三酰甘油、凝血酶原时间、尿酸联合检测在子痫前期诊断中的应用
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摘要
目的对84例子痫前期患者和健康孕产妇部分实验室指标进行比较分析,探讨其临床意义。方法选择2014年6月至2017年10月该院收治的子痫前期患者84例作为病例组,并为每例子痫前期患者选取3例健康孕产妇作为对照组。采用t检验对相关实验室指标进行组间比较,采用条件logistics回归模型分析子痫前期的独立影响指标,采用受试者工作特征(ROC)曲线分析多指标联合应用对子痫前期的诊断价值。结果子痫前期患者三酰甘油(TG)、尿酸(UA)水平[分别为(1.86±0.77)mmol/L、(299.36±77.07)μmol/L]均显著高于对照组[分别为(1.50±0.61)mmol/L、(247.02±57.04)μmol/L],差异均有统计学意义(t=4.37、5.72,P=0.001);血小板计数(PLT)、凝血酶原时间(PT)水平[分别为(211.65±49.70)×109/L、(11.80±3.47)s]均显著低于对照组[分别为(227.06±51.00)×109/L、(13.64±3.85)s],差异均有统计学意义(t值为-2.41、-3.89,P值为0.016、0.001)。两组患者其他实验室指标比较,差异均无统计学意义(P>0.05)。TG、PT、UA是子痫前期的独立影响因素(OR:1.941、0.928、0.994,95%CI:1.317～2.862、0.871～0.989、0.991～0.998)。TG、PT、UA联合诊断子痫前期的ROC曲线下面积分别为0.872,而TG、PT、UA单独诊断子痫前期ROC曲线下面积分别为0.830、0.653和0.750,联合检测效果更好。结论 TG、PT、UA是孕产妇子痫前期症状的独立预测指标,TG、PT、UA联合检测对子痫前期的诊断效果更好。
Objective To explore the clinical significance of some laboratory indicators in pre-eclampsia and provide evidence for early pre-eclampsia diagnosis.Methods 84 cases of pre-eclampsia patients were selected as observation group,and according to the similar age and gestational age,3 healthy pregnant woman was chosen as the control case for each of preeclampsia patients,from 2014.6 to 2017.10.The statistical difference of the indicators between the two groups was compared with the ttest.The Conditional Logistic regression method was used to analyze the independent influence index of preeclampsia.The ROC curve was used to analysis the value of diagnosis with Multiple laboratory indexes.Results Univariate analysis showed that pre-eclampsia patients had higher TG levels(1.86±0.77)mmol/L than control group(1.50±0.61)μmol/L(t=4.37,P=0.001).The UA level of pre-eclamptic patients(299.36±77.07)mmol/L was higher than the control group(247.02±57.04)μmol/L(t=5.72,P=0.001).The PLT level in patients was(211.65±49.70)×109/L lower than that in the control group(227.06±51.00)×109/L(t=-2.41,P=0.016).The pre-eclamptic patients had a lower PT level(11.80±3.47)s than the control group(13.64±3.85)s(t=-3.89,P=0.001).The level of other laboratory indicators in patients was not statistically different between the two groups(P>0.05).Multivariate analysis showed that TG,PT,and UA were independent factors of preeclampsia.The OR(95%CI)were 1.941(1.317,2.862),0.928(0.871,0.989),and 0.994(0.991,0.998),respectively.The area under the ROC curve for the combined diagnosis was 0.872,while the areas for TG,PT,and UA alone diagnosis were 0.830,0.653,and 0.750,the combined detection effect was better.Conclusion TG,PT,UA are important indicators of the preeclampsia,Joint application of three indicators in the diagnosis of preeclampsia is of great significance.TG,PT and UA were independent predictors of preeclampsia symptoms.The ROC curve suggested that combined detection of TG,PT,and UA had better diagnostic effects on preeclampsia.
