子痫前期患者妊娠晚期24h动态血压数据与不良妊娠结局的相关性分析

Ambulatory blood pressure monitoring in third-trimester for predicting adverse pregnancy outcomes associated with preeclampsia

目的探究子痫前期(PE)患者妊娠晚期24h动态血压监测(ABPM)与不良妊娠结局的相关性。方法回顾分析2017年1月至2019年12月在上海交通大学医学院附属仁济医院产科妊娠晚期诊断PE并首次进行规范ABPM的171例PE患者的完整临床资料,其中有不良妊娠结局者为A组(112例),无不良妊娠结局者为B组(59例)。比较两组患者的ABPM指标,利用ROC曲线比较相关指标对不良妊娠结局的预估能力并确定平均ABPM的最佳临界值;采用logistic回归估计白昼及夜间高血压对不良妊娠结局的风险。结果A组与B组最高诊室SBP及DBP值比较,差异均无统计学意义(P均>0.05)。两组患者ABPM所得数值指标中,A组全天、白昼及夜间SBP及DBP平均值及血压负荷值均显著高于B组,差异有统计学意义(P均<0.05)。其中夜间及全天SBP负荷值对不良妊娠结局的预估性能较好(AUC分别为0.713和0.703)。计算得到6项ABPM血压平均值的临界值分别为24h SBP均值(129.5mmHg)、24h DBP均值(84.5mmHg)、白昼SBP均值(133.5mmHg)、白昼DBP均值(86.5mmHg)、夜间SBP均值(125.5mmHg)及夜间DBP均值(78.5mmHg)。夜间收缩期高血压(OR=4.232,95%CI为1.307~13.703,P=0.016)和夜间舒张期高血压(OR=2.625,95%CI为0.312~22.085,P=0.375)增加了不良妊娠结局的相对风险。结论与诊室血压相比,24h ABPM可更好地评估PE患者预后。24h和夜间SBP负荷可能对评估不良妊娠结局有较好的临床价值。根据ABPM血压指标得到的临界血压数值可为临床降压治疗的目标提供新的循证证据。个性化的治疗计划应考虑夜间血压水平。

Objective:To explore the correlation between 24h ambulatory blood pressure monitoring(ABPM)in the third trimester of pregnancy and adverse pregnancy outcomes in patients with preeclampsia(PE).Methods:We carried out a retrospective study of patients who had been diagnosed as PE and had undergone the first standardized ABPM examination during the third trimester at Renji hospital from January 2017 to December 2019.The patients were divided into two groups:Group A included 112 patients with APO,Group B included 59 patients without APO.The predictive performance of ABPM indicators for APO were examined using the receiver operating characteristic(ROC)curves.Optimal cut-off values of average ABPM indexes were determined.The adjusted risk of APO attributed to diurnal and nocturnal hypertension was estimated using logistic regression.Results:There were no significant differences in the highest office BP between Group A and B(all P>0.05).Among the ABPM indexes,the average ABPM levels and BP loads in Group A were all significantly higher than those in Group B(all P<0.05).The load of nocturnal and 24h systolic blood pressure(SBP)were strongly associated with APO(area under the curve=0.713 and 0.703,respectively).The six critical average values of ABPM were 24h average SBP(129.5mmHg),24-hour average DBP(84.5mmHg),diurnal average SBP(133.5mmHg),diurnal average DBP(86.5mmHg),nocturnal average SBP(125.5mmHg)and nocturnal average DBP(78.5mmHg).Systolic nocturnal hypertension(OR=4.232,95%CI 1.307~13.703,P=0.016)and diastolic nocturnal hypertension(OR=2.625,95%CI 0.312~22.085,P=0.375)markedly increased the relative risk of APO.Conclusions:Compared with office BP,ABPM can better assess the prognosis of PE.The 24h and nocturnal SBP load may have good clinical value in evaluating APO.The presented ABPM cut-off values can provide new targets for antihypertensive treatment.Individualized treatment plans should consider nocturnal BP level.