孕20周前妊娠期高血压孕妇常规检验指标的新临床意义研究

Study on the New Clinical Significance of Routine Indexes in Pregnant Women with HDP before 20 Weeks of Pregnancy

目的通过孕20周前妊娠期高血压疾病(HDP)孕妇及正常妊娠孕妇的生化、凝血、血细胞计数指标等常规检测项目的对比分析,研究其新临床意义,寻找早期预测HDP的标志物。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的孕妇的临床资料,按孕周、年龄匹配分为HDP组和对照组,分析两组孕20周前产检的相关检验指标。两组之间的变量采用Kolmogorov-Smirnov进行正态分布性分析,近似正态分布的计量资料数据用均数±标准差(珚x±s)表示,偏态分布用中位数及百分位数[M(P25~P75)]表示。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组生化指标AST,γ-GT和UA均高于正常组,差异具有统计学意义(t=2.50,3.34,4.56,均P<0.05);同时HDP组血细胞计数指标RBC,PLT和HCT均显著高于正常组,差异具有统计学意义(t=3.29,4.51,2.89,均P<0.01)。而两组孕妇其余指标(ALT,TBIL,Cr,Urea,PT,APTT,TT,FIB和HGB)比较,差异无统计学意义(t=0.25~1.85,均P>0.05)。预测Logistic回归模型:Y=-5.497+0.010*PLT+0.043*γ-GT+0.007*UA+0.045*AST。PLT,γ-GT,UA和AST四个变量联合检测用于预测HDP的敏感度为0.818,特异度为0.523,AUC为0.746。结论孕20周前,HDP孕妇与正常孕妇相比,肝肾功能受损及血液高凝状态明显,临床上可通过联合检测AST,γ-GT,UA和PLT,提高早期妊娠期高血压疾病诊断效能,优于各单项目检测。

Objective To explore the new clinical significance of these routine test indexes and find the early biomarkers for predicting hypertension disorder complicating pregnancy（HDP）by the comparative analysis between pregnant women with HDP and normal pregnant women before 20 weeks,including biochemical,blood coagulation and blood routine indexes.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 were divided into HDP group and control group according to the gestational week and age.Analyzed the related test indexes before20 weeks of pregnancy.The two groups variables were analyzed by Kolmogorov-Smirnov for normal distribution.Approximate measurement data of normal distribution were mean±standard deviation（珚x±s）for statistical description,while the data of the skewed distribution was median and percentile[M（P25-P75）]for statistical description.The diagnostic value was analyzed by logistic regression equation and receiver operating characteristic curves（ROC）.Results The level of biochemical indexes（AST,γ-GT and UA）of HDP group was significantly higher than the normal group（t=2.50,3.34,4.56,P〈0.05）.Meanwhile the level of blood indexes（RBC,PLT and HCT）of HDP group was significantly higher than the normal group（t=2.89,4.51,3.29,all P〈0.01）.Other indicators of two groups（ALT,TBIL,Cr,Urea,PT,APTT,TT,FIB and HGB）were not significantly different（t=0.25-1.85,all P〉0.05）.Then the logistic regression model equation was Y=-5.497＋0.010＊PLT＋0.043＊γ-GT＋0.007＊UA＋0.045＊AST.The area under ROC curve（AUC）was 0.746 for the combination of the four indexes.The combination resulted in a higher sensitivity of 0.818 and specificity of 0.523.Conclusion Before 20 weeks of gestation,compared with normal group,liver and kidney function in patients with HDP and high blood coagulation state was damaged.Can by combined detection of AST,UA,γ-GT and PLT index,early prevention and diagnosis of gestational hypertension,effective intervention measures taken as soon as possible to improve the prognosis of pregnancy.