妊娠中期肝功能与子痫前期的相关性及其对子痫前期的预测价值-现代医学

妊娠中期肝功能与子痫前期的相关性及其对子痫前期的预测价值

单位：乌鲁木齐市妇幼保健院妇产科, 新疆乌鲁木齐 830001

分类号：R714.7

出版年·卷·期（页码）：2019·47·第六期（667-671）

摘要：

目的：探讨妊娠中期肝功能与子痫前期（PE）的相关性及其对PE的预测价值。方法：对2016年1月至2018年5月我院诊治的72例PE产妇（PE组）及同时期的110例健康产妇（对照组）的临床资料进行分析，比较两组产妇的临床资料以及妊娠中期丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、总胆红素（TB）和白蛋白（ALB）等肝功能指标的水平，应用多因素Logistic回归模型分析影响PE发生的独立危险因素，并应用受试者工作特征曲线评估肝功能指标对PE的预测价值。结果：PE组产妇的体质指数（BMI）和舒张压明显高于对照组（P<0.05），两组产妇的妊娠年龄、产次、孕次、收缩压、空腹血糖和高血压家族史等临床资料间差异均无统计学意义（P>0.05）。PE组产妇的AST、ALT、ALP、GGT明显高于对照组（P<0.05），两组产妇的ALB和TB差异无统计学意义（P>0.05）。多因素Logistic回归分析显示，妊娠中期血清AST （OR=1.106，P=0.000）和GGT水平（OR=1.066，P=0.001）是影响PE发生的独立危险因素。妊娠中期血清GGT和AST联合预测PE发生的受试者工作特征曲线下面积明显高于GGT或AST单独应用（Z=3.226、2.731，P=0.001、0.006），最佳截点分别为GGT≥28.28 U·L^-1、AST≥25.13 U·L^-1，联合诊断的敏感性和特异性分别为81.94%和70.00%。结论：妊娠中期GGT和AST水平是PE发生的独立危险因素，GGT≥28.28 U·L^-1和AST≥25.13 U·L^-1联合应用对预测孕妇发生PE具有较高的诊断效能。

Objective:To explore the correlation between liver functionand preeclampsia(PE) in second trimester of pregnancy and its predictive value for PE. Methods:The clinical data of 72 PE parturients (PE group) and 110 healthy parturients (control group) in our hospital from January 2016 to May 2018 were analyzed. The clinical data and the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), total bilirubin(TB) and albumin(ALB) of the two groups were compared. Multivariate Logistic regression model was used to explore the independent risk factors affecting PE. And the receiver operating characteristic curve was used to evaluate the predictive value of liver function index for PE. Results:Body mass index (BMI) and diastolic blood pressure of pregnant women in PE group were significantly higher than those in the control group (P<0.05). There was no significant difference between the two groups in pregnancy age, parity, pregnancy, systolic blood pressure, fasting blood glucose and family history of hypertension (P>0.05). AST, ALT, ALP and GGT in pregnant women of PE group were significantly higher than those in control group (P<0.05). There was no significant difference in ALB and TB between the two groups (P>0.05). Multivariate Logistic regression analysis showed that serum AST (OR=1.106, P=0.000) and GGT (OR=1.066, P =0.001) were independent risk factors for PE. Area under curve (AUC) predicted by serum GGT and AST in the second trimester of pregnancy was significantly higher than that predicted by GGT and AST alone (Z=3.226,2.731, P=0.001,0.006). The best cut-off point was GGT ≥ 28.28 U·L^-1 and AST ≥ 25.13 U·L^-1, the sensitivity and specificity of combined diagnosis were 81.94% and 70% respectively. Conclusion:the levels of GGT and AST in the second trimester of pregnancy are independent risk factors for PE. The combined application of GGT ≥ 28.28 U·L^-1 and AST ≥ 25.13 U·L^-1 has a higher diagnostic efficiency for predicting PE in pregnant women.

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