动态血压监测预测妊娠期高血压疾病的价值

Predictive value of 24-hour ambulatory blood pressure monitoring for hypertensive disorder complicating pregnancy

目的了解动态血压监测对妊娠期高血压疾病的预测价值。方法对350例孕妇在21-27孕周进行24小时动态血压监测，分析妊娠结局与动态血压监测指标的关系。结果323例孕妇中有28例发生妊娠期高血压疾病，为妊娠期高血压疾病组，其余295例患者为对照组。妊娠期高血压疾病组患者与对照组比较，24小时血压平均值（收缩压t=13．69、舒张压t=13．58、平均动脉压t=13．80），日均血压值（收缩压t=13．12、舒张压t=9．32）及夜均血压值（收缩压t=10．27、舒张压t=13．56）均有极显著性差异（P〈0．01）。以24小时平均舒张压等于8．9kPa为切点预测妊娠期高血压疾病敏感性为85．7％；特异性为94．6％；以24小时平均动脉压等于11．2kPa为切点预测妊娠期高血压疾病敏感性为89．3％；特异性为93．9％。结论在孕中期，利用动态血压监测的24小时平均舒张压和24小时平均动脉压均可较好的预测妊娠期高血压疾痛。

Objective To investigate predictive value of 24-hour ambulatory blood pressure monitoring for hypertensive disorder complicating pregnancy（HDCP）. Methods 350 pregnant women received 24-hour ambulatory blood pressure monitoring at their 21 -27 weeks of gestation. All pregnant women were followed-up longitudinally until post-partum. The relationship between pregnancy outcomes and ABPM indexes was analyzed. Results Among 323 pregnant, 28 pregnant women with HDCP were assigned to the HDCP group and the rest 295 normal pregnant women were assigned to the control group. The mean 24-hour blood pressure （ for systolic blood pressure ： t = 13.69; for diastolic blood pressure： t = 13.58; for mean arterial pressure： t = 13.80） and men day blood pressure （for systolic blood pressure： t = 13.12 ,for diastolic blood pressure： t = 9.32） and men night blood pressure （for systolic blood pressure： t = 10.27; for diastolic blood pressure ： t = 13.56 ） were significantly higher than those in the control group （ P 〈 0. 01 ）. If the cut-off level of mean 24-hour diastolic blood pressure was determined as 8.9kPa, the sensitivity for prediction of HDCP was 85.7% and the specificity was 94.6%. If the cut-off level of mean 24-hour arterial pressure was determined as11.2kPa, the sensitivity for prediction of HDCP was 89.3% and the specificity was 93.9%. Conclusion In the second trimester of pregnancy, mean 24-hour diastolic blood pressure and 24-hour mean arterial pressure by ambulatory bood pressure momitoring can predict HDCP reliably.