妊娠高血压综合征Leptin和CPR及β-HCG联合检测诊断效能分析
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摘要
目的妊娠高血压综合征是我国孕产妇及新生儿病死率升高的原因之一,故提高妊娠高血压综合征的早期生物学标志物对其早期干预和治疗有重要意义。本研究探讨瘦素(Leptin)、C-反应蛋白(C-reactive protein,CRP)和人绒毛膜促性腺激素(human chorionic gonadotropin,β-HCG)联合检测对妊娠高血压综合征的诊断价值,为妊娠高血压综合征的早期筛查提供有效方法。方法选择2016-01-01-2017-08-31新疆维吾尔自治区职业病医院妇产科就诊的妊娠高血压综合征患者40例,选择同院同期产检并生产的健康妊娠妇女50名及体检的非妊娠妇女50名作为研究对象,采用酶联免疫吸附测定法(enzyme-linked immuno sorbent assay,ELISA)分别对三组研究对象进行瘦素、CRP和β-HCG检测,采用方差分析和ROC曲线对其诊断价值进行分析。结果妊娠高血压综合征组Leptin水平为(44.44±5.22)ng/mL,健康妊娠组为(38.87±3.99)ng/mL,非妊娠组为(10.09±2.90)ng/mL,差异有统计学意义,F=11.433,P<0.001;CRP妊娠高血压综合征组为(10.22±1.10)mg/L,健康妊娠组为(6.99±0.12)mg/L,非妊娠组为(0.89±0.10)mg/L,差异有统计学意义,F=5.981,P=0.018;β-HCG妊娠高血压综合征组为(70.12±9.65)mIU/mL,健康妊娠组为(62.04±4.10)mIU/mL,非妊娠组为(1.09±0.21)mIU/mL,差异有统计学意义,F=14.876,P<0.001。三项指标对妊娠高血压综合征均有一定的筛查能力,其中CRP效能最高。三项指标联合试验灵敏度为1,特异度为0.660。CRP+β-HCG联合试验灵敏度为0.975,特异度为0.800,Kappa值最高。结论 Leptin、CPR和β-HCG三项指标均有一定诊断效能,CRP+β-HCG并联试验可提高诊断效能。
OBJECTIVE Pregnancy-induced hypertension syndrome is one of the reasons for increase of the maternal and neonatal mortality in our country.So it is of great significance to improve the early diagnosis level in hypertensive disorder complicating pregnancy(HDCP).The study is to discuss the diagnostic value of combined detection of Leptin,Creactive protein(CRP)andβhuman chorionic gonadotropin(β-HCG)in the HDCP,and to provide an effective method for diagnosis of HDCP.METHODS 40 cases of HDCP,50 cases of healthy pregnancy and 50 cases of non-pregnant women were randomly selected as study objects from January 1,2016 to August 31,2017.The enzyme immunoassay method was used to test the Leptin,CRP andβ-HCG,variance analysis and ROC curve was used to analyze the diagnostic value.RESULTS Leptin levels in the three groups were respectively(44.44±5.22),(38.87±3.99)and(10.09±2.90)ng/ml,with statistically significant differences(F=11.433,P<0.001).CRP were(10.22±1.10),(6.99±0.12)and(0.89±0.10)mg/L,respectively,with statistically significant differences(F=5.981,P=0.018).β-HCG were(70.12±9.65),(62.04±4.10)and(1.09±0.21)mIU/ml,respectively,with statistically significant differences(F=14.876,P<0.001).The three indicators had certain screening ability for pregnancy-induced hypertension syndrome,among which CRP had the highest efficacy.The sensitivity and specificity of the combined test were 1 and 0.660,respectively.The sensitivity and specificity of CRP andβ-HCG combined test were 0.975 and 0.800,respectively,and the kappa value was the highest.CONCLUSIONS Leptin,CRP andβ-HCG have certain diagnostic efficacy.The combined detection of CRP andβ-HCG can improve the diagnostic efficiency.
OBJECTIVE Pregnancy-induced hypertension syndrome is one of the reasons for increase of the maternal and neonatal mortality in our country.So it is of great significance to improve the early diagnosis level in hypertensive disorder complicating pregnancy(HDCP).The study is to discuss the diagnostic value of combined detection of Leptin,Creactive protein(CRP)andβhuman chorionic gonadotropin(β-HCG)in the HDCP,and to provide an effective method for diagnosis of HDCP.METHODS 40 cases of HDCP,50 cases of healthy pregnancy and 50 cases of non-pregnant women were randomly selected as study objects from January 1,2016 to August 31,2017.The enzyme immunoassay method was used to test the Leptin,CRP andβ-HCG,variance analysis and ROC curve was used to analyze the diagnostic value.RESULTS Leptin levels in the three groups were respectively(44.44±5.22),(38.87±3.99)and(10.09±2.90)ng/ml,with statistically significant differences(F=11.433,P<0.001).CRP were(10.22±1.10),(6.99±0.12)and(0.89±0.10)mg/L,respectively,with statistically significant differences(F=5.981,P=0.018).β-HCG were(70.12±9.65),(62.04±4.10)and(1.09±0.21)mIU/ml,respectively,with statistically significant differences(F=14.876,P<0.001).The three indicators had certain screening ability for pregnancy-induced hypertension syndrome,among which CRP had the highest efficacy.The sensitivity and specificity of the combined test were 1 and 0.660,respectively.The sensitivity and specificity of CRP andβ-HCG combined test were 0.975 and 0.800,respectively,and the kappa value was the highest.CONCLUSIONS Leptin,CRP andβ-HCG have certain diagnostic efficacy.The combined detection of CRP andβ-HCG can improve the diagnostic efficiency.
