血清乳酸脱氢酶与子痫前期及妊娠不良结局的关系  

Association between Serum Lactate Dehydrogenase and Pre-eclampsia, Adverse Outcomes of Pregnancy

作　　者：陈大立[1] 柴利强[1] 彭兰[1] 汪云[1] 许慧[1] 陈继明[1] 周玉珍 高红 金蕾[4] 汤在祥[5] 

机构地区：[1]南京医科大学附属苏州医院产科,江苏省苏州市215000 [2]江苏省苏州市中西医结合医院 [3]江苏省苏州市吴江第一人民医院 [4]江苏省苏州市吴中人民医院 [5]苏州大学医学部公共卫生学院流行病与卫生统计系

出　　处：《国际妇产科学杂志》2016年第4期393-398,共6页Journal of International Obstetrics and Gynecology

基　　金：国家自然科学基金(31100882;81573253);苏州市临床重点病种诊疗技术专项项目(LCZX201308);中国博士后科学基金(2012M521116);江苏省博士后科研资助计划(1202045C)

摘　　要：目的：探讨血清乳酸脱氢酶（LDH）与子痫前期及妊娠不良结局的关系,并分析其对子痫前期的预测价值。方法：采用回顾性研究,调查分析了江苏省苏州地区2 236例妊娠期高血压疾病患者血清LDH水平及其他临床资料,妊娠期高血压组（998例）,子痫前期组（1 238例）,子痫前期组内又分为轻度子痫前期组（305例）,重度子痫前期组（933例）。采用Logistic回归方法分析血清LDH水平与子痫前期的关系,按照LDH水平四分位数进行分层,并初步探讨血清LDH水平与妊娠不良结局的关系。结果：1妊娠期高血压疾病患者的LDH水平为228.0（179.6~444.0）U/L,子痫前期组LDH水平高于妊娠期高血压组（P〈0.01）,重度子痫前期组LDH水平高于轻度子痫前期组（P〈0.01）。2LDH水平与子痫前期发病风险：以LDH≤179.6 U/L为参照组,无论是调整前还是调整后,随着LDH水平的升高,子痫前期的发病风险显著升高,3种模型下LDH〉444.0 U/L组的发病风险相对参照组的OR（95%CI）为18.92（13.56~26.37）,13.26（9.42~18.67）和7.97（5.37~11.84）。LDH水平与子痫前期发病风险之间存在剂量反应关系经趋势检验有统计学意义。3LDH水平与重度子痫前期发病风险：LDH〉547.0 U/L组,3种模型下的发病风险相对参照组（LDH水平≤200 U/L）的OR（95%CI）为11.56（6.74~19.83）,7.30（4.20~12.71）和4.43（2.47~7.94）。LDH水平与重度子痫前期严重程度之间存在剂量反应关系。4进一步采用受试者工作特征曲线（ROC）分析,发现以血清LDH水平、LDH与白蛋白（ALB）比值、LDH与结合胆红素（DBIL）比值为分析指标,预测子痫前期或重度子痫前期的曲线下面积均低于0.8。上述指标在子痫前期或重度子痫前期的诊断预测价值一般。5按照中位数将LDH分组后,发现在重度子痫前期中,LDH高水平组母亲不良结局、胎儿不良结局以及新生儿不良结局的发生率高于低水平组�Objective：To explore the relationship between serum lactate dehydrogenase （LDH） level and pre-eclampsia,adverse outcomes of pregnancy, and to confirm the predictive value of serum LDH level on pre -eclampsia. Methods ： Aretrospective study was performed in the present study which involved 2 236 patients with hypertensive disorders in Suzhou areaof Jiangsu Province in China. The number of patients in gestational hypertension, mild and severe pre-eclampsia groups were998, 305 and 933. Logistic regression was used to analyze the association between serum LDH and pre-eclampsia, the serumLDH and clinical records were investigated, and chi-square test was used to analyze the association between serum LDH andadverse outcomes of pregnancy. Results ： （l）The level of LDH in group gestational hypertension was 228.0 （179.6-444.0） U/L.Significant difference （P〈0.01） was revealed in serum LDH level between the gestational hypertension and pre-eclampsiagroups, also between mild and severe pre-eclampsia groups. ？Patients were stratified according to quartiles of serum LDH.Compared the lowest quartiles （^179.6 U/L）, the risk of pre-eclampsia increased significantly than the other three groups.Three models were used in logistic analysis, unadjusted model, adjusted model for tradition factors and adjusted model forselected factors by multiple regression. The odds ratio （O R ） and 95% confidence interval （95% C I） for the three models were18.92 （13.56-26.37）, 13.26 （9.42-18.67） and 7.97 （5.37-11.84） in the highest quartiles （LDH〉444.0 U/L）, respectively.An obvious dose-response relationship was also showed in three models. （3） For mild and severe pre-eclampsia patients,compared with the lowest quartiles （ 200 U/L）, the OR and 95% CI for the three models mentioned above were 11.56 （6.7419.83）,7.30 （4.20-12.71） and 4.43 （2.47-7.94） for the highest quartiles （LDH〉547.0 U/L）, respectively. The pathogenesisrisk increased with the LDH level elevation. （4�

关 键 词：L-乳酸脱氢酶 高血压 妊娠性 先兆子痫 妊娠结局 LOGISTIC模型 

分 类 号：R714.244[医药卫生—妇产科学]