子痫前期孕妇白蛋白-肌酐比值与疾病严重程度及妊娠结局的关系

Relationships between albumin-creatinine ratio with disease severity and pregnancy outcome in pregnant women with preeclampsia

目的分析白蛋白-肌酐比值(albumin creatinine ratio,ACR)与子痫前期孕妇疾病严重程度及妊娠结局的关系。方法将2016年1月至2017年10月在延安大学附属医院产科诊治的106例子痫前期孕妇,根据病情程度分为轻度组65例和重度组41例,根据ACR分为高ACR组47例,低ACR组59例,同期产检正常的50例孕妇为对照组。分别检测受试孕妇尿ACR及24 h尿蛋白量,分析尿ACR与孕妇病情严重程度及新生儿结局的关系。结果尿ACR及24 h尿蛋白量子痫前期孕妇高于对照组,重度组高于轻度组,差异均有统计学意义(P<0.05);子痫前期孕妇尿ACR与24 h尿蛋白量呈显著正相关关系(r=0.704,P=0.000)。高ACR组收缩压、舒张压及尿酸高于低ACR组,血清白蛋白低于低ACR组;早产或引产、胎儿宫内生长受限等并发症发生率和低蛋白血症发生率均高于低ACR组;新生儿体重低于低ACR组,新生儿重症监护等不良结局发生率高于低ACR组,以上各项比较差异均有统计学意义(P<0.05)。结论子痫前期孕妇ACR越高,病情越严重,不良妊娠结局发生率越高,尿ACR检测有助于对患者病情发展及妊娠结局做出快速判断及预测。

Objective To analyze the relationships between albumin-creatinine ratio(ACR) with the disease severity and pregnancy outcome in pregnant women with preeclampsia. Methods From January 2016 to October 2017, 106 pregnant women with preeclampsia treated in Department of Obstetrics in Yan’an University Affiliated Hospital were selected, according to the severity, they were divided into the mild group(65 cases) and the severe group(41 cases), according to ACR, they were divided into high ACR group(47 cases) and low ACR group(59 cases), at the same time, 50 normal pregnant women were selected as the control group. The urinary ACR and 24 h urine protein were measured in the pregnant women, and the relationship between urinary ACR and maternal disease severity and neonatal outcome was analyzed. Results The urinary ACR and 24-hour urinary protein levels of pregnant women with preeclampsia in the mild group and severe group were significantly higher than those in the control group(P<0.05), and the severe group higher than the mild group(P<0.05);there was a significant positive correlation between urinary ACR and 24-hour urine protein levels in pregnant women with preeclampsia(r=0.704, P=0.000). The systolic blood pressure, diastolic blood pressure, and uric acid in the high ACR group were significantly higher than those in the low ACR group(P<0.05), and serum albumin was significantly lower than the low ACR group(P<0.05), the incidence of complications such as premature labor or induction of labor, intrauterine growth restriction and the incidence of hypoproteinemia were higher than those in the low ACR group;neonatal weight was lower than that in the low ACR group, and the incidence of adverse outcomes such as neonatal intensive care was higher than lower ACR group, the above differences were statistically significant(P<0.05). Conclusion The higher the ACR in pregnant women with pre-eclampsia, the more serious the condition is, and the higher the incidence rate of adverse pregnancy outcomes. The urinary ACR detection can help to make rapid judgment and prediction of the patient’s disease development and pregnancy outcome.