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| Hcy D-D UA水平联合检测在子痫前期诊断及重度子痫前期预测中的应用 |
| Application of combined detection of Hcy, D-D and UA levels in diagnosis of preeclampsia and prediction of severe preeclampsia |
| 投稿时间：2022-07-11 |
| DOI： |
| 中文关键词: 半胱氨酸 D-二聚体 尿酸 子痫前期 受试者工作特征曲线 诊断 |
| 英文关键词: Homocysteine D-dimer Uric acid Preeclampsia ROC curve Diagnosis |
| 基金项目: |
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| 摘要点击次数: 520 |
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| 中文摘要: |
| 目的 探讨同型半胱氨酸(Hcy)、D-二聚体(D-D)、尿酸(UA)血清水平联合检测在子痫前期(PE)诊断及重度PE预测中的应用价值。方法 回顾性分析2020年1月至2022年4月铜陵市妇幼保健院收治的229例孕妇的临床资料,参照《妇产科学》第八版中PE诊断标准将其分为PE组(n=148)与非PE组(n=81),根据PE病情严重程度将PE患者分为轻度PE组(n=85)与重度PE组(n=63)。记录并比较各组患者Hcy、D-D、UA水平,以《妇产科学》第八版中的PE、轻度PE、重度PE诊断标准为“金标准”绘制受试者工作特征(ROC)曲线,评价Hcy、D-D、UA水平联合检测在PE诊断及重度PE预测中的应用价值。结果 PE组孕妇收缩压、舒张压、平均动脉压、剖宫产史比例以及24 h尿蛋白均高于非PE组(P均<0.05)。PE组孕妇Hcy(12.85±1.4[JP2]3)μmol/L、D-D(2.39±0.42)μg/mL及UA(407.83±48.86)μmol/L均高于非PE组(9.51±1.14)μmol/L、(1.61±0.27)μg/mL、(321.43±41.67)μmol/L(P均<0.05)。Hcy+D-D+UA联合检测用于诊断PE的曲线下面积(AUC)为0.976,灵敏度为98.65%,特异度为97.53%,Hcy+D-D+UA联合检测PE诊断的效能优于Hcy、D-D、UA单独及任意两指标联合。重度PE组患者Hcy(13.98±1.52)μmol/L、D-D(2.12±0.35)μg/mL及UA(443.17±51.39)μmol/L均高于轻度PE组(12.01±1.37)μmol/L、(2.12±0.35)μg/mL、(381.64±46.98)μmol/L(P均<0.05)。PE患者Hcy水平分别与D-D、UA水平呈正相关(r=0.739、0.861,P均<0.05),D-D水平与UA水平呈正相关(r=0.708,P<0.05);而Hcy、D-D及UA水平分别与PE严重程度均呈正相关(r=0.654、0.813、0.776,P均<0.05)。Hcy+D-D+UA联合检测对重度PE预测的AUC为0.941,灵敏度为90.48%,特异度为95.29%,Hcy+D-D+UA联合检测较Hcy、D-D、UA单独及任意两指标联合用于重度PE预测的效能更优。结论 PE患者Hcy、D-D、UA水平均升高且相互呈正相关,而重度PE患者Hcy、D-D、UA水平均升高更为明显,Hcy+D-D+UA联合检测可提高PE诊断效能与重度PE预测效果,值得借鉴。 |
| 英文摘要: |
| Objective To discuss the application of combined detection of homocysteine (Hcy), D-dimer (D-D) and uric acid (UA) levels in the diagnosis of preeclampsia (PE) and the prediction of severe PE.Methods The clinical data of 229 pregnant women with PE high-risk factors treated in Tongling Maternity and Child Healthcare Hospital from Jan 2020 to Apr 2022 were analyzed retrospectively, and they were divided into the PE group (148 cases) and the non PE group (81 cases)according to the diagnostic criteria of PE in the eighth edition of Obstetrics and Gynecology. Furthermore, according to the severity PE, patients were divided into the mild PE group (85 cases) and the severe PE group (63 cases). Hcy, D-D and UA levels of each group were recorded and compared. The diagnostic criteria of PE, mild PE and severe PE in the eighth edition of Obstetrics and Gynecology were taken as the "gold standard",and the application value of the combined detection of Hcy, D-D and UA in the diagnosis of PE and the prediction of severe PE was evaluated by drawing the receiver operating characteristic (ROC) curve.Results The systolic blood pressure, diastolic blood pressure, mean arterial pressure, cesarean section history ratio and 24h urinary protein of the PE group were significantly higher than those of the non PE group (all P<0.05). Hcy (12.85±1.43) μmol/L, D-D (2.39±0.42) μg/mL and UA (407.83±48.86) μmol/L of the PE group pregnant women were significantly higher than those of the non PE group [(9.51±1.14) μmol/L,(1.61±0.27) μmol/L,(321.43±41.67) μmol/L,repectively] (all P<0.05). The area under curve (AUC value) of Hcy+D-D+UA combined detection in PE diagnosis was 0.976, the sensitivity was 98.65% and the specificity was 97.53%, which indicating that the efficiency of Hcy+D-D+UA combined detection for PE diagnosis was better than Hcy, D-D, UA alone and any two indicators combined detection. Hcy (13.98±1.52) μmol/L, D-D (2.12±0.35) μg/mL and UA (443.17±51.39) μmol/L of the severe PE group patients were significantly higher thanthose of the mild PE group [(12.01±1.37) μmol/L,(2.12±0.35) μmol/L,(381.64±46.98) μmol/L,repectively] (all P<0.05). D-D level of PE patients was positively correlated with the levels of D-D and UA,and the value of was 0.739 and 0.861, respectively(all P<0.05), and D-D level was positively correlated with UA level(r=0.708, P<0.05), while Hcy, D-D and UA levels were positively correlated with the severity of PE (r=0.654, 0.813, 0.776,respectively, allP<0.05). AUC value of Hcy+D-D+UA combined detection in the prediction of severe PE was 0.941, the sensitivity was 90.48% and the specificity was 95.29%, which indicating that Hcy+D-D+UA combined detection was more effective than Hcy, D-D, UA alone and any two indicators combined detectionin the prediction of severe PE.Conclusion Hcy, D-D, UA levels of the PE patients increasesignificantly and are positively correlated with each other, while Hcy, D-D, UA levels of patients with severe PE increase more markedly.Hcy+D-D+UA combined detection can significantly improve the diagnostic efficiency of PE and the prediction effect of severe PE, which is worth reference. |
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