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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(P<0.05)。结论:血清LDH水平与子痫前期及妊娠不良结局存在紧密的关联,是子痫前期疾病严重程度的重要临床参考指标之一。在重度子痫前期中,发现血清LDH水平的明显升高应高度警惕母婴不良结局的发生,及时减少有效措施,对于减少妊娠不良结局的发生,保障母婴安全健康可能具有十分重要的意义。
Objective: To investigate the relationship between serum lactate dehydrogenase (LDH) and preeclampsia and poor pregnancy outcome, and to analyze its predictive value in preeclampsia. Methods: A retrospective study was conducted to investigate the serum LDH levels and other clinical data of 2 236 hypertensive patients with gestational hypertension in Suzhou district of Jiangsu Province. The levels of serum LDH, gestational hypertension (998), preeclampsia (1 238) , Preeclampsia group was divided into mild preeclampsia group (305 cases), severe preeclampsia group (933 cases). Logistic regression was used to analyze the relationship between serum LDH levels and preeclampsia, stratified by quartiles of LDH level, and the relationship between serum LDH levels and poor outcome of pregnancy was also discussed. LDH levels in patients with gestational hypertension were 228.0 (179.6 ~ 444.0) U / L, LDH levels in preeclampsia group were higher than those in gestational hypertension group (P <0.01), LDH level in severe preeclampsia group was high In mild preeclampsia group (P <0.01). 2LDH levels and the risk of preeclampsia: LDH≤179.6 U / L as the reference group, either before adjustment or after adjustment, with the rise of LDH levels, the risk of preeclampsia increased significantly, under the three models The OR (95% CI) risk of LDH> 444.0 U / L group was 18.92 (13.56 ~ 26.37), 13.26 (9.42 ~ 18.67) and 7.97 (5.37 ~ 11.84) with respect to the reference group. Dose-response relationship between LDH levels and the risk of preeclampsia was statistically significant by trend test. The risk of 3LDH and severe preeclampsia: LDH> 547.0 U / L, the OR (95% CI) of onset risk under the 3 models was 11.56 (6.74-19.83) compared with the reference group (LDH level ≤200 U / L) ), 7.30 (4.20 ~ 12.71) and 4.43 (2.47 ~ 7.94). There is a dose-response relationship between LDH levels and severity of severe preeclampsia. Furthermore, by using the receiver operating characteristic curve (ROC) analysis, it was found that the level of serum LDH, the ratio of LDH to albumin (ALB) and the ratio of LDH to DBIL were used as predictors of preeclampsia or severe preeclampsia The area under the curve of preeclampsia was lower than 0.8. The above indicators in pre-eclampsia or severe pre-eclampsia diagnostic predictive value of the general. 5 According to the median LDH grouping, we found that in the severe preeclampsia, the incidence of maternal adverse outcomes, adverse fetal outcomes and neonatal adverse outcomes in the high LDH group was higher than that in the low-level group (P <0.05). Conclusion: There is a close relationship between serum LDH level and preeclampsia and poor pregnancy outcome, which is one of the important clinical reference indexes for the severity of preeclampsia. In severe preeclampsia, we found that the significant increase of serum LDH levels should be highly vigilant against the occurrence of maternal and infant adverse outcomes, and timely reduction of effective measures to reduce the incidence of adverse pregnancy outcomes to protect the safety and health of maternal and baby may be of great significance.