摘要
目的 探讨妊娠期容量负荷总体液(Total body water,TBW)评估与妊娠期高血压疾病(Hypertensive disorder complicated pregnancy,HDCP)的相关性.方法 选取2020年1月至2022年7月于南京医科大学附属江苏盛泽医院就诊的妊娠期高血压孕妇(n=30)、子痫前期孕妇(n=50)作为病例组(n=80),选择同期正常妊娠孕妇作为对照组(n=100);对比两组24 h尿钠、TBW、细胞外液(Extracellular water,ECW)和细胞内液(Intracellular water,ICW)水平以及对HDCP的预测价值.结果 病例组妊娠早、中、晚期TBW、ECW、ICW水平均高于对照组[(40.42±5.45)L vs(36.98±5.61)L、(44.51±5.21)L vs(40.63±5.29)L、(47.76±5.84)L vs(44.07±5.78)L,(15.56±2.11)Lvs(12.12±2.01)L、(17.45±2.46)Lvs(13.97±2.28)L、(19.16±2.31)L vs(14.13±2.48)L,(29.88±1.03)L vs(27.39±1.04)L、(31.98±1.46)L vs(28.56±1.25)L、(36.56±1.11)L vs(32.12±1.01)L,P均＜0.05];病例组妊娠早、中、晚期24 h尿钠水平均高于对照组[(109.16±8.94)mmol/d vs(95.77±7.78)mmol/d、(118.93± 8.25)mmol/d vs(103.13±8.31)mmol/d、(133.67±8.45)mmol/d vs(108.08±8.33)mmol/d,P均＜0.05].子痫前期孕妇妊娠早、中、晚期TBW、ECW和ICW水平均高于妊娠高血压孕妇和对照组(P＜0.05),妊娠期高血压孕妇妊娠早、中、晚期TBW、ECW和ICW水平均高于对照组(P＜0.05),子痫前期孕妇妊娠早、中、晚期24 h尿钠水平均高于妊娠高血压孕妇和对照组(P＜0.05);妊娠期高血压孕妇妊娠早、中、晚期24 h尿钠水平均高于对照组(P＜0.05).调整孕前BMI、年龄后,妊娠早、中期孕妇24 h尿钠水平(OR=2.180,95％CI:1.139～4.172;OR=2.088,95％CI:1.243～3.508)、TBW(OR=2.744,95％CI:1.885～3.994;OR=3.177,95％CI:2.106～4.792)、ECW(OR=1.015,95％CI:0.994～1.037;OR=1.077,95％CI:0.992～1.171)和ICW(OR=2.752,95％CI:1.886～4.015;OR=2.906,95％CI:1.691～4.994)均是HDCP的独立危险因素(P＜0.05).妊娠早期孕妇24 h尿钠水平、TBW、ECW和ICW预测HDCP的截断位分别为125.16 mmol/d、39.24 L、14.67 L、28.92 L,四者联合筛查时曲线下面积(Area under curve,AUC)为0.86(95％ CI:0.719～0.872,P＜0.001),筛查灵敏度和特异度分别为73.4％、85.2％,优于单项筛查.结论 妊娠期TBW变化与妊娠期高血压疾病具有相关性,TBW、ECW、ICW和24 h尿钠水平联合筛查有助于HDCP的早期识别,可为HDCP早期发现提供依据.
Abstract
Objective To explore the correlation between gestational capacity load assessment and the con-dition and prognosis of hypertensive disorder complicating pregnancy(HDCP).Methods From January 2020 to July 2022,pregnant women with pregnancy-induced hypertension(n=30)and pre-eclampsia(n=50)in the hospital were selected as case group(n=80)and normal pregnant women as control group(n=100).Compare the levels of 24-hour urinary sodium,maternal total body water(TBW),extracellular wa-ter(ECW),and intracellular water(ICW)between 2 groups,as well as their predictive value for HDCP.Results The levels of TBW,ECW,and ICW in the case group during early,middle,and late pregnancy were higher than those in the control group[(40.42±5.45)L vs(36.98±5.61)L,(44.51±5.21)L vs(40.63±5.29)L,(47.76±5.84)L vs(44.07±5.78)L,(15.56±2.11)L vs(12.12±2.01)L,(17.45± 2.46)L vs(13.97±2.28)L,(19.16±2.31)L vs(14.13±2.48)L,(29.88±1.03)L vs(27.39± 1.04)L,(31.98±1.46)L vs(28.56±1.25)L,(36.56±1.11)L vs(32.12±1.01)L,all P＜0.05].The urinary sodium levels in the case group at 24 hours of early,middle and late pregnancy were higher than those in the control group[(109.16±8.94)mmol/d vs(95.77±7.78)mmol/d,(118.93±8.25)mmol/d vs(103.13±8.31)mmol/d,(133.67±8.45)mmol/d vs(108.08±8.33)mmol/d,all P＜0.05].The overall fluid TBW,ECW and ICW levels in pregnant women with preeclampsia were higher than those in pregnant women with gestational hypertension and the control group(P＜0.05).The overall fluid TBW,ECW and ICW levels in pregnant women with gestational hypertension were higher than those in the con-trol group(P＜0.05).The 24-hour urinary sodium levels in pregnant women with preeclampsia were higher than those in pregnant women with gestational hypertension and the control group(P＜0.05).Pregnant women with gestational hypertension had higher urinary sodium levels at 24 hours in the early,middle and late stages of pregnancy compared to the control group(P＜0.05).After adjusting for pre-pregnancy body mass index,age and 24-hour urinary sodium levels(OR=2.180,95％CI:1.139-4.172;OR=2.088,95％CI:1.243-3.508),total fluid volume load(TBW)(OR=2.744,95％CI:1.885-3.994;OR=3.177,95％CI:2.106-4.792),ECW(OR=1.015,95％CI:0.994-1.037;OR=1.077,95％CI:0.992-1.171),and ICW(OR=2.752,95％CI:1.886-4.015;OR=2.906,95％CI:1.691-4.994)were all independent risk factors for HDCP(P＜0.05).The cutoff points for predicting HDCP in early pregnancy women with 24-hour urinary sodium levels,total fluid TBW,ECW and ICW were 125.16 mmol/d,39.24 L,14.67 L and 28.92 L,respectively.When the 4 were combined for screening,the area under the curve(AUC)was 0.86(95％CI:0.719-0.872,P＜0.001),and the screening sensitivity and specificity were 73.4％and 85.2％,respectively,which were better than single screening.Conclusion There is a correlation between changes in TBW during pregnancy and gestational hypertension.Impaired urinary sodium excretion is an important cause of HDCP.The combined screening of TBW,ECW,ICW and 24-hour urinary sodium levels can help in the early identification of HDCP and provide basis for the earlv detection of HDCP.
基金项目
苏州市吴江区"科教兴卫"项目(WWK201930)
维普
万方数据