Objective To explore the clinical significance of some laboratory indicators in pre-eclampsia and provide evidence for early pre-eclampsia diagnosis.Methods 84 cases of pre-eclampsia patients were selected as observation group,and according to the similar age and gestational age,3 healthy pregnant woman was chosen as the control case for each of preeclampsia patients,from 2014.6 to 2017.10.The statistical difference of the indicators between the two groups was compared with the ttest.The Conditional Logistic regression method was used to analyze the independent influence index of preeclampsia.The ROC curve was used to analysis the value of diagnosis with Multiple laboratory indexes.Results Univariate analysis showed that pre-eclampsia patients had higher TG levels(1.86±0.77)mmol/L than control group(1.50±0.61)μmol/L(t=4.37,P=0.001).The UA level of pre-eclamptic patients(299.36±77.07)mmol/L was higher than the control group(247.02±57.04)μmol/L(t=5.72,P=0.001).The PLT level in patients was(211.65±49.70)×109/L lower than that in the control group(227.06±51.00)×109/L(t=-2.41,P=0.016).The pre-eclamptic patients had a lower PT level(11.80±3.47)s than the control group(13.64±3.85)s(t=-3.89,P=0.001).The level of other laboratory indicators in patients was not statistically different between the two groups(P>0.05).Multivariate analysis showed that TG,PT,and UA were independent factors of preeclampsia.The OR(95%CI)were 1.941(1.317,2.862),0.928(0.871,0.989),and 0.994(0.991,0.998),respectively.The area under the ROC curve for the combined diagnosis was 0.872,while the areas for TG,PT,and UA alone diagnosis were 0.830,0.653,and 0.750,the combined detection effect was better.Conclusion TG,PT,UA are important indicators of the preeclampsia,Joint application of three indicators in the diagnosis of preeclampsia is of great significance.TG,PT and UA were independent predictors of preeclampsia symptoms.The ROC curve suggested that combined detection of TG,PT,and UA had better diagnostic effects on preeclampsia.
引文
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[15]熊钰,楼懿婷,蔡旭,等.子痫前期孕妇分娩前后出凝血功能动态改变[J].中国实用妇科与产科杂志,2013,29(3):200-203.
[16]刘晓洁,韩磊,韩健,等.子痫前期孕妇凝血功能及血小板变化的研究[J].第三军医大学学报,2014,36(9):962-965.
[2]祝明.某区妊娠期高血压疾病的流行病学调查及其相关危险因素分析[J].中国医药指南,2016,14(24):146-147.
[3]郭冰杰,杨彩梅.子痫前期孕妇的血脂、血糖与维生素A、E的水平及其临床意义[J].广西医学,2017,39(10):1474-1476.
[4]李小叶,唐雅兵.子痫前期孕妇血清以及胎盘组织中ITGB1的表达及临床意义[J].实用医学杂志,2017,33(19):3263-3266.
[5]庄艳艳.子痫前期患者组织中晚期氧化蛋白产物水平测定及意义[D].广州:南方医科大学,2012.
[6]华绍芳,李月琴.早发子痫前期患者血浆胎盘生长因子水平与围生结局的研究[J].实用妇产科杂志,2017,33(10):768-771.
[7]杨孜.子痫前期多因素发病及多机制发病通路之综合征再认识[J].中华医学杂志,2015,95(1):7-9.
[8]谢幸,苟文丽.妇产科学[M].北京:人民卫生出版社,2013:64-66.
[9]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志,2015,50(10):721-728.
[10]苏秀梅,李林娜.妊娠晚期血脂水平与不同类型子痫前期相关性分析[J].中山大学学报(医学科学版),2016,37(3):428-432.
[11]王贺.孟涛.血脂代谢异常与子痫前期发病类型的关系[J].中国妇幼保健,2013,28(23):3755-3757.
[12]钱宇佳,贾瑞喆,刘晓梅,等.子痫前期患者肾功能损害及其与血流动力学变化的关系[J].实用妇产科杂志,2012,28(9):751-754.
[13]CROWLEY S D,ZHANG J,HERRERA M,et al.Role of AT1receptor-mediated salt retention in angiotensin II-dependent hypertension[J].Am J Physiol Renal Physiol,2011,301(5):F1124-1130.
[14]徐飞,马月丽,阮红杰.子痫前期患者肾功能的评价及其临床意义[J].江苏医药,2015,41(4):420-422.
[15]熊钰,楼懿婷,蔡旭,等.子痫前期孕妇分娩前后出凝血功能动态改变[J].中国实用妇科与产科杂志,2013,29(3):200-203.
[16]刘晓洁,韩磊,韩健,等.子痫前期孕妇凝血功能及血小板变化的研究[J].第三军医大学学报,2014,36(9):962-965.