Efficacy Analysis Combined Prediction of Postpartum Hypertension by 24-hour Urinary Protein，Hematocrit-albumin，and BNP in Patients with Severe Preeclampsia at the End of Pregnancy
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摘要:
目的 探讨重度子痫前期患者妊娠末期24 h尿蛋白定量（24-hUP）、红细胞压积与血浆白蛋白差值（HCT-ALB）、脑钠肽（BNP）联合预测产后高血压的效能。 方法 采用整群抽样法，回顾性选取重庆医科大学附属大学城医院2018年1月—2022年12月540例重度子痫前期患者，根据是否发生产后高血压分为高血压组（98例）与非高血压组（442例）。比较两组临床资料[年龄、体质量指数（BMI）、产妇类型、流产史、高血压家族史、吸烟史、总胆固醇（TC）、甘油三酯（TG）、空腹血糖（FBG）、收缩压（SBP）、舒张压（DBP）]及妊娠末期24-hUP、HCT-ALB、BNP水平，分析妊娠末期24-hUP、HCT-ALB、BNP水平对产后高血压的预测价值。 结果 高血压组BMI、高血压家族史、TC、TG、FBG、SBP、DBP水平高于非高血压组[（25.63±1.37） kg/m2 vs （23.05±1.23） kg/m2，70.41% vs 30.54%，（5.32±1.14） mmol/L vs （3.91±0.95） mmol/L，（3.48±0.82） mmol/L vs （1.66±0.43） mmol/L，（7.24±1.60） mmol/L vs （4.83±1.22） mmol/L，（148.27±13.29） mmHg vs （127.65±10.71） mmHg，（92.36±5.17） mmHg vs （84.20±4.35） mmHg]，差异有统计学意义（P < 0.05）；高血压组妊娠末期24-hUP、HCT、HCT-ALB、BNP水平高于非高血压组[（7.82±2.18） g/24 h vs （6.15±1.26） g/24 h，（34.22±3.15）% vs （32.80±1.77）%，（6.19±2.01） vs （3.46±0.90），（646.43±170.59） pg/mL vs （523.81±134.62） pg/mL]，ALB水平低于非高血压组[（28.03±1.13） g/L vs （29.34±1.44） g/L]，差异有统计学意义（P < 0.05）；妊娠末期24-hUP、HCT、HCT-ALB、BNP与SBP、DBP呈正相关，ALB与之呈负相关，差异有统计学意义（P < 0.05）；妊娠末期24-hUP、HCT-ALB、BNP是产后高血压的独立危险因素，各指标联合预测产后高血压的AUC为0.930（95%CI：0.905～0.950），约登指数为0.719，敏感度为85.71%，特异度为86.20%，且联合预测的AUC明显大于三者单独预测，差异有统计学意义（P < 0.05）。 结论 妊娠末期24-hUP、HCT-ALB、BNP是产后高血压的独立危险因素，联合预测效能明显优于单一指标，可作为临床预测重度子痫前期患者是否发生产后高血压的优选方式。 Abstract:Objective To investigate the efficacy of combined prediction of postpartum hypertension using 24-h urinary protein quantification （24-hUP）, hematocrit and plasma albumin difference （HCT-ALB）, and brain natriuretic peptide （BNP） in patients with severe preeclampsia at the end of pregnancy. Methods A retrospective study was conducted using cluster sampling to select 540 patients with severe preeclampsia from the University City Hospital affiliated to Chongqing Medical University between January 2018 and December 2022 . Patients were divided into a hypertension group （98 cases） and a non-hypertension group （442 cases） based on the occurrence of postpartum hypertension. Clinical data [age, body mass index （BMI）, maternal type, abortion history, family history of hypertension, smoking history, total cholesterol （TC）, triglyceride （TG）, fasting blood glucose （FBG）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）] and levels of 24-hour urinary protein excretion （UP）, hematocrit-albumin （HCT-ALB）, and BNP in the third trimester of pregnancy were compared between the two groups to analyze the predictive value of these indicators for postpartum hypertension. Results The levels of BMI, family history of hypertension, TC, TG, FBG, SBP and DBP in hypertensive group were higher than those in non-hypertensive group [（25.63±1.37） kg/m2 vs （23.05±1.23） kg/m2, 70.41% vs 30.54%]. （5.32±1.14） mmol/L vs （3.91±0.95） mmol/L, （3.48±0.82） mmol/L vs （1.66±0.43） mmol/L, （7.24±1.60） mmol/L vs （4.83±1.22） mmol/L, （148.27±13.29） mmHg vs （127.65±10.71） mmHg, （92.36±5.17） mmHg vs （84.20±4.35） mmHg], the difference was statistically significant （P < 0.05）. The levels of urinary protein, HCT, HCT-ALB and BNP at 24 h at the end of pregnancy in hypertension group were also higher than those in non-hypertension group [（7.82±2.18） g/24 h vs （6.15±1.26） g/24 h, （34.22±3.15） % vs （32.80±1.77） %]. （6.19±2.01） vs （3.46±0.90）, （646.43±170.59） pg/mL vs （523.81±134.62） pg/mL], while ALB level was lower than that of the non-hypertension group [（28.03±1.13） g/L vs （29.34±1.44） g/L]. with statistically significant differences （P < 0.05）. There was a positive correlation between 24-hUP, HCT, HCT-ALB, BNP and SBP, DBP, while ALB was negatively correlated with SBP and DBP, the difference was statistically significant（P < 0.05）. 24-hUP, HCT-ALB and BNP at the end of pregnancy were independent risk factors for postpartum hypertension, with a combined prediction AUC of 0.930 （95%CI: 0.905-0.950）, a Jordon index of 0.719, sensitivity of 85.71%, the specificity of 86.20%. The AUC of the combined prediction was significantly greater than that of each individual predictor, with statistically significant differences（P < 0.05）. Conclusion 24-hUP, HCT-ALB, and BNP at the end of pregnancy are independent risk factors for postpartum hypertension. Their combined predictive efficacy is significantly superior to that of individual indicators and can be used as an optimal clinical method for predicting whether patients with severe preeclampsia will develop postpartum hypertension. -
图 1 妊娠末期24-hUP、HCT-ALB、BNP预测产后高血压价值
Figure 1. Predictive value of 24-hUP，HCT-ALB，BNP for postpartum hypertension
图 2 妊娠末期24-hUP、HCT-ALB、BNP联合预测价值
Figure 2. Combined predictive value of 24-hUP，HCT-ALB，and BNP in late pregnancy
表 1 两组临床资料比较[$ \bar x \pm s $/n（%）]
Table 1. Comparison of clinical data between two groups [$ \bar x \pm s $/n（%）]
项目 高血压组
（n = 98）非高血压组
（n = 442）t/χ2 P 年龄（岁） 28.76 ± 2.31 28.41 ± 2.07 1.482 0.139 BMI（kg/m2） 25.63 ± 1.37 23.05 ± 1.23 产妇类型 0.026 0.872 初产妇 55（56.12） 252（57.01） 经产妇 43（43.88） 190（42.99） 流产史 0.063 0.802 无 74（75.51） 339（76.70） 有 24（24.49） 103（23.30） 吸烟史 0.119 0.730 无 67（68.37） 310（70.14） 有 31（31.63） 132（29.86） 高血压家族史 54.233 < 0.001* 无 29（29.59） 307（69.46） 有 69（70.41） 135（30.54） TC（mmol/L） 5.32 ± 1.14 3.91 ± 0.95 12.795 < 0.001* TG（mmol/L） 3.48 ± 0.82 1.66 ± 0.43 31.209 < 0.001* FBG（mmol/L） 7.24 ± 1.60 4.83 ± 1.22 16.645 < 0.001* SBP（mmHg） 148.27 ± 13.29 127.65 ± 10.71 16.461 < 0.001* DBP（mmHg） 92.36 ± 5.17 84.20 ± 4.35 16.209 < 0.001* *P < 0.05。 
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表 2 两组妊娠末期24-hUP、HCT-ALB、BNP水平比较（$\bar x \pm s $）
Table 2. Comparison of 24-hUP，HCT-ALB，and BNP levels between two groups during late pregnancy （$ \bar x \pm s $）
