轻度子痫前期实验室血液指标危险因素及诊断价值分析

Risk factors and diagnostic value of laboratory blood indexes in mild preeclampsia

目的 探讨轻度子痫前期实验室血液指标变化特征,寻找轻度子痫前期的危险因素,分析各研究指标对轻度子痫前期的诊断价值。方法 选择2020年12月—2021年12月江西省妇幼保健院孕20周后正常孕妇158例作为对照组,同期收治104例轻度子痫前期孕妇作为观察组。比较两组在血常规、生化、凝血、甲功及炎症指标的变化特征,用logistic回归分析上述实验室血液指标的危险因素,并运用受试者工作曲线(ROC)分析实验室血液指标对轻度子痫前期诊断价值。结果 血常规指标中,两组在红细胞(RBC)、白细胞(WBC)、中性粒细胞比率(NEU)、血小板压积(PCT)、平均血小板体积(MPV)及血小板分布宽度(PDW)水平比较差异均有统计学意义(均P<0.05),其中观察组RBC[(3.91±0.62)]、MPV[10.60(10.00~11.6)]均高于对照组RBC[(3.69±0.32)]、MPV[10.10(9.50~10.70)],而观察组LYM[14.35(12.05~16.90)%]低于对照组LYM[18.40(16.20~21.50)%],RBC、LYM及MPV为轻度子痫前期的危险因素(P<0.05);(2)凝血指标中,两组在凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(ATⅢ)、D-Ⅱ聚体(DD)及纤维蛋白(原)降解产物(FDP)水平比较差异均有统计学意义(均P<0.05)。其中,观察组PT[9.95(9.40~10.30)]低于对照组PT[10.50(10.20~10.70)],而观察组FDP[3.13(1.81~5.42)]水平显著高于对照组FDP[0.36(0.08~0.68)],PT、FDP为轻度子痫前期的危险因素(P<0.05);(3)在炎症指标C-反应蛋白(CRP)、甲功三项,两组各指标水平比较差异无统计学意义(P>0.05);(4)在生化指标中,两组在肝功能上,观察组在谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)及乳酸脱氢酶(LDH)水平均高于对照组(P<0.05),而直接胆红素(DBIL)、总蛋白(TP)、白蛋白(ALB)及白球比(A/G)水平低于对照组(P<0.05);在肾功能上,观察组在胱抑素C(CYSC)、肌酐(CR)、尿素(BUN)及尿酸(UA)水平均显著高于对照组(P<0.001);在心肌酶谱上,两组在肌酸激酶(CK)、肌酸激酶同工酶(CKMB)及ɑ-羟丁酸(HBDH)水平上,差异均无统计学意义(均P>0.05);在血脂上,观察组总胆固醇(TCHOL)、三酰甘油(TG)、高密度脂蛋白(HDL)、载脂蛋白A1(APOA1)及载脂蛋白B(APOB)水平均高于对照组(P<0.05);在电解质水平上,观察组镁(MG)及磷(P)水平均高于对照组(P<0.05)。结论 通过对实验室血液指标的检测,及早发现孕妇的子痫前期,以防止母婴不良妊娠结局。

Objective To explore the changes in laboratory blood indicators of mild preeclampsia,identify risk factors for mild preeclampsia,and analyze the diagnostic value of various research indicators for mild preeclampsia.Methods A total of 158 normal pregnant women after 20 weeks of pregnancy at Jiangxi Maternal and Child Health Hospital from December 2020 to December 2021 were selected as the control group,and 104 mild preeclampsia pregnant women admitted during the same period were selected as the observation group.Compare the changes in blood routine,biochemistry,coagulation,thyroid function,and inflammation indicators between two groups,use logistic regression to analyze the risk factors of the above laboratory blood indicators,and use receiver operating curve(ROC)to analyze the diagnostic value of laboratory blood indicators for mild preeclampsia.Results In the blood routine indicators,there were statistically significant differences(P<0.05)between the two groups in red blood cell(RBC),white blood cell(WBC),neutrophil ratio(NEU),platelet hematocrit(PCT),mean platelet volume(PV)and platelet distribution width(PDW)levels.Among them,the RBC(3.91±0.62)and MPV 10.60(10.00-11.6)in the observation group were higher than those in the control group(3.69±0.32)and MPV value 10.10(9.50-10.70),while the LYM 14.35(12.05-16.90)%in the observation group was lower than that in the control group18.40(16.20-21.50)%.RBC,LYM,and MPV are risk factors for mild preeclampsia(P<0.05);②In coagulation indicators,there were statistically significant differences(P<0.05)between the two groups in prothrombin time(PT),international standardized ratio(INR),activated partial prothrombin time(APTT),fibrinogen(FIB),antithrombin III(AT II),D-dimer(DD),and fibrinogen degradation products(FDP)levels.Among them,the PT 9.95(9.40-10.30)in the observation group was lower than that in the control group PT[10.50(10.20-10.70)J,while the FDP[3.13(1.81-5.42)] level in the observation group was significantly higher than that in the control group FDP 0.36(0.08-0.68).PT and FDP were risk factors for mild preeclampsia(P<0.05);③There was no statistically significant dfference in the levels of inflammation markers C-reactive protein(CRP)and thyroid function between the two groups(P>0.05)In terms of biochemical indicators,in terms of liver function,the observation group had higher levels of aspartate aminotransferase((AST),glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),and lactate dehydrogenase(LDH)than the control group(P<0.05),while the levels of direct bilirubin(DBIL),total protein(TP),albumin(ALB),and white blood cell ratio(A/G)were lower than the control group(P<0.05);In terms of renal function,the observation group showed significantly higher levels of cystatin C(CYSC),creatinine(CR),urea(BUN),and uric acid(UA)than the control group(P<0.001);On the myocardial enzyme spectrum,the two groups showed creatine kinase(CK),creatine kinase isoenzyme(CKMB)a-There was no statistically significant dfference in the level of hydroxybutyric acid(HBDH)(P>0.05);In terms of blood lipids,the levels of total cholesterol(TCHOL),triglycerides(TG),high-density lipoprotein(HDL),apolipoprotein A1(APOAI),and apolipoprotein B(APOB)in the observation group were higher than those in the control group(P<O.05);At the electrolyte level,the magnesium(MG)and phosphorus(P)levels in the observation group were higher than those in the control group(P<0.05).Among them,TP,ALB,A/G,CYCS,CR,UA,BUN,TCHOL,TG,APOA,APOBI,MG are all risk factors for mild preeclampsia(P<0.05),while HDL is a protective factor for mild preeclampsia(P<0.05);From the ROC curve,it can be seen that FDP with mild preeclampsia has the highest diagnostic efficacy,with an AUC of 0.947(95%CI 0.919-0.975,P<0.001),a sensitivity of 91.3%,and a specificity of 91.1%;Next are UA,ALB,BUN,and TG,with AUC of 0.867,0.851,0.840 and 0.792,respectively.ConclusionBy detecting laboratory blood indicators,early detection of preeclampsia in pregnant women can prevent adverse pregnancy outcomes for both mother and baby.