同型半胱氨酸对妊娠期高血压发生的预测价值

The value of serum homocysteine level for predicting the occurance of pregnancy induced hypertension

目的:寻找同型半胱氨酸(HCY)预测妊娠期高血压疾病的最佳时期及阈值,为临床早期预防提供参考。方法:选取本院产前检查孕妇718例,其中妊娠期高血压106例、其它疾病372例,同期正常孕妇240例,检测各组孕妇妊娠16、24、30周血清HCY水平,行logistic回归分析、随机森林分析、决策树分析及ROC曲线分析。结果:HCY是妊娠期高血压疾病发生的独立风险因素(P<0.01);妊娠24、30周时HCY水平的平均基尼指数减少量(MDG)为41.744、46.928,在所有分类因子中占比重较大,以妊娠24周HCY检测值预测最佳,其诊断阈值为11.13μmol/L,ROC曲线下面积为0.84,对应的灵敏度为54.7%,特异度为96.2%。结论:妊娠24周HCY检测值对预测妊娠期高血压疾病有重要判定价值,当HCY≥11.13μmol/L且年龄≥24.5岁或11.13μmol/L>HCY≥8.95μmol/L且伴有妊娠期糖尿病时,孕妇有较大概率发生妊娠期高血压疾病。

Objective:To identify the optimal time of detection and threshold of homocysteine(HCY)for predicting the occurance of pregnancy induced hypertensionin(PIH),and to provide evidence for clinical prevention of PIH early.Methods:718 pregnant women were selected in this study,which included 106 women with PIH,372 women with other pregnant diseases.240 normal pregnant women were selected as comparison subjiects duringthe same period.The serum HCY levels of all included women were detected in the 16th,24th,and 30th getional week.Logistic regression analysis,Random forest analysis,Decision tree model,and ROC curve analysis were conducted.Results:HCY level was an independent risk factor for the occurrence of PIH(P<0.01).The mean decrease gini(MDG)of the serum HCY level in the 24th and 30th gestional week were 41.744 and 46.928,which accounted for a larger proportion in all classification factors.HCY level of women detected in the 24th gestional week had the best value for predicting PIH.Its diagnostic threshold,the area under the curve(AUC),the sensitivity,and the specificity were 11.13umol/L,0.84,54.7%,96.2%,respectively.Conclusion:The serum HCY level of pregnant women detected in the 24th gestional week has value for predicting PIH.When≥24.5 years old pregnant women have HCY level≥11.13 umol/L,or when pregnant women with gestational diabetes mellitus have HCY level form 11.13umol/L to 8.95umol/L,they maybe the probability of occurrence of PIH.