妊娠期高血压疾病UPCR、FDP/D-D、IMA变化对病情进展影响及联合检测预测妊娠结局的价值  

Impact of changes in UPCR,FDP/D-D,and IMA on disease progression in hypertensive disorders of pregnancy and the value of combined detection in predicting pregnancy outcomes

作　　者：李亚南 梁晓娜 杜琳 才琳琳 LI Ya-nan;LIANG Xiao-na;DU Lin;CAI Lin-lin(Department of Obstetrics and Gynecology,Puyang Huimin Hospital,Puyang 457000,Henan,CHINA)

机构地区：[1]濮阳惠民医院妇产科,河南濮阳457000

出　　处：《海南医学》2025年第6期817-822,共6页Hainan Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20231918)。

摘　　要：目的探讨妊娠期高血压疾病(HDP)患者随访中尿蛋白肌酐比值(UPCR)、纤维蛋白原降解产物/D-二聚体(FDP/D-D)、缺血修饰白蛋白(IMA)变化对病情进展的影响及联合检测预测妊娠结局的价值。方法前瞻性选取2022年4月至2024年4月濮阳惠民医院收治的105例HDP患者作为研究对象,其中妊娠期高血压组54例,子痫前期组51例,根据妊娠结局情况分为不良组33例和良好组72例。比较妊娠期高血压组与子痫前期组患者的基线和病情进展时的UPCR、FDP/D-D、IMA水平,同时比较不同妊娠结局患者的临床资料及基线UPCR、FDP/D-D、IMA水平,采用多因素Logistic回归分析基线UPCR、FDP/D-D、IMA水平对妊娠结局的影响,采用受试者工作特征(ROC)曲线分析基线UPCR、FDP/D-D、IMA水平单独及联合预测不良妊娠结局的价值。结果子痫前期组患者基线、病情进展时的UPCR、FDP/D-D、IMA[(53.00±12.83)mg/mmol、4.09±1.3、(126.38±22.79)U/mL,(92.79±21.55)mg/mmol、4.94±1.58、(165.11±28.84)U/mL]明显高于妊娠期高血压组[(15.25±3.70)mg/mmol、3.15±1.00、(108.67±16.40)U/mL,(80.45±19.26)mg/mmol、4.26±1.13、(131.00±23.25)U/mL],且两组患者病情进展时的UPCR、FDP/D-D、IMA明显高于基线时,差异均有统计学意义(P<0.05);不良组患者的基线UPCR、FDP/D-D、IMA分别为(54.95±18.78)mg/mmol、4.82±1.03、(149.00±22.31)U/mL,明显高于良好组的(23.80±7.55)mg/mmol、3.06±0.79、(102.73±19.56)U/mL,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,基线UPCR(OR=1.129,95%CI:1.066~1.195)、FDP/D-D(OR=1.188,95%CI:1.114~1.267)、IMA(OR=1.082,95%CI:1.009~1.160)均是妊娠结局的独立相关影响因素(P<0.05);ROC分析结果显示,基线UPCR、FDP/D-D、IMA联合预测不良妊娠结局的价值明显优于各指标单独预测效能(Z=3.414、3.168、3.415,P<0.05)。结论基线UPCR、FDP/D-D、IMA均是HDP病情进展及妊娠结局的影响因素,联合检测对不良妊娠结局具有一定�Objective To investigate the impact of changes in urinary protein-to-creatinine ratio(UPCR),fibrinogen degradation products/D-dimer(FDP/D-D),and ischemia-modified albumin(IMA)on disease progression in patients with hypertensive disorders of pregnancy(HDP)and the value of combined detection in predicting pregnancy outcomes.Methods A prospective study was conducted on 105 HDP patients admitted to Puyang Huimin Hospital from April 2022 to April 2024.The patients were divided into a gestational hypertension group(54 cases)and a preeclampsia group(51 cases).Based on pregnancy outcomes,they were further categorized into an adverse outcome group(33 cases)and a favorable outcome group(72 cases).The baseline and disease progression levels of UPCR,FDP/D-D,and IMA were compared between the gestational hypertension and preeclampsia groups.Clinical data and baseline levels of UPCR,FDP/D-D,and IMA were also compared between patients with different pregnancy outcomes.Multivariate logistic regression analysis was used to assess the impact of baseline UPCR,FDP/D-D,and IMA levels on pregnancy outcomes.Receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive value of baseline UPCR,FDP/D-D,and IMA levels,both individually and in combination,for adverse pregnancy outcomes.Results The levels of UPCR,FDP/D-D,and IMA were(53.00±12.83)mg/mmol,4.09±1.3,(126.38±22.79)U/mL at baseline and(92.79±21.55)mg/mmol,4.94±1.58,(165.11±28.84)U/mL at disease progression in the preeclampsia group,respectively,significantly higher than(15.25±3.70)mg/mmol,3.15±1.00,(108.67±16.40)U/mL and(80.45±19.26)mg/mmol,4.26±1.13,(131.00±23.25)U/mL in the gestational hypertension group.Additionally,the levels of UPCR,FDP/D-D,and IMA at disease progression were significantly higher than baseline levels in both groups(P<0.05).The baseline UPCR,FDP/D-D,and IMA levels in the adverse outcome group were(54.95±18.78)mg/mmol,4.82±1.03,(149.00±22.31)U/mL,respectively,significantly higher than(23.80±7.55)mg/mmol,3.06±0.79,(1

关 键 词：妊娠期高血压疾病 尿蛋白肌酐比值 纤维蛋白原降解产物 D-二聚体 缺血修饰白蛋白 病情进展 预测 妊娠结局 

分 类 号：R714.246[医药卫生—妇产科学]