摘要
目的探讨妊娠期高血压疾病(HDP)患者随访中尿蛋白肌酐比值(UPCR)、纤维蛋白原降解产物/D-二聚体(FDP/D-D)、缺血修饰白蛋白(IMA)变化对病情进展的影响及联合检测预测妊娠结局的价值。方法前瞻性选取2022年4月至2024年4月濮阳惠民医院收治的105例HDP患者作为研究对象,其中妊娠期高血压组54例,子痫前期组51例,根据妊娠结局情况分为不良组33例和良好组72例。比较妊娠期高血压组与子痫前期组患者的基线和病情进展时的UPCR、FDP/D-D、IMA水平,同时比较不同妊娠结局患者的临床资料及基线UPCR、FDP/D-D、IMA水平,采用多因素Logistic回归分析基线UPCR、FDP/D-D、IMA水平对妊娠结局的影响,采用受试者工作特征(ROC)曲线分析基线UPCR、FDP/D-D、IMA水平单独及联合预测不良妊娠结局的价值。结果子痫前期组患者基线、病情进展时的UPCR、FDP/D-D、IMA[(53.00±12.83)mg/mmol、4.09±1.3、(126.38±22.79)U/mL,(92.79±21.55)mg/mmol、4.94±1.58、(165.11±28.84)U/mL]明显高于妊娠期高血压组[(15.25±3.70)mg/mmol、3.15±1.00、(108.67±16.40)U/mL,(80.45±19.26)mg/mmol、4.26±1.13、(131.00±23.25)U/mL],且两组患者病情进展时的UPCR、FDP/D-D、IMA明显高于基线时,差异均有统计学意义(P<0.05);不良组患者的基线UPCR、FDP/D-D、IMA分别为(54.95±18.78)mg/mmol、4.82±1.03、(149.00±22.31)U/mL,明显高于良好组的(23.80±7.55)mg/mmol、3.06±0.79、(102.73±19.56)U/mL,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,基线UPCR(OR=1.129,95%CI:1.066~1.195)、FDP/D-D(OR=1.188,95%CI:1.114~1.267)、IMA(OR=1.082,95%CI:1.009~1.160)均是妊娠结局的独立相关影响因素(P<0.05);ROC分析结果显示,基线UPCR、FDP/D-D、IMA联合预测不良妊娠结局的价值明显优于各指标单独预测效能(Z=3.414、3.168、3.415,P<0.05)。结论基线UPCR、FDP/D-D、IMA均是HDP病情进展及妊娠结局的影响因素,联合检测对不良妊娠结局具有一定预测价值,可作为临床判断病情、预测妊娠结局的辅助指标,并可指导临床决策。
Objective To investigate the impact of changes in urinary protein-to-creatinine ratio(UPCR),fibrinogen degradation products/D-dimer(FDP/D-D),and ischemia-modified albumin(IMA)on disease progression in patients with hypertensive disorders of pregnancy(HDP)and the value of combined detection in predicting pregnancy outcomes.Methods A prospective study was conducted on 105 HDP patients admitted to Puyang Huimin Hospital from April 2022 to April 2024.The patients were divided into a gestational hypertension group(54 cases)and a preeclampsia group(51 cases).Based on pregnancy outcomes,they were further categorized into an adverse outcome group(33 cases)and a favorable outcome group(72 cases).The baseline and disease progression levels of UPCR,FDP/D-D,and IMA were compared between the gestational hypertension and preeclampsia groups.Clinical data and baseline levels of UPCR,FDP/D-D,and IMA were also compared between patients with different pregnancy outcomes.Multivariate logistic regression analysis was used to assess the impact of baseline UPCR,FDP/D-D,and IMA levels on pregnancy outcomes.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive value of baseline UPCR,FDP/D-D,and IMA levels,both individually and in combination,for adverse pregnancy outcomes.Results The levels of UPCR,FDP/D-D,and IMA were(53.00±12.83)mg/mmol,4.09±1.3,(126.38±22.79)U/mL at baseline and(92.79±21.55)mg/mmol,4.94±1.58,(165.11±28.84)U/mL at disease progression in the preeclampsia group,respectively,significantly higher than(15.25±3.70)mg/mmol,3.15±1.00,(108.67±16.40)U/mL and(80.45±19.26)mg/mmol,4.26±1.13,(131.00±23.25)U/mL in the gestational hypertension group.Additionally,the levels of UPCR,FDP/D-D,and IMA at disease progression were significantly higher than baseline levels in both groups(P<0.05).The baseline UPCR,FDP/D-D,and IMA levels in the adverse outcome group were(54.95±18.78)mg/mmol,4.82±1.03,(149.00±22.31)U/mL,respectively,significantly higher than(23.80±7.55)mg/mmol,3.06±0.79,(102.73±19.56)U/mL in the favorable outcome group(P<0.05).Multivariate logistic regression analysis showed that baseline UPCR(OR=1.129,95%CI:1.066-1.195),FDP/D-D(OR=1.188,95%CI:1.114-1.267),and IMA(OR=1.082,95%CI:1.009-1.160)were independent factors influencing pregnancy outcomes(P<0.05).ROC analysis revealed that the combined prediction of adverse pregnancy outcomes using baseline UPCR,FDP/D-D,and IMA was significantly better than the individual predictive performance of each indicator(Z=3.414,3.168,3.415,P<0.05).Conclusion Baseline UPCR,FDP/D-D,and IMA are all influencing factors for disease progression and pregnancy outcomes in HDP.Combined detection has certain predictive value for adverse pregnancy outcomes and can serve as an auxiliary indicator for clinical judgment of disease status and prediction of pregnancy outcomes,guiding clinical decision-making.
作者
李亚南
梁晓娜
杜琳
才琳琳
LI Ya-nan;LIANG Xiao-na;DU Lin;CAI Lin-lin(Department of Obstetrics and Gynecology,Puyang Huimin Hospital,Puyang 457000,Henan,CHINA)
出处
《海南医学》
2025年第6期817-822,共6页
Hainan Medical Journal
基金
河南省医学科技攻关计划联合共建项目(编号:LHGJ20231918)。
关键词
妊娠期高血压疾病
尿蛋白肌酐比值
纤维蛋白原降解产物
D-二聚体
缺血修饰白蛋白
病情进展
预测
妊娠结局
Hypertensive disorders of pregnancy
Urinary protein-to-creatinine ratio
Fibrinogen degradation products
D-dimer
Ischemia-modified albumin
Disease progression
Prediction
Pregnancy outcomes
作者简介
第一作者:李亚南(1982-),女,副主任医师,主要研究方向为妇产科常见病、疑难病的诊断与治疗;通讯作者:才琳琳(1977-),女,副主任医师,主要研究方向为妇产科常见病、疑难病的诊断与治疗,E-mail:1271265991@qq.com。
