脂蛋白酯酶和脐动脉S/D值在预测子痫前期中的意义

Significance of Lipoprotein Esterase and Umbilical Artery S/D Value in Predicting Preeclampsia

目的评价联合应用脂蛋白酯酶(LPL)和脐动脉S/D值预测子痫前期的诊断价值。方法对在哈尔滨市红十字中心医院2018年1月至12月分娩的120例产妇的资料进行回顾性队列研究分析,根据子痫发生情况分为子痫前期(40例),重度子痫前期(40例)和对照组(剖宫产健康孕妇40例)。根据患者一般资料、脂蛋白酯酶(LPL)和脐动脉S/D值指标,以临床诊断为“金标准”应用受试者工作特征(receiver operating characteristic,ROC)曲线比较不同指标对于预测PE的诊断价值以及诊断效能。结果单因素分析显示,3组的LPL分别是(2.25±0.11)、(2.07±0.10)和(1.96±0.11)ug/L,子痫前期水平明显低于对照组(t=6.63,P<0.05)。3组的脐动脉S/D分别是(2.06±0.35)、(2.29±0.39)和(2.52±0.32),子痫前期水平明显高于对照组(t=-2.649,P<0.05)。Logistic回归分析显示,脂蛋白酯酶(OR=0.000,95%CI=0.000,P=0.000)是PE的独立的危险因素,脐动脉S/D(OR=6.346,95%CI=1.243~32.404,P=0.026)是PE的独立危险因素。ROC曲线显示,曲线下面积脐动脉S/D为0.751、LPL为0.932。若将脂蛋白酯酶和脐动脉S/D值得测定,两项指标联合起来进行预测,则R OC曲线下面积增大AUC:0.936。单独应用脂蛋白酯酶脐动脉S/D值敏感度是90%,单独应用脐动脉S/D值敏感度是75%,联合应用的敏感度是92.5%。约登指数(Youden)计算出其最佳截点分别为S/D≥2.165和LPL≤2.125 ug/L。结论联合利用LPL和脐动脉S/D的测定可以高水平地预测子痫前期的发生。

Objective To evaluate the diagnostic value of combined application of lipoprotein esterase(LPL)and umbilical artery S/D value in predicting preeclampsia.Methods A retrospective cohort study was conducted on the data of 120 parturients delivered from January to December 2018 in the Central Hospital of the Red Cross in Harbin.According to the condition of eclampsia,they were classified as preeclampsia(40 cases),severe preeclampsia(40 cases)and control group(40 cases).According to patients'general data,LPL and S/D value of umbilical artery,the receiver operating characteristic(ROC)curve was used to compare the diagnostic value and diagnostic efficiency of different indexes for predicting preeclampsia.Results Single factor analysis showed that the LPL of the three groups were 2.25±0.11,2.07±0.10 and 1.96±0.11 ug/L respectively,and the preeclampsia level was significantly lower than that of the control group(t=6.63,P<0.05).The S/D of umbilical artery in the three groups were 2.06±0.35,2.2±0.39 and 2.52±0.32 respectively.the preeclampsia level was significantly higher than that in the control group(t=-2.649,P<0.05).The umbilical artery S/D of the three groups were 2.06±0.35,2.29±0.39,2.52±0.32.The level of preeclampsia was significantly higher than that of the control group(P<0.05).Logistic regression analysis showed that lipoprotein esterase(OR=0.000,95%CI=0.000,P=0.000)was an independent risk factor for preeclampsia.Umbilical artery S/D(OR=6.346,95%CI=1.243-32.404,P=0.026)was an independent risk factor for PE.ROC curve showed that the area under curve of umbilical artery S/D was 0.751 and LPL was 0.932.If the lipoprotein esterase and umbilical artery S/D are worth measuring and the two indicators are combined to predict,the area under the ROC curve will increase by AUC:0.936.The sensitivity of S/D value of umbilical artery with lipoprotein esterase alone was 90%,that of umbilical artery alone was 75%,and that of combined application was 92.5%.The best cut-off points calculated by Youden index were S/D≥2.165 and LPL≤2.125 ug/L.Conclusion The combination of LPL and umbilical artery S/D can predict the occurrence of preeclampsia at a high level.