妊娠末期红细胞压积及血浆白蛋白对重度子痫前期产后血压的影响

The effect of hematocrit and plasma albumin at the end of pregnancy on postpartum blood pressure in patients with severe preeclampsia

目的评价红细胞压积(HCT)与血浆白蛋白(ALB),以及它们之间的差值(HCT-ALB)对重度子痫前期患者产后产褥期血压高峰期(产后3～6天)血压的影响,初步探讨妊娠末期HCT、ALB对重度子痫前期患者产后产褥期血压升高的预测价值。方法选取2015年7月至2017年8月在东莞市妇幼保健院分娩的妇女243例,分为3组,第1组为正常妊娠组(1组,n=83),将产后收缩压<150 mm Hg和舒张压<100 mm Hg的患者纳入第2组(2组,n=79),产后收缩压≥150 mm Hg和(或)舒张压≥100 mm Hg的患者纳入为第3组(3组,n=81)。收集三个组患者产前同一时间点测量的HCT、ALB,并计算HCT与ALB的差值。比较三组患者HCT、ALB、HCT与ALB的差值,并应用受试者工作曲线(ROC)对三个组别的ALB、HCT-ALB进行统计学分析。结果 (1)与1组相比,2、3组患者的ALB均值降低(P <0. 01),HCT、HCT-ALB均值升高(P <0. 01);与2组相比,3组ALB均值下降(P <0. 05),HCT-ALB均值升高(P <0. 05),HCT均值差异无统计学意义(P> 0. 05)。(2)以1组为金标准,对2组及3组ALB和HCT-ALB的ROC进行分析,ALB临界值均在32. 8时相对应的曲线下面积(AUC)最大,诊断具有一定的敏感性和较高的特异性。HCT与ALB的差值分别在0. 9与1. 5时,相对应的AUC最大,均具有一定的敏感性和较高的特异性。(3)以2组为金标准,对3组ALB及HCT-ALB的ROC进行分析,ALB在临界值29. 2时,AUC最大,诊断具有较低的敏感性和特异性。HCT与ALB的差值在临界值6. 1时,AUC最大,诊断具有较低的敏感性和特异性。结论已诊断为重度子痫前期的孕妇,妊娠末期ALB<29. 2 g/L、HCT-ALB>6. 1时产后易发生血压异常增高,可作为产后血压变化的预警指标,警示临床严密监护。正常妊娠孕妇,当妊娠末期ALB<32. 8和(或) HCT-ALB>1. 5时,有很大机率会发生产后高血压,但仍需临床证据支持。

To investigate the effect of hematocrit(HTC),plasma albumin(ALB)and difference between the two indexes(HCT-ALB)on peak of postpartum high blood pressure(postpartum 3-6 days)in patients with severe preeclampsia,and explore the predictive values of HCT and ALB at the end of pregnancy with severe preeclamptic for postpartum high blood pressure.A total of 243 women delivered at the Dongguan Maternal and Child Health Hospital between July 2015 and August 2017 were selected and divided into normal pregnancy group(the first group,n=83),the second group with postpartum blood pressure<150/100 mmHg(n=79)and the third group with postpartum blood pressure≥150/100 mmHg(n=81).The HCT and ALB were measured at the same time before birth and the difference between HCT and ALB was calculated.The HCT-ALB,HCT and ALB were compared among the three groups.ROC curve analysis was used for ALB and HCT-ALB in the three groups.1).Compared with the group 1,the mean ALB levels in the group 2 and 3 were decreased(P<0.01)while the mean values of HCT and HCT-ALB were increased(P<0.01).Compared with the group 2,the mean value of ALB in the group 3 was decreased(P<0.05)while the mean value of HCT-ALB was increase(P<0.05)but no significant difference in the mean value of HCT was found(P>0.05).2).Using group 1 as the gold standard,we analyzed the ROC curve of ALB and HCT-ALB in the group 2 and 3.The area under the curve(AUC)was the highest when the ALB threshold was designed at 32.8.The diagnosis had certain sensitivity and high specificity.When HCT-ALB was set at 0.9 and 1.5,respectively,the corresponding AUC was maximum with certain sensitivity and high specificity.3.Using the group 2 as the gold standard,the ROC of ALB and HCT-ALB in the group 3 was analyzed.ALB had the highest AUC at the critical value of 29.2,and the diagnosis had lower sensitivity and specificity.HCT-ALB had the highest AUC at a cutoff value of 6.1,and the diagnosis had low sensitivity and specificity.Pregnant women with severe preeclampsia probably have postpartum high blood pressure when ALB<29.2 g/L and HCT-ALB>6.1 at the end of pregnancy.This could be used as an early warning indicator for postpartum blood pressure change,clinical intensive care,timely treatment and avoiding deterioration of the disease.Moreover,normal pregnant women have a great probability of hypertension after birth when ALB<32.8 and/or HCT-ALB>1.5 at the end of pregnancy.This still needs clinical evidence support.