动脉弹性系数对妊娠期高血压疾病患者不良预后的评估价值  

Assessment of the Value of Arterial Elasticity Measurement in Hypertensive Disorders in Pregnancy for Patients with Poor Prognosis

作　　者：陈湘漪[1] 

机构地区：[1]湖北省妇幼保健院妇产科,武汉430070

出　　处：《临床误诊误治》2015年第12期80-84,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨动脉弹性系数对妊娠期高血压疾病(HDCP)患者不良预后的评估价值。方法前瞻性、连续性纳入2013年1月—2014年7月妇产科接诊的尚处于妊娠高血压期(PIH)的HDCP产妇49例,收集相关危险因素的临床资料,按随访终点事件是否进展为重度子痫前期(SP)分为妊娠高血压期(PIH)组和SP组。分析并比较两组产妇初检时各项指标的差异性,并使用Logistic回归分析进一步提取独立敏感指标,绘制相应指标的受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。结果 SP组患者的发病孕龄、高血压家族史占比、平均动脉压(MAP)、体重指数、血小板、血浆纤维蛋白原(FIB)、胱抑素C(Cys C)、溶血磷脂酸(LPA)、白蛋白(ALB)、小动脉弹性系数(C2)等与PIH组比较差异均有统计学意义(P均<0.05),经多因素Logistic回归分析得出MAP、FIB、Cys C、LPA、C2等5项指标是HDCP不良预后的独立、敏感影响因素,其中C2用于判定不良预后的AUC为0.730,通过对ROC曲线最佳评估截点分析得出C2的预测临界值为8.75 ml/mm Hg×100。联合测定MAP、FIB、Cys C、LPA 4项指标判定HDCP不良预后的AUC为0.830,加入C2后AUC增至0.854。结论 C2水平可作为评判PIH不良预后的独立敏感因素,将C2纳入HDCP的诊疗体系用于临床干预高危风险的产妇具有重要意义。Objective To investigate the adverse prognostic value in arterial elasticity coefficient（ compliance,C）for hypertensive disorders in pregnant（ HDCP） patient assessment. Methods Clinical data of related risk factors of 49 cases of maternal HDCP and prospective continuity incorporated during January 2013 and July 2014 in obstetrics and gynecology admissions of pregnancy-induced hypertension（ PIH） were collected and according to follow-up endpoint progress into severe preeclampsia（ SP）,the patients were divided into pregnancy-induced hypertension of（ PIH） group and SP group. Early detection indicators of the two groups were compared and analyzed for differences,and Logistic regression analysis was used to further extract independently sensitive indicators,draw the corresponding index of receiver operating characteristic（ ROC）curve and calculate the area under the curve（ AUC）. Results The patients of SP group of the incidence of gestational age,family history of hypertension,accounting,mean arterial pressure（ MAP）,body mass index,platelet,plasma fibrinogen（ FIB）,cystatin endostatin C（ Cys C）,lysophosphatidic acid（ LPA）,albumin（ ALB）,small artery elasticity（ C2） of SP group showed statistically significant differences（ P〈0. 05）,when compared with that of PHI group,multivariate Logistic regression analysis of MAP,FIB,Cys C,LPA,C2,the 5 indicators were independent,and sensitive HDCP poor prognosis factors,including poor prognosis for determining C2 AUC 0. 730,ROC curve analysis obtained the best assessment predicted intercept point threshold value C2 8. 75 ml / mm Hg × 100. MAP,FIB,Cys C,LPA,the 4 indicators of poor prognosis determination HDCP AUC 0. 830,to 0. 854 after adding C2 AUC were jointly determined. Conclusion C2 levels can be used as an independent index to judge PIH sensitive factors of poor prognosis,the C2 system included in HDCP and used in clinical intervention for pregnant women at high risk is of significant value.

关 键 词：动脉弹性系数 高血压 妊娠性 子痫 妊娠期高血压疾病 

分 类 号：R714.246[医药卫生—妇产科学]