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目的探讨一种易于临床推广的联合预测子痫前期的方法。方法选取2014年1月-2016年6月在扬州市妇幼保健院产科门诊正规产前检查至住院分娩的单胎妊娠孕妇,诊断为子痫前期的患者82例为子痫前期组,其中重度子痫前期患者58例,轻度子痫前期患者24例;随机选取正常妊娠孕妇68例为对照组。两组孕妇均无糖尿病、心脏病、慢性肾炎、免疫系统疾病等妊娠并发症及合并症,比较两组孕妇各项指标的差异。结果子痫前期组孕妇血钙、血浆白蛋白浓度均低于对照组孕妇,血尿酸浓度明显高于对照组孕妇,差异有统计学意义(P<0.05)。58例重度子痫前期孕妇中同时出现两项指标异常的22例,占37.93%;三项异常的29例,占50.00%。24例轻度子痫前期孕妇中同时出现两项指标异常的10例,占41.67%;三项异常的5例,占20.83%。68例对照组孕妇中同时出现两项指标异常的19例,占27.94%;三项异常的3例,占4.41%。对照组与轻、重度子痫前期组比较差异有统计学意义(P<0.05)。单项指标血钙、血尿酸、血浆白蛋白预测子痫前期的灵敏度分别为42.7%、60.7%、65.4%,特异度分别为61.4%、64.7%、32.4%。三项联合预测时灵敏度为93.1%,特异度为86.7%,比单一预测的阳性预测值高。结论血钙、血浆白蛋白、血尿酸可作为子痫前期的有效预测指标,但联合检测可明显提高子痫前期的预测率。
Objective To explore a method of joint prediction of preeclampsia which is easy to be popularized in clinic. Methods From January 2014 to June 2016, 82 pregnant women with preeclampsia who were diagnosed as preeclampsia were enrolled in this study. The prenatal examination from obstetric clinic of Yangzhou MCH hospital to singleton pregnant women hospitalized for delivery was performed. Among them, severe preeclampsia 58 cases of preeclampsia, 24 cases of mild preeclampsia; 68 normal pregnant women were randomly selected as the control group. The two groups of pregnant women without complications of diabetes, heart disease, chronic nephritis, immune system diseases and complications of pregnancy, pregnant women compared the two groups of indicators of differences. Results The levels of serum calcium and plasma albumin in pregnant women with preeclampsia were significantly lower than those in pregnant women in the control group (P <0.05). The serum uric acid concentrations in pregnant women with preeclampsia were significantly higher than those in pregnant women in the control group (P <0.05). In 58 cases of severe preeclampsia, there were 22 cases (37.93%) with two abnormal indicators in the pregnant women at the same time, and 29 cases with three abnormalities (50.00%). Twenty-four pregnant women with mild preeclampsia also showed two abnormalities in 10 of them, accounting for 41.67%. Five of the three abnormalities accounted for 20.83%. In the 68 pregnant women with control group, there were 19 cases (27.94%) with abnormal indexes in two indicators at the same time, and 3 cases with three abnormalities (4.41%). The difference between the control group and the mild and severe preeclampsia group was statistically significant (P <0.05). The single indexes of serum calcium, serum uric acid, and plasma albumin were 42.7%, 60.7% and 65.4% respectively, and the specificity were 61.4%, 64.7% and 32.4% respectively. The sensitivity of the three combined predictions was 93.1% and the specificity was 86.7%, higher than the single predictive positive predictive value. Conclusion Serum calcium, serum albumin and serum uric acid can be used as effective predictors of preeclampsia, but the combined detection can significantly improve the predictive rate of preeclampsia.