Clinical Analysis Of Hypertentive Disorders Of Pregnancy And Ratio Of Urine Microalbumin And Creatinine

Objective:To investigate the correlation between Ratio of Urine Microalbumin and Creatinine(ACR)and clinical indexes in patients with different types of hypertentive disorders of pregnancy and its clinical significance in the diagnosis of hypertentive disorders of pregnancy.Methods:Pregnant women who received regular prenatal examination and gave birth in Affiliated hospital of Qingdao university from May 2018 to October 2019 were selected.There were 225 patients with different types of hypertentive disorders of pregnancy,including 55 patients with gestational hypertention,89 patients with preeclampsia,4 patients with eclampsia,37 patients with chronic hypertension with superimposed preeclampsia,40 patients with chronic hypertension.A total of 60 cases of normal single pregnant women in our hospital during the same period were randomly selected as the normal group.The selected subjects were screened.Pregnant women without diabetes mellitus,the kidney disease,hepatic and renal dysfunction and rheumatic immune disease were selected.All patients met the diagnostic criteria for the classification of hypertentive disorders in pregnancy in the ninth edition of obstetrics and gynecology,and all pregnant women gave informed consent to the study and volunteered to participate in the study.All subjects needed to check ratio of urine microalbumin and creatinine,blood routine,blood coagulation routine,urine routine,liver and kidney function,blood lipid and other biochemical indicators.Statistical methods were used to analyze and compare the data of each group,and the differences of urine protein ratio of microalbumin and creatinine,blood routine,and biochemical criterion in each group were compared.The correlation between ACR,24 hours urinary protein,blood routine and biochemical criterion in different types of hypertentive disorders of pregnancy were analysed to evaluate its diagnostic value.Results:(1)Different types of hypertentive disorders of pregnancy were compared with normal pregnant women in general clinical data and Ratio of Urine Microalbumin and Creatinine,the differences in body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP)were statistically significant(P<0.05).The differences of age were not statistically significant(P>0.05).The patients with preeclampsia,eclampsia and chronic hypertension with superimposed preeclampsia had lower levels of delivery gestations than the normal group.ACR data did not conform normal distribution,and anova was performed after data transformation.Compared with normal pregnant women,ACR were significantly higher in women with preeclampsia,eclampsia and chronic hypertension with superimposed preeclampsia,the difference was statistically significant(P < 0.05).There were no significant differences in ACR between gestational hypertention and chronic hypertension and the normal group.Further pairwise comparison between the groups showed that preeclampsia and eclampsia were higher than chronic hypertension with superimposed preeclampsia,and chronic hypertension with superimposed preeclampsia were higher than other groups.(2)Comparison of clinical test indexes between different types of hypertentive disorders of pregnancy and normal pregnant women,the patients with preeclampsia,eclampsia and chronic hypertension with superimposed preeclampsia had higher levels of lactate dehydrogenase(LDH),alanine transaminase(ALT),glutamate transaminase(AST),creatinine,(Cr),urea,uric acid(UA)and total cholesterol(TC),and lower levels of platelet(PLT),albumin(ALB)than the normal group,the difference was statistically significant(P<0.05).The differences of hemoglobin(Hb),fasting blood glucose(FBG)and triglyceride(TG)were not statistically significant(P>0.05).(3)Correlation between ratio of urine microalbumin and creatinine and 24 hours urinary protein quantification: Pearsons correlation coefficient was used to represent the correlation degree of the two.Correlation analysis showed that the correlation between ACR and 24 hours urinary protein quantification was highly linear,and the correlation coefficient was equal to 0.8(P<0.05).(4)After the transformation of ACR into logACR,the data followed a normal distribution.Taking logACR as the dependent variable,the indicators of statistically significant clinical data in one-way analysis of variance were taken as independent variables,and correlation analysis and multiple linear stepwise regression analysis were carried out.ACR was positively correlated with diastolic blood pressure,uric acid,urea,and lactate dehydrogenase(r=0.48 4,0.574,0.515,0.544),and negatively correlated with albumin(r=0.579),All of which were statistically significant(P<0.05).(5)The diagnostic value of UA and ACR in different types of hypertentive disorders of pregnancy with renal injury:ROC curves were drawn with the combined predictive values UA,ACR and both as test variables,the results showed that the area under the curve of UA and ACR in the diagnosis of renal injury in patients with HDP was 0.878,0.994,the cut-off value was 0.502,0.679,the specificity was 0.852,0.955,and the sensitivity was 0.807,0.982.The area under the curve,the cut-off value,specificity and sensitivity of the combined diagnosis of renal injury in HDP were 0.996,0.881,0.951 and 0.929,respectively.Conclusion:(1)The ratio of microalbumin creatinine in different types of hypertentive disorders of pregnancy was associated with increased diastolic blood pressure,uric acid,urea,lactate dehydrogenase,as well as with decreased albumin.(2)ACR is highly linearly correlated with 24-hour urine protein quantification,which is more accurate and convenient value in the diagnosis of different types of hypertentive disorders of pregnancy.(3)UA and ACR increased with the increased of the severity of different types of hypertentive disorders of pregnancy,the combination of the two has certain clinical value in the diagnosis of renal injury in patients with hypertentive disorders of pregnancy.