摘要
目的研究子痫前期(PE)蛋白尿孕妇尿微量白蛋白(mAlb)、转铁蛋白(TRF)及α1-微球蛋白(α1-MG)的妊娠期界值。方法收集2016年1月至2019年12月于上海交通大学医学院附属仁济医院产前检查并住院分娩的孕妇210例,其中PE孕妇92例(43.8%),正常孕妇118例(56.2%)。按照诊断性试验评价方法分析非妊娠期尿mAlb、TRF及α1-MG界值对24 h尿蛋白定量判定的阳性预测值、阴性预测值、准确率,并通过对不同种类尿蛋白与24 h尿蛋白定量进行受试者工作特征(ROC)曲线评估,确定妊娠期尿mAlb、TRF及α1-MG的最佳切点值。结果(1)非妊娠期成人尿mAlb、TRF及α1-MG界值对于24 h尿蛋白定量判定的诊断性研究:当尿mAlb、TRF、α1-MG分别以30.0、2.5、12.5 mg/L为界值时,三者对应的尿蛋白定量≥300 mg/24 h的阳性预测值分别为88.1%(89/101)、88.2%(90/102)、78.9%(75/95),阴性预测值分别为97.2%(106/109)、98.1%(106/108)、85.2%(98/115),准确率分别为92.9%(195/210)、93.3%(196/210)、82.4%(173/210)。以尿蛋白定量≥300 mg/24 h为"金标准",尿mAlb、TRF分别以30.0、2.5 mg/L为界值的诊断方法分别与"金标准"比较,差异均有统计学意义(P均<0.05),尿α1-MG以12.5 mg/L为界值的诊断方法与"金标准"无显著性差异(P>0.05)。(2)尿mAlb、TRF及α1-MG值对24 h尿蛋白定量判定的ROC曲线及最佳切点值:以尿蛋白定量≥300 mg/24 h为判定标准,尿mAlb、TRF和α1-MG水平的ROC曲线下面积分别为0.992、0.984和0.907。尿mAlb、TRF、α1-MG的最佳切点值分别为86.5 mg/L(Youden指数=0.927)、5.5 mg/L(Youden指数=0.923)、15.4 mg/L(Youden指数=0.687)。(3)尿mAlb、TRF及α1-MG最佳切点值对于24 h尿蛋白定量判定的诊断性研究:尿mAlb、TRF、α1-MG分别以86.5、5.5、15.4 mg/L为界值时,三者对应的尿蛋白定量≥300 mg/24 h的阳性预测值分别为98.9%(86/87)、95.7%(88/92)、87.7%(71/81),其阴性预测值分别为95.1%(117/123)、96.6%(114/118)、83.7%(108/129),其准确率分别为96.7%(203/210)、96.2%(202/210)、85.2%(179/210),均高于非妊娠期界值的准确率。以尿蛋白定量≥300 mg/24 h为"金标准",尿mAlb、TRF、α1-MG以86.5、5.5、15.4 mg/L为界值的诊断方法分别与"金标准"比较,差异均无统计学意义(P均>0.05)。结论推荐将尿mAlb、TRF、α1-MG的妊娠期界值分别定义为86.5 mg/L、5.5 mg/L、15.4 mg/L。
Objective To study the cut-off values of urinary microalbumin(mAlb),transferrin(TRF)andα1-microglobulin(α1-MG)during pregnancy in pre-eclampsia(PE)with proteinuria.Methods A total of 210 pregnant women were enrolled in Renji Hospital from January 2016 to December 2019,including 92(43.8%)cases of PE pregnant women and 118(56.2%)cases of normal pregnant women.According to the diagnostic test evaluation method,the positive predictive values,negative predictive values and accuracy of non-pregnant cut-off values of urinary mAlb,TRF andα1-MG for the quantitative determination of 24-hour proteinuria were analyzed.The receiver operating characteristic(ROC)curve was applied to determine the optimal cut-point values of urinary mAlb,TRF andα1-MG during pregnancy.Results(1)The diagnostic study of non-pregnant adults urinary mAlb,TRF andα1-MG cut-off values for the determination of 24-hour proteinuria value:when urinary mAlb was 30.0 mg/L,TRF was 2.5 mg/L,α1-MG was 12.5 mg/L as the cut-off value,the positive predictive values of the corresponding 24-hour proteinuria value≥300 mg were 88.1%(89/101),88.2%(90/102)and 78.9%(75/95),its negative predictive values were 97.2%(106/109),98.1%(106/108)and 85.2%(98/115),its diagnostic accuracy were 92.9%(195/210),93.3%(196/210)and 82.4%(173/210),respectively.As the 24-hour proteinuria value≥300 mg was the golden standard,there were significant differences between the diagnostic method of the non-pregnant cut-off value of urinary mAlb,TRF and the golden standard(P<0.05).There was no significant difference between the diagnostic method of the non-pregnant cut-off value of urinaryα1-MG and the golden standard(P>0.05).(2)Research on the ROC curve and the optimal cut-point value of urinary mAlb,TRF andα1-MG value:as the 24-hour proteinuria value≥300 mg as the criterion,the ROC curve of urinary mAlb,TRF andα1-MG were 0.992,0.984 and 0.907,respectively.The optimal cut-point values of urinary mAlb,TRF andα1-MG were 86.5 mg/L(Youden index=0.927),5.5 mg/L(Youden index=0.923),and 15.4 mg/L(Youden index=0.687).(3)The diagnostic study of the optimal cut-point value of urinary mAlb,TRF andα1-MG for the determination of 24-hour proteinuria value:according to the ROC results,when urinary mAlb was 86.5 mg/L,urinary TRF was 5.5 mg/L,and urinaryα1-MG was 15.4 mg/L as the cut-off value,the positive predictive values of the corresponding 24-hour proteinuria value≥300 mg were 98.9%(86/87),95.7%(88/92),87.7%(71/81),and its negative predictive values were 95.1%(117/123),96.6%(114/118),83.7%(108/129),and its accuracy were 96.7%(203/210),96.2%(202/210),85.2%(179/210).As the 24-hour proteinuria value≥300 mg was the golden standard,there was no significant difference between the diagnostic method of the best cut-off values of urinary mAlb,TRF,α1-MG and the golden standard(P>0.05).Conclusion It is recommended to define the cut-off values of mAlb,TRF andα1-MG as 86.5 mg/L,5.5 mg/L and 15.4 mg/L,respectively,during pregnancy.
作者
庄旭
冯蜀欢
陈漪
牟姗
林建华
Zhuang Xu;Feng Shuhuan;Chen Yi;Mou Shan;Lin Jianhua(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Nephrology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2021年第10期665-670,共6页
Chinese Journal of Obstetrics and Gynecology
基金
国家自然科学基金(81770668, 81873887)
上海交通大学“交大之星”计划医工交叉研究基金(YG2021QN24)
关键词
先兆子痫
蛋白尿
白蛋白尿
转铁蛋白
参考值
Pre-eclampsia
Proteinuria
Albuminuria
Transferrin
Reference values
