血清白蛋白、前白蛋白、血红蛋白及尿液β_(2)-微球蛋白对不同类型子痫前期的预测价值

Predictive value of serum albumin,prealbumin,hemoglobin and urineβ_(2)-microglobulin in different types of preeclampsia

目的:探讨分析血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、血红蛋白(hemoglobin,Hb)及尿液β_(2)-微球蛋白(β_(2)-mG)水平对不同类型子痫前期的预测价值。方法:选取2018年1月至2020年12月马鞍山市妇幼保健院收治的91例子痫前期患者作为观察组,根据相关指南将其分为轻度组(轻度子痫前期38例)、早发型组(早发型重度子痫前期32例)、晚发型组(晚发型重度子痫前期21例),并选取同期于马鞍山市妇幼保健院产检的健康产妇90例作为对照组,比较各组间孕妇血清ALB、PA、Hb及β_(2)-mG水平差异,采用logistic单因素、多因素分析筛选导致子痫前期患者发病的相关危险因素,采用受试者工作特征(receiver operator characteristic,ROC)曲线分析各指标对不同类型子痫前期的预测价值。结果:观察组血清ALB、PA及Hb水平均低于对照组,β_(2)-mG水平高于对照组,差异具有统计学意义(P<0.05);不同类型子痫前期亚组及对照组血清ALB、PA、Hb及β_(2)-mG水平相比较差异具有统计学意义(P<0.05)。两两比较结果显示:轻度组、早发型组、晚发型组及对照组在ALB和β_(2)-mG水平上差异有统计学意义(P<0.05)。早发型组PA水平明显高于晚发型组和对照组,晚发型组PA水平明显低于轻度组,差异有统计学意义(P<0.05)。轻度组Hb水平明显低于早发型组、晚发型组和对照组,晚发型组Hb水平明显高于轻度组,差异具有统计学意义。经logistic单因素、多因素分析筛选发现,血清ALB、Hb低水平和β_(2)-mG高水平是轻度子痫前期的危险因素(P<0.05)。血清A L B低水平和β_(2)-mG高水平是早发型重度子痫前期的危险因素(P<0.05)。血清ALB、PA低水平和β_(2)-mG高水平是晚发型重度子痫前期的危险因素(P<0.05)。血清ALB、PA、Hb、β_(2)-mG联合检测预测轻度子痫前期、早发型重度子痫前期、晚发型重度子痫前期的ROC曲线下面积分别为0.854、0.933、0.994,灵敏度分别为94.38%、92.13%、98.88%,特异度分别为60.53%、78.13%、95.24%,血清ALB、PA、Hb、β_(2)-mG联合检测对早发型重度子痫前期、晚发型重度子痫前期的预测价值较高,而对轻度子痫前期的预测价值相对较低。结论:血清ALB、PA、Hb及β_(2)-mG联合检测对早发型、晚发型重度子痫前期具有较好的预测价值,值得在临床上予以推广实施。

Objective:To explore the predictive value of serum albumin(ALB),prealbumin(PA),hemoglobin(Hb)and urineβ_(2)-microglobulin(β_(2)-mG)in different types of preeclampsia.Methods:A total of 91 patients with preeclampsia treated in our hospital from January 2018 to December 2020 were selected as the observation group.According to the relevant guidelines,they were divided into mild group(38 cases),early onset group(32 cases)and late onset group(21 cases),and 90 healthy pregnant women who underwent antenatal examination in our hospital in the same period were selected as the control group.The levels of serum ALB,PA,Hb andβ_(2)-mG in pregnant women were compared.Logistic univariate and multivariate analysis was used to screen the risk factors of preeclampsia.ROC curve was used to analyze the predictive value of each indicator for different types of preeclampsia.Results:There were significant differences in serum ALB,PA and Hb levels between the observation group and the control group(P<0.05).The serum ALB,PA and Hb levels in observation group were lower than those in control group,whileβ_(2)-m G level was higher than that in control group.There were significant differences in serum ALB,PA,Hb andβ_(2)-m G levels between different types of preeclampsia subgroups and control group(P<0.05).The results of pairwise comparison showed that the levels of ALB andβ_(2)-m G in mild group,earlyonset group,late-onset group and control group were significantly different(P<0.05).The level of PA in earlyonset group was significantly higher than that in late-onset group and control group,and the level of PA in lateonset group was significantly lower than that in mild group,with statistical significance(P<0.05).The Hb level in the mild group was significantly lower than that in the early-onset group,late-onset group and control group,and the Hb level in the late-onset group was significantly higher than that in the mild group,with statistical significance.According to logistic univariate and multivariate analysis,low serum ALB and Hb levels and high serumβ_(2)-mG levels were risk factors for mild preeclampsia(P<0.05).Low serum ALB level and high serumβ_(2)-m G level were risk factors for early onset severe preeclampsia(P<0.05).Low levels of ALB and PA and high levels ofβ_(2)-mG were risk factors for late onset severe preeclampsia(P<0.05).The area under ROC curve of serum ALB,PA,Hb andβ_(2)-m G for predicting mild preeclampsia,early-onset severe preeclampsia and late-onset severe preeclampsia were 0.854,0.933 and 0.994,respectively.The sensitivities were 94.38%,92.13%and 98.88%,respectively.The specificities were 60.53%,78.13%and 95.24%.Conclusion:The levels of serum ALB,PA,Hb andβ_(2)-mG have good predictive value in early-onset and late-onset severe preeclampsia,which is worth popularizing and implementing in clinic.