| Objective:By retrospectively analyzing the basic clinical data,blood indexes [aspartate aminotransferase(AST),alanine aminotransferase(ALT),total protein,creatinine,uric acid],24 h urine protein,fetal umbilical artery hemodynamic indexes [umbilical artery peak endsystolic/end-diastolic velocity(S/D),pulsatility index(PI),resistance index(RI))],and neonatal indicators(1-minute Apgar score,5-minute Apgar score,newborn weight),to investigate the correlation of maternal blood NT-pro BNP,umbilical artery S/D with clinical characteristics of preeclampsia during pregnancy,and the clinical prediction value of both levels for the onset of severe preeclampsia.,in order to provide a new reference for the accurate identification of severe PE.Methods:In this study,a retrospective case-control study was conducted to collect 241 pregnant women with preeclampsia admitted to the First Hospital of Jilin University from August2018 to December 2022 [109 patients without severe clinical manifestations(PE group);132patients with severe clinical manifestations(severe PE group)],including age,height,prepregnancy weight,confirmed gestational age,gestational age at delivery,gravidity,paritiy,admission systolic blood pressure,admission diastolic blood pressure,blood NTpro BNP,AST,ALT,total protein,creatinine,uric acid,24 h urinary protein,umbilical artery S/D,umbilical artery PI,umbilical artery RI,1-minute Apgar score,5-minute Apgar score and neonate birth weight.SPSS27.0 software was used for statistical analysis,to analyze the differences in patients’ general data,blood indicators,24 h urine protein and neonatal indicators between PE group and severe PE group,and to analyze the correlation between blood NTpro BNP,umbilical artery S/D and general conditions,blood indicators,24 h urine protein and neonatal indicators in PE patients,and to explore the predictive value of blood NT-pro BNP,uric acid,24 h urinary protein,S/D and the combination between them(NT-pro BNP combined with uric acid,NT-pro BNP combined with 24 h urinary protein,NT-pro BNP combined with S/D,uric acid combined with 24 h urinary protein)for the onset of severe PE,and draw ROC curve to obtain the sensitivity,specificity and optimal diagnostic threshold.Results:(1)There was no statistical difference in age between PE group and severe PE group(P=0.1).Pre-pregnancy BMI,confirmed gestation week and gestational week at delivery in PE group were higher than those in severe PE group,with statistical significance(P < 0.05).The pregnancy time,admission systolic blood pressure,admission diastolic blood pressure and NT-pro BNP in PE group were all lower than those in severe PE group,with statistical significance(P < 0.05).There was no significant difference in age and pre-pregnancy BMI between the early-onset PE group and the late-onset PE group(P =0.334,P =0.975).The pregnancy time,admission systolic blood pressure and admission diastolic blood pressure in early-onset PE group were higher than those in late-onset PE group,with statistical significance(P < 0.05).The confirmed gestation weeks and delivery gestation weeks of earlyonset PE group were smaller than those of late-onset PE group,with statistical difference(P< 0.05).(2)AST,ALT,creatinine,uric acid and 24-hour urinary protein in PE group were all lower than those in severe PE group,which was statistically significant(P < 0.001).The total protein of PE group was higher than that of severe PE group,which was statistically significant(P < 0.001).There was no statistical significance in AST between early-onset PE group and late-onset PE group(P =0.052).ALT,creatinine,uric acid,NT-pro BNP and 24-hour urinary protein in early-onset PE group were higher than those in late-onset PE group,which was statistically significant(P < 0.05).The total protein of early-onset PE group was lower than that of late-onset PE group,which was statistically significant(P < 0.05).(3)The 1-minute Apgar score,5-minute Apgar score and neonate birth weight in PE group were higher than those in severe PE group,which was statistically significant(P <0.001).The umbilical artery S/D,umbilical artery PI and umbilical artery RI in PE group were lower than those in severe PE group,with statistical difference(P < 0.001).The 1-minute Apgar score,5-minute Apgar score and neonate birth weight in the early-onset PE group were lower than those in the late-onset PE group,which was statistically significant(P < 0.001).The umbilical artery S/D,PI and RI in early-onset PE group were lower than those in lateonset PE group,with statistical difference(P < 0.001).(4)In patients with preeclampsia,NT-pro BNP was positively correlated with admission systolic blood pressure(P < 0.001),admission diastolic blood pressure(P < 0.001),creatinine(P < 0.001),uric acid(P < 0.001),24 h urinary protein(P < 0.001).It was negatively correlated with total protein(P < 0.001).(5)In patients with preeclampsia,NT-pro BNP was positively correlated with umbilical artery S/D(P < 0.001),PI(P < 0.001),and RI(P < 0.001).It was negatively correlated with neonatal weight(P < 0.001),1-minute Apgar score(P < 0.001)and 5-minute Apgar score(P < 0.001).(6)In patients with preeclampsia,umbilical artery S/D was positively correlated with admission systolic blood pressure(P < 0.001),admission diastolic blood pressure(P=0.019),creatinine(P=0.037),uric acid(P < 0.001),and 24 h urinary protein(P < 0.001).It was negatively correlated with total protein(P=0.015).Umbilical artery S/D was negatively correlated with neonatal weight(P < 0.001),1-minute Apgar score(P < 0.001)and 5-minute Apgar score(P < 0.001).(7)In preeclampsia patients,umbilical artery PI was positively correlated with admission systolic blood pressure(P < 0.001),admission diastolic blood pressure(P=0.016),uric acid(P =0.005),and 24 h urinary protein(P < 0.001).It was not correlated with total protein and creatinine(P > 0.05).It was a negative correlation with neonatal weight(P <0.001),1-minute Apgar score(P < 0.001),and 5-minute Apgar score(P < 0.001).(8)In preeclampsia patients,umbilical artery RI was positively correlated with admission systolic blood pressure(P < 0.001),admission diastolic blood pressure(P=0.017),creatinine(P =0.023),uric acid(P < 0.001)and 24 h urinary protein(P < 0.001),negatively with total protein(P =0.015).Umbilical artery RI was a negative correlation with neonatal weight(P < 0.001),1-minute Apgar score(P < 0.001),and 5-minute Apgar score(P < 0.001).(9)Binary Logistic regression analysis was conducted on NT-pro BNP,uric acid,24 h urinary protein and umbilical artery S/D respectively.They were all all influencing factors of severe preeclampsia.Their OR values were 1.007,1.008,1.302 and 3.840,respectively.(10)The ROC curve showed that NT-pro BNP,uric acid,24 h urinary protein and umbilical artery S/D all had suggestive significance in the diagnosis of severe preeclampsia.The area under the curve(AUC)of NT-pro BNP was 0.865.The best diagnostic threshold of NT-pro BNP was 112.0.The sensitivity was 0.820,and the specificity was 0.829.The area under the curve of uric acid was 0.837.The optimal diagnostic threshold was 