引文
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[10]刘炳刚,李虹,刘大庆.血清瘦素、胱抑素C和人绒毛膜促性腺激素在妊娠高血压综合征检测中的意义[J].临床和实验医学杂志,2015,14(1):12-14.
[11]Komurcu-Bayrak E,Erginel-Unaltuna N,Onat A,et al.Association of C-reactive protein(CRP)gene allelic variants with serum CRP levels and hypertension in Turkish adults[J].Atherosclerosis,2009,206(2):474-479.
[12]杨芳,刘虎.炎性因子联合检测应用于评估妊娠期高血压疾病预后的临床意义[J].齐齐哈尔医学院学报,2017,38(7):768-770.
[13]邝苑丽.妊高症孕妇血清中超敏CRP、尿酸、钙离子的变化规律及其临床意义分析[J].中国实用医药,2016,11(19):120-121.
[14]洪映玲.妊娠高血压综合征患者检测血HCG的临床意义[J].吉林医学,2014,35(2):328-329.
[15]Revankar VM,Narmada L.Assessment of serumβ-hCG and lipid profile in early second trimester as predictors of hypertensive disorders of pregnancy[J].Int J Gynaecol Obstet,2017,138(3):331-334.
[16]Vest AR,Cho LS.Hypertension in pregnancy[J].Curr Atheroscler Rep,2014,16(3):395.
[17]栗庆华.妊娠高血压综合征筛查及早期预防在围产期保健中的应用价值研究[J].临床医药实践,2018,27(5):350-352.
[2]王万里,励银环,郭迎春,等.妊高症患者心功能损伤程度与血浆NT-proBNP水平的相关性[J].基因组学与应用生物学,2018,37(3):956-962.
[3]苏丽花.优质护理在妊高症产妇产后出血护理中的应用[J].临床合理用药杂志,2016,9(28):147-148.
[4]Zeng Y,Li M,Yue C,et al.Homocysteine,endothelin-1and nitric oxide in patients with hypertensive disorders complicating pregnancy[J].Int J of Clin Exp Path,2015,8(11):15275.
[5]樊秦娥,吴立兵,刘雪琴,等.妊娠高血压患者血清瘦素、Cys C及β-HCG水平检测的临床意义[J].现代生物医学进展,2016,16(5):910-912.
[6]Andersson UH,Svedin P,Andreasson U,et al.Central and peripheral leptin and agouti-related protein during and after pregnancy in relation to weight change[J].Clin Endocrinol,2017,88(2):263-271.
[7]温小刚,胡初娇,王午英.妊高症孕妇血清CRP、尿酸、钙离子检测的临床意义[J].实验与检验医学,2015,33(3):322-324.
[8]Makles H,Wilczyński JR.Cerebroplacental ratio(CPR)and amniotic fluid index(AFI)as prognostic factors of terminating pregnancy with cesarean section after induction of labour[J].Pol Merkur Lekarski,2017,43(257):203-206.
[9]Duan H,Zhao G,Xu B,et al.Maternal serum PLGF,PAPPA,β-hCG and AFP levels in early second trimester as predictors of preeclampsia[J].Clin Lab,2017,63(5):921-926.
[10]刘炳刚,李虹,刘大庆.血清瘦素、胱抑素C和人绒毛膜促性腺激素在妊娠高血压综合征检测中的意义[J].临床和实验医学杂志,2015,14(1):12-14.
[11]Komurcu-Bayrak E,Erginel-Unaltuna N,Onat A,et al.Association of C-reactive protein(CRP)gene allelic variants with serum CRP levels and hypertension in Turkish adults[J].Atherosclerosis,2009,206(2):474-479.
[12]杨芳,刘虎.炎性因子联合检测应用于评估妊娠期高血压疾病预后的临床意义[J].齐齐哈尔医学院学报,2017,38(7):768-770.
[13]邝苑丽.妊高症孕妇血清中超敏CRP、尿酸、钙离子的变化规律及其临床意义分析[J].中国实用医药,2016,11(19):120-121.
[14]洪映玲.妊娠高血压综合征患者检测血HCG的临床意义[J].吉林医学,2014,35(2):328-329.
[15]Revankar VM,Narmada L.Assessment of serumβ-hCG and lipid profile in early second trimester as predictors of hypertensive disorders of pregnancy[J].Int J Gynaecol Obstet,2017,138(3):331-334.
[16]Vest AR,Cho LS.Hypertension in pregnancy[J].Curr Atheroscler Rep,2014,16(3):395.
[17]栗庆华.妊娠高血压综合征筛查及早期预防在围产期保健中的应用价值研究[J].临床医药实践,2018,27(5):350-352.