组别 n 24-hUP（g/24 h） HCT（%） ALB（g/L） HCT-ALB BNP（pg/mL） 高血压组 98 7.82 ± 2.18 34.22 ± 3.15 28.03 ± 1.13 6.19 ± 2.01 646.43 ± 170.59 非高血压组 442 6.15 ± 1.26 32.80 ± 1.77 29.34 ± 1.44 3.46 ± 0.90 523.81 ± 134.62 t 10.181 6.093 8.445 20.721 7.746 P < 0.001* < 0.001* < 0.001* < 0.001* < 0.001* *P < 0.05。
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表 3 妊娠末期24-hUP、HCT-ALB、BNP与SBP、DBP的相关性
Table 3. Correlation between 24-hUP，HCT-ALB，BNP and SBP，DBP in late pregnancy
指标 SBP DBP r P r P 24-hUP 0.683 < 0.001* 0.691 0.042* HCT 0.511 0.034* 0.507 0.003* ALB −0.489 0.019* −0.493 < 0.001* HCT-ALB 0.626 < 0.001* 0.644 0.004* BNP 0.649 < 0.001* 0.672 < 0.001* *P < 0.05。
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表 4 妊娠末期24-hUP、HCT-ALB、BNP对产后高血压的影响
Table 4. Effects of 24-hUP，HCT-ALB，and BNP in late pregnancy on postpartum hypertension
变量 β S.E. Waldχ2 OR 95%CI P 24-hUP 2.106 0.441 22.814 8.218 2.247～30.059 < 0.001* HCT-ALB 1.942 0.528 13.530 6.974 1.753～27.741 < 0.001* BNP 1.921 0.603 10.151 6.829 2.034～22.928 < 0.001* *P < 0.05。
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表 5 ROC曲线对比结果
Table 5. Comparison results of ROC curve
成对对比 AUC差异 标准误差 95%CI Z P 联合-24-hUP 0.149 0.028 0.094～0.205 5.248 < 0.001* 联合-HCT-ALB 0.117 0.026 0.066～0.167 4.486 < 0.001* 联合-BNP 0.147 0.032 0.084～0.209 4.616 < 0.001* *P < 0.05。
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[1] Yang YY,Le Ray I,Zhu J,et al. Preeclampsia prevalence,risk factors,and pregnancy outcomes in Sweden and China[J]. JAMA Netw Open,2021,4(5):e218401-e218401. doi: 10.1001/jamanetworkopen.2021.8401 [2] Chang KJ,Seow KM,Chen KH. Preeclampsia: Recent advances in predicting,preventing,and managing the maternal and fetal life-threatening condition[J]. Int J Environ Res Public Health,2023,20(4):2994-2994. doi: 10.3390/ijerph20042994 [3] Muteke K,Musaba MW,Mukunya D,et al. Postpartum resolution of hypertension,proteinuria and acute kidney injury among women with preeclampsia and severe features at Mulago National Referral Hospital,Uganda: A cohort study[J]. Afr Health Sci,2023,23(3):27-36. [4] Stamilio DM,Beckham AJ,Boggess KA,et al. Risk factors for postpartum readmission for preeclampsia or hypertension before delivery discharge among low-risk women: A case-control study[J]. Am J Obstet Gynecol MFM,2021,3(3):100317-100317. doi: 10.1016/j.ajogmf.2021.100317 [5] Herman HG,Barda G,Miremberg H,et al. Management of pregnancies with suspected preeclampsia based on 6-hour vs 24-hour urine protein collection-a randomized double-blind controlled pilot trial[J]. Am J Obstet Gynecol MFM,2021,3(5):100429-100429. doi: 10.1016/j.ajogmf.2021.100429 [6] 程敏,李青,李志芳. 红细胞压积及白蛋白指标评估子痫前期治疗效果的应用价值研究[J]. 河北医药,2022,44(8):1221-1223. [7] Rao S,Daines B,Hosseini O,et al. The utility of brain natriuretic peptide in patients undergoing an initial evaluation for pulmonary hypertension[J]. J Community Hosp Intern Med Perspect,2022,12(3):48-52. doi: 10.55729/2000-9666.1048 [8] 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2015)[J]. 