血清CysC、PLT及RDW联合检测在HDP诊断中的价值
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摘要
目的探讨血清胱抑素C(Cys C)、血小板(PLT)与红细胞体积分布宽度(RDW)联合检测在妊娠期高血压(HDP)诊断的临床意义。方法采用病例-对照研究方法,查阅2012-2016年在广州市妇女儿童医疗中心产检并分娩孕妇的临床资料,按孕周、年龄匹配分为HDP组和对照组,分析两组孕20周前Cys C、PLT及RDW的水平。用Logistic回归模型绘制ROC曲线并计算曲线下面积(AUC),以评价各单项及联合指标的诊断价值。结果 HDP组血清门冬酸氨基转移酶、总胆汁酸、Cys C、PLT及RDW均高于正常组,差异有统计学意义(t=2.50、2.38、7.78、4.51、5.12,P均<0.05)。预测Logistic回归模型:Y=-11.927+0.017*PLT+0.338*RDW+4.728*Cys C。Cys C、PLT、RDW 3个变量联合检测用于预测HDP的敏感度为0.84,特异性为0.78,AUC为0.848,高于各指标单项检测的AUC(分别为0.744、0.654和0.682)。Pearson相关性分析显示,Cys C与RDW呈弱负相关(r=-0.24,P<0.01)。结论孕20周前,血清Cys C、PLT及RDW联合检测有助于提高早期妊娠期高血压诊断效能,优于各单项目检测。
Objective To explore the clinical significance of combined detection of serum cystatin C(Cys C),blood platelet(PLT)and red blood cell distribution width(RDW)in the diagnosis of hypertension disorders complicating pregnancy(HDP).Methods A case-control study was conducted to review the clinical data of pregnant women who were undertaken prenatal examination and delivered in Guangzhou women and children′s medical center from 2012 to 2016.The pregnancy divided into HDP group and control group according to the gestational week and age.The levels of Cys C,PLT and RDW were analyzed before 20 weeks of pregnancy.The diagnostic value was analyzed by logistic regression equation and receiver operating characteristic curves(ROC).Results The level of indexes(AST,TBA,Cys C,PLT,RDW)of HDP group was significantly higher than those of the normal group(t=2.50,2.38,7.78,4.51,5.12;P<0.05,P<0.05,P<0.01,P<0.01,P<0.01,respectively).The logistic regression model equation was Y=-11.927+0.017*PLT+0.338*RDW+4.728* Cys C.The area under ROC curve(AUC)was 0.848 for the combination of the three indexes and was higher than that of any single index.The combination resulted with a sensitivity of 0.84 and specificity of 0.78.Person correlation analysis showed Cys C was weakly and negatively associated with RDW(r=-0.24,P<0.01).Conclusion Before 20 weeks of gestation,the combined detection of Cys C,PLT and RDW is superior to a single index detection,which can significantly improve diagnostic efficiency for early HDP.
Objective To explore the clinical significance of combined detection of serum cystatin C(Cys C),blood platelet(PLT)and red blood cell distribution width(RDW)in the diagnosis of hypertension disorders complicating pregnancy(HDP).Methods A case-control study was conducted to review the clinical data of pregnant women who were undertaken prenatal examination and delivered in Guangzhou women and children′s medical center from 2012 to 2016.The pregnancy divided into HDP group and control group according to the gestational week and age.The levels of Cys C,PLT and RDW were analyzed before 20 weeks of pregnancy.The diagnostic value was analyzed by logistic regression equation and receiver operating characteristic curves(ROC).Results The level of indexes(AST,TBA,Cys C,PLT,RDW)of HDP group was significantly higher than those of the normal group(t=2.50,2.38,7.78,4.51,5.12;P<0.05,P<0.05,P<0.01,P<0.01,P<0.01,respectively).The logistic regression model equation was Y=-11.927+0.017*PLT+0.338*RDW+4.728* Cys C.The area under ROC curve(AUC)was 0.848 for the combination of the three indexes and was higher than that of any single index.The combination resulted with a sensitivity of 0.84 and specificity of 0.78.Person correlation analysis showed Cys C was weakly and negatively associated with RDW(r=-0.24,P<0.01).Conclusion Before 20 weeks of gestation,the combined detection of Cys C,PLT and RDW is superior to a single index detection,which can significantly improve diagnostic efficiency for early HDP.
引文
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[13]胡艳红,徐忠芳.妊娠期高血压疾病产妇围生期血液黏度与血小板参数的变化研究[J].中国医学创新,2016,13(19):95-97.Hu YH,Xu ZF.Study on the change of blood viscosity and platelet parameters of delivery women with hypertensive disorders in pregnancy during the perinatal period[J].Medical Innovation of China,2016,13(19):95-97.
[14]许超,张茵,冯香萍,等.红细胞分布宽度检测在妊娠期高血压疾病中的应用[J].海南医学,2015,26(24):3658-3660.Xu C,Zhang Y,Feng XP,et al.Application of detection of red blood cell distribution width in pregnancy hypertension disease[J].Hainan Med J,2015,26(24):3658-3660.
[2]李晓梅,李秀英,王鑫,等.单纯性子痫前期与慢性高血压并发子痫前期的临床对比分析[J].热带医学杂志,2016,16(12):1494-1497.Li XM,Li XY,Wang X,et al.Clinical comparative analysis of pure preeclampsia and chronic hypertension complicating preeclampsia[J].J Trop Med,2016,16(12):1494-1497.
[3]杨孜,张为远.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.Yang Z,Zhang WY.Guidelines for the diagnosis and treatment of hypertensive disorders in pregnancy(2015)[J].Chin JObstet Gynecol,2015,50(10):721-728.
[4]蒋晓岚,王翔,杨帆,等.妊娠合并肝功能异常260例临床分析[J].中国计划生育和妇产科,2016,8(7):22-25,33.Jiang XL,Wang X,Yang F,et al.A clinical analysis of 260cases of hepatic dysfunction during gestational period[J].Chinese Journal of Family Planning&Gynecotokology,2016,8(7):22-25,33.
[5]张伟龙,肖翔,潘理想,等.ADA与ALT、AST、GGT联合检测在肝脏疾病诊断的价值研究[J].中国实用医药,2017,12(1):53-55.Zhang WL,Xiao X,Pan LX,et al.Research of value by combined detection of ADA,ALT,AST and GGT in diagnosis of hepatic disease[J].China Prac Med,2017,12(1):53-55.
[6]姜帆,罗德梅.血清Cys-C、Hcy、NAG及m ALB水平检测诊断妊娠期高血压疾病早期肾损害的价值[J].中国妇幼保健,2017,32(15):3437-3439.Jiang F,Luo DM.Diagnostic value of measurement of serum levels of Cys-C,Hcy,NAG and m ALB in pregnancy induced hypertension syndrome with early kindy injury[J].Maternal and Child Health Care of China,2017,32(15):3437-3439.
[7]张丽岩,刘艳庚,颜媛.UTRF、ET-1和Cys C在诊断妊娠高血压患者早期肾功能损害中的价值[J].热带医学杂志,2015,15(12):1618-1621.Zhang LY,Liu YG,Yan Y.Significance of UTRF,ET-1 and Cys C in pregnancy-induced hypertension patients with renal impairment[J].J Trop Med,2015,15(12):1618-1621.
[8]Tsuboi S,Miyauchi K,Kasai T,et al.Impact of red blood cell distribution width on long-term mortality in diabetic patients after percutaneous coronary intervention[J].Circ J,2013,77(2):456-461.
[9]Molvarec A,Szarka A,Walentin S,et al.Serum leptin levels in relation to circulating cytokines,chemokines,adhesion molecules and angiogenic factors in normal pregnancy and preeclampsia[J].Reprod Biol Endocrinol,2011,9:124.
[10]高飞,郑浩,邱先桃,等.妊娠期糖尿病患者红细胞分布宽度及中性粒细胞/淋巴细胞比值分析[J].国际检验医学杂929志,2017,38(6):774-776.Gao F,Zheng H,Qiu XT,et al.Analysis on erythrocyte distribution width and neutrophil/lymphocyte ratio in patients with gestational diabetes mellitus[J].Int J Lab Med,2017,38(6):774-776.
[11]张玉鑫.外周血细胞与冠状动脉慢血流的相关性研究[D].郑州:郑州大学,2015.Zhang YX.Correlation on study between peripheral blood cells and slow coronary flow[D].Zhengzhou:Zhengzhou University,2015.
[12]郑红梅,张强,杨丽红,等.原发性高血压患者红细胞分布宽度与Framingham心血管病风险等级的关系[J].中华高血压杂志,2017,25(1):38-42.Zheng HM,Zhang Q,Yang LH,et al.Relationship between red blood cell distribution width and the risk levels of Framingham cardiovascular score in patients with essential hypertension[J].Chin J Hypertens,2017,25(1):38-42.
[13]胡艳红,徐忠芳.妊娠期高血压疾病产妇围生期血液黏度与血小板参数的变化研究[J].中国医学创新,2016,13(19):95-97.Hu YH,Xu ZF.Study on the change of blood viscosity and platelet parameters of delivery women with hypertensive disorders in pregnancy during the perinatal period[J].Medical Innovation of China,2016,13(19):95-97.
[14]许超,张茵,冯香萍,等.红细胞分布宽度检测在妊娠期高血压疾病中的应用[J].海南医学,2015,26(24):3658-3660.Xu C,Zhang Y,Feng XP,et al.Application of detection of red blood cell distribution width in pregnancy hypertension disease[J].Hainan Med J,2015,26(24):3658-3660.