妊娠期高血压疾病预测方法的对比研究

A contrast study on different predicting methods for hypertensive disorders complicating pregnancy

目的 探讨6项指标联合预测孕妇发生妊娠期高血压疾病的临床可行性,了解其预报的灵敏度及特异度.方法 对妊娠14～28w的446名孕妇进行血β-绒毛膜促性腺激素、红细胞比容、平均动脉压、外周血管阻力、波形系数、体重指数共6项指标的测定.结果 6项指标联合阳性预测值为93.33%、阴性预测值为98.14%;6项指标联合预测组的阳性预测值明显高于其他各组,差异具有显著性（均P＜0.05）;无创检测（用妊娠期高血压疾病检测仪检测）联合血β-绒毛膜促性腺激素阳性预测值为57.69%、阴性预测值为98.33%;无创检测联合红细胞比容阳性预测值为64.00%、阴性预测值为98.57%;无创检测阳性预测值为64.29%,阴性预测值为99.04%,无创检测联合单项指标未能提高阳性预测值,差异无显著性（均P＞0.05）.结论 在基层医院应用检测仪即能较好的预测妊娠期高血压疾病,对妊娠期高血压疾病检测仪筛查出来的阳性孕妇再增加血β-绒毛膜促性腺激素、红细胞比容等6项指标联合预测,则可提高阳性预测值,更利于进行早期干预性治疗和围产期监护.

Objective To investigate clinical feasibility of combined detections of human chorionic gonadotrophin （hCG）, hematocrit （HCT）, and measurement of mean arterial pressure （MAP）, peripheral vascular resistance, waveform coefficient and body mass index （BMI） for predicting incidence of hypertensive disorders complicating pregnancy, and to compare its sensitivity and specificity with other predicting methods. Methods 446 pregnant women who were in 14-28 weeks of gestation were enrolled in the study. All of them were asked to detect serum hGG and HCT, or measure MAP, peripheral vascular resistance, waveform coefficient and BMI. Sensitivity, specificity and predictive values were calculated for each detection or measurement. Results The positive predictive value and negative predictive value of the combined predicting methods were 93.33% and 98. 14% respectively. The positive predictive value of the combined predicting methods was significantly higher than other predicting methods （ all P 〈 0.05 ）. The positive predictive value and negative predictive value of noninvasive hypertensive disorder complicating pregnancy （HDCP） examination apparatus （ noninvassive method in brief） combined with serum detection of hCG were 57.69% and 98.33% respectively. The positive predictive value and negative predictive value of noninvasive method combined with detection of serum HCT were 64% and 98.57% respectively. The positive predictive value and negative predictive value of noninvasive method alone were 64.29% and 99.04% respectively. The noninvasive method combined with other single predicting methods failed to improve the positive predictive value, and there were no significant differences between the other groups （ all P 〉 0.05 ）. Conclusion In local hospitals, noninvasive HDCP examination apparatus can better predict HDCP. The positive preditctive value could be improved if the combined six indexes predicting methods such as serum detection of 13-hCG and HCT combined with the noninvassive predicting methods are used for those positive pregnant women screened by the noninvassive predicting methods, which is more helpful to perform early interventive treatment and prenatal monitoring.