国家自然科学基金项目（81771603，假基因来源Lnc RNA DUXAP8调控子痫前期螺旋动脉重铸障碍机制研究）
The First Affiliated Hospital of Nanjing Medical University
The National Natural Science Foundation of China（81771603）
目的 回顾性分析子痫前期患者24小时尿蛋白定量与妊娠结局的相关性，为子痫前期诊治提供临床依据。 方法 选择2018.1~2019.7在南京医科大学第一附属医院产科收治的子痫前期患者222例，依据24小时尿蛋白定量结果将其分为轻、中、重度蛋白尿组，并分析各组间临床表现、实验室指标及孕产妇、围生儿不良妊娠结局差异。 结果 1、临床表现：中、重度组子痫前期患者的发病孕周明显早于轻度组，临床表现更严重。2、实验室指标：血浆白蛋白、血清总胆固醇、乳酸脱氢酶、尿素氮及肌酐水平在中、重度组中明显上升；与轻度组相比，重度组患者的血小板计数明显下降，谷草转氨酶、甘油三酯及D二聚体水平明显上升。3、孕产妇不良妊娠结局：中、重度组患者胸腔积液、HELLP综合征及腹腔积液的发生率显著增高。4、围生儿不良结局：医源性早产、胎儿生长受限及新生儿窒息的发生率在中、重度组中显著增高。5、ROC曲线分析法显示，24小时尿蛋白定量对孕妇HELLP综合征、胸腹腔积液、医源性早产及FGR发生有一定的预测价值。 结论 24h尿蛋白定量程度与HELLP综合征、胸腹腔积液、FGR、医源性早产等母儿不良妊娠结局相关，可以作为子痫前期病情发展的一个观察指标。
Objective The correlation between 24-hour urinary protein quantity and pregnancy outcome in patients with preeclampsia was analyzed retrospectively, which provided clinical basis for diagnosis and treatment of preeclampsia. Methods 222 patients with preeclampsia treated in the First Affiliated Hospital of Nanjing Medical University，Department of Obstetrics，were selected（Diagnosis of gestational age 22~40+6weeks）. According to the results of 24-hour urinary protein quantification, they were divided into mild albuminuria group， moderate albuminuria group，and severe albuminuria group . We compare the clinical manifestations, laboratory indexes and adverse pregnancy outcomes of pregnant women, fetuses and newborns among the three groups. Results 1. Clinical manifestations: In the moderate and severe group, the onset of preeclampsia was significantly earlier than that of the mild group, and the clinical manifestations were more serious. 2.Laboratory indexes: Plasma albumin, serum total cholesterol, lactate dehydrogenase, urea nitrogen and creatinine levels increased significantly in the moderate and severe groups; platelet count decreased significantly in the severe group compared with the mild group, while glutamic oxaloacetic transaminase, triglyceride and D dimer levels increased significantly in the severe group. 3.Maternal adverse pregnancy outcome：The incidence of pleural effusion, HELLP syndrome and peritoneal effusion in moderate and severe group increased significantly. 4.Fetal adverse pregnancy outcome：Iatrogenic preterm birth, fetal growth restriction and neonatal asphyxia increased significantly in moderate and severe groups. 5. ROC curve analysis showed that 24-hour urinary protein quantitative analysis had certain predictive value for HELLP syndrome，pleural effusions and hydroceliac effusion, iatrogenic premature delivery and the occurrence of FGR in pregnant women. Conclusion 24h urine protein quantitative degree is associated with adverse pregnancy outcomes such as HELLP syndrome, pleural and peritoneal effusion, FGR，iatrogenic preterm birth, and can be used as an observation index for the development of preeclampsia.