(2.75,5.04)mmol/L、(6.90±2.07)mmol/L,明显高于子痫前期组的10.35(8.15,11.92)×10^(9)/L、29.33(16.00,27.00)U/L、23.77(10.00,21.00)U/L、3.69(2.84,4.28)mmol/L、55.63(44.00,66.50)μmol/L、(372.83±111.66)μmol/L、235.20(173.50,253.00)U/L、2.51(1.04,2.61)μg/mL、3.93(2.40,4.53)mmol/L、(5.72±1.47)mmol/L,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,BUN、D-D、CHOL是重度子痫前期的独立影响因素(OR=2.111、0.841、1.645,P<0.05);BUN、D-D、CHOL单独诊断重度子痫前期的AUC分别为0.705、0.583、0.673,三者联合诊断时AUC为0.811,特异度为86.42%,敏感度为66.00%。结论BUN、D-D和CHOL是重度子痫前期的独立影响因素,三者联合检测对重度子痫前期具有潜在的辅助诊断价值。
Objective To identify laboratory markers among blood routine,liver/kidney function,coagulation function,and blood lipid parameters variables that can be used for the diagnosis of severe preeclampsia.Methods We studied records of 393 women with preeclampsia in Department of Obstetrics,Hechi People’s Hospital located in Guangxi Zhuang Autonomous Region from January 2016 to September 2020,including 185 cases in the mild preeclampsia group and 208 cases in the severe preeclampsia group.The baseline characteristics and the laboratory parameters of blood of two groups were compared.Logistic regression method was used to analyze the independent influence index of severe preeclampsia.The diagnostic test and ROC analysis were used to analyze the assistant diagnostic value of urea nitrogen(BUN),D-Dimer(D-D),cholesterol(CHOL)for severe preeclampsia.Results There were no significant differences in blood hemoglobin(HGB),alkaline phosphatase(ALP),fibrinogen(FIB),activated partial thromboplastin time(APTT)between the two groups(P>0.05).In the severe preeclampsia group,the platelet count(PLT),total protein(TP),albumin(ALB),estimated glomerular filtration rate(eGFR),calcium(Ca)levels were 198.68(149.75,248.00)×10^(9)/L,(54.68±7.64)g/L,(30.49±5.15)g/L,(105.93±29.16)mL/(min·1.73 m^(2)),(2.05±0.27)mmol/L,respectively,significantly lower than 220.68(175.00,260.00)×10^(9)/L,(59.44±6.08)g/L,(33.88±4.01)g/L,(121.94±29.50)mL/(min·1.73 m^(2)),(2.16±0.23)mmol/L in the mild preeclampsia group,while the white blood cell(WBC),aspartate aminotransferase(AST),alanine aminotransferase(ALT),BUN,serum creatinine(CREA),uric acid(UA),lactate dehydrogenase(LDH),D-D,triglyceride(TG),CHOL levels were 11.54(8.76,13.79)×10^(9)/L,62.78(19.00,41.00)U/L,41.26(12.00,32.25)U/L,5.05(3.54,5.92)mmol/L,71.58(52.75,81.25)μmol/L,(439.46±107.56)μmol/L,357.13(210.00,358.00)U/L,3.32(1.25,3.64)μg/mL,4.40(2.75,5.04)mmol/L,(6.90±2.07)mmol/L,respectively,significantly higher than 10.35(8.15,11.92)×10^(9)/L,29.33(16.00,27.00)U/L,23.77(10.00,21.00)U/L,3.69(2.84,4.28)mmol/L,55.63(44.00,66.50)μmol/L,(372.83±111.66)μmol/L,235.20(173.50,253.00)U/L,2.51(1.04,2.61)μg/mL,3.93(2.40,4.53)mmol/L,(5.72±1.47)mmol/L in the mild preeclampsia group(P<0.05).Multivariate logistic regression analysis showed that BUN,D-D,and CHOL were independent factors associated with severe preeclampsia(OR=2.111,0.841,1.645,P<0.05).The results of diagnostic test and ROC analysis showed that the AUC of BUN,D-D,CHOL were 0.705,0.583,0.673,respectively,and combined detection of BUN,D-D,CHOL showed the highest auxiliary diagnostic value for the severe preeclampsia(AUC=0.811,specificity=86.42%,sensitivity=66.00%).Conclusion BUN,D-D and CHOL are independent influencing factors for severe preeclampsia and may have auxiliary diagnostic value for severity.
作者
刘倩
梁婵玉
朱燕莉
黄晓燕
孙波
赵卫华
LIU Qian;LIANG Chan-yu;ZHU Yan-li;HUANG Xiao-yan;SUN Bo;ZHAO Wei-hua(Department of Obstetrics,Shenzhen Second People’s Hospital,Shenzhen 518035,Guangdong,CHINA;Department of Obstetrics,Hechi People's Hospital,Hechi 547000,Guangxi,CHINA;Department of Obstetrics,Shenzhen Bao'an District Maternal and Child Health Hospital Affiliated to Jinan University,Shenzhen 518035,Guangdong,CHINA)
出处
《海南医学》
CAS
2022年第2期175-179,共5页
Hainan Medical Journal
关键词
子痫前期
血尿素氮
D-二聚体
胆固醇
受试者工作特征曲线
Preeclampsia
Blood urea nitrogen(BUN)
D-dimer(D-D)
Cholesterol(CHOL)
Receiver operator characteristic curve(ROC)