中华妇产科杂志,2015,50(10):721-728. doi: 10.3760/cma.j.issn.0529-567x.2015.10.001 [9] 国家基本公共卫生服务项目基层高血压管理办公室,基层高血压管理专家委员会. 国家基层高血压防治管理指南[J]. 中国循环杂志,2017,32(11):1041-1048. doi: 10.3969/j.issn.1000-3614.2017.11.001 [10] Alese MO,Moodley J,Naicker T. Preeclampsia and HELLP syndrome,the role of the liver[J]. J Matern Fetal Neonatal Med,2021,34(1):117-123. doi: 10.1080/14767058.2019.1572737 [11] Peterson JA,Sandgren K,Levine LD. Severe preterm preeclampsia: an examination of outcomes by race[J]. Am J Obstet Gynecol MFM,2020,2(4):100181-100181. doi: 10.1016/j.ajogmf.2020.100181 [12] 刘蓉,林晓峰,魏璞,等. 子痫前期产妇产后高血压的发病情况及其危险因素分析[J]. 实用预防医学,2018,25(8):954-957. [13] Abdelazim IA,Amer OO,Shikanova S,et al. Protein/creatinine ratio versus 24-hours urine protein in preeclampsia[J]. Ginekol Pol,2022,93(12):975-979. [14] Aynaoğlu Yıldız G,Topdağı Yılmaz EP. The association between protein levels in 24-hour urine samples and maternal and neonatal outcomes of pregnant women with preeclampsia[J]. J Turk Ger Gynecol Assoc,2022,23(3):190-198. doi: 10.4274/jtgga.galenos.2022.2022-4-3 [15] 王之信,周萍. 24 h尿蛋白、胱抑素C、D-二聚体及超敏C-反应蛋白与妊娠期高血压疾病严重程度的相关性及对不良妊娠结局的预测价值[J]. 安徽医药,2022,26(8):1584-1589. doi: 10.3969/j.issn.1009-6469.2022.08.023 [16] Sukmanee J,Rothmanee P,Sriwimol W,et al. Levels of blood pressure,cardiovascular biomarkers and their correlations in women with previous pre-eclamptic pregnancy within 7 years postpartum: a cross-sectional study in Thailand[J]. BMJ Open,2022,12(6):e055534-e055534. doi: 10.1136/bmjopen-2021-055534 [17] Trejo-Soto C,Hernández-Machado A. Normalization of blood viscosity according to the hematocrit and the shear rate[J]. Micromachines (Basel),2022,13(3):357-357. doi: 10.3390/mi13030357 [18] Zhao RM,Dai H,Arias RJ,et al. Direct activation of the proton channel by albumin leads to human sperm capacitation and sustained release of inflammatory mediators by neutrophils[J]. Nat Commun,2021,12(1):3855-3855. doi: 10.1038/s41467-021-24145-1 [19] 程敏,李青,李志芳. 红细胞压积及白蛋白指标评估子痫前期治疗效果的应用价值研究[J]. 河北医药,2022,44(8):1221-1223. [20] von Petersdorff-Campen K,Fischer P,Bogdanova A,et al. Potential factors for poor reproducibility of in vitro hemolysis testing[J]. ASAIO J,2022,68(3):384-393. doi: 10.1097/MAT.0000000000001577 [21] Van de Wouw J,Joles JA. Albumin is an interface between blood plasma and cell membrane,and not just a sponge[J]. Clin Kidney J,2021,15(4):624-634. [22] Nishikimi T,Nakagawa Y. B-Type Natriuretic Peptide (BNP) revisited-is BNP still a biomarker for heart failure in the angiotensin receptor/neprilysin inhibitor era[J]?Biology (Basel),2022,11(7): 1034-1034. [23] 黄钧,胡玲,佘广彤. 联合监测无创血流动力学和脑钠肽评估妊娠高血压病患者心功能的价值[J]. 江苏医药,2020,46(10):984-988. [24] Boucly A,Tu L,Guignabert C,et al. Cytokines as prognostic biomarkers in pulmonary arterial hypertension[J]. Eur Respir J,2023,61(3):2201232-2201232. doi: 10.1183/13993003.01232-2022 -
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