测定双胎妊娠母体血清尿酸水平的临床意义  

The clinical utility of maternal serum uric acid measurements in twin gestations.

作　　者：丁依玲[1] 林宜珍[1] 朱付凡[1] 陈桂华[1] 

机构地区：[1]湖南医科大学附属第二医院妇产科,长沙410011

出　　处：《中国实用妇科与产科杂志》2001年第9期543-544,共2页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的　探讨双胎妊娠母体血清尿酸水平的变化及测定的临床意义。方法　对 6 8例血压正常和 2 9例患妊高征的双胎孕妇 ,85例正常血压和 2 0例妊高征单胎孕妇测定血清尿酸值并进行比较分析。制作受试者工作特性曲线 (ROC) ,以选择双胎孕妇的血清尿酸水平作为妊高征高危标志的最佳临界值 ,以最佳临界值为标准 ,计算其作为诊断妊高征的似然比。结果　双胎孕妇的血清尿酸平均水平比单胎孕妇高 ,分别为 (32 2 8± 10 7 0 )μmol/L和 (2 5 4 6± 6 4 6 ) μmol/L ,P <0 0 1;患妊高征双胎孕妇的平均血清尿酸水平也比妊高征单胎孕妇的血清尿酸水平高 ,分别为 (4 6 0 0± 77 3) μmol/L和 (36 5 0± 80 4) μmol/L ,P <0 0 1。应用ROC曲线 ,选定血清尿酸值 40 0 0 μmol/L作为诊断双胎妊高征指标之一 ,其敏感性为 93% ,特异性为 79%。当血尿酸值≥ 40 0 0 μmol/L时 ,患妊高征的阳性似然比为 4 4。结论　有无妊高征双胎妊娠孕妇其血清尿酸水平明显高于有无妊高征单胎妊娠。双胎妊娠母体血尿酸水平≥ 40 0 0 μmol/L时 ,可以作为识别该孕妇处于妊高征危险期的辅助方法之一。Objective To study changes of maternal serum uric acid and evaluate its clinical utility in twin gestations.Methods Sixty eight normotensive and twenty nine pregnancy induced hypertension(PIH) women with twin gestations, who had no underlying chronic hypertension or liver and renal insufficiency, had maternal serum uric acid measured. These levels were compared with those of 85 normotensive and 20 PIH singleton gravidas. A receiver operating characteristic (ROC) curve was used to determine the optimal maternal serum uric acid cutoff value for twin gestations.We calculated the likelihood ratios for optimal cutoff value in diagnosing PIH.Results Women with non PIH twin pregnancies had significantly higher mean serum uric acid concentration than those with non PIH singleton pregnancies(322 8±107\^0)versus(254 6±64 6)μmol/L, respectively, P<0 01. Gravidas with twin gestations complicated by PIH had significantly higher serum uric acid levels than their PIH singleton counterparts (460\^0±77 3)μmol/L versus(365\^0±80 4)μmol/L, respectively, P<0 01.Using a ROC curve, we determined that a maternal serum uric acid level of 400\^0μmol/L appeared to be the optimal cutoff for identifying PIH in twin gestations, with a sensitivity of 93% and specificity of 79%.The likelihood ratio of having PIH with a serum uric acid value of over 400\^0μmol/L was 4 4 in twin gestations. Conclusion With or without PIH, women carrying twins have significantly higher serum uric acid levels than their singleton counterparts. we propose that a serum uric acid level of 400\^0μmol/L or greater be used to identify those women with twin gestations who are at higher risk of PIH.

关 键 词：尿酸 双胎妊娠 妊娠高血压综合征 

分 类 号：R714.23[医药卫生—妇产科学] R714.246[医药卫生—临床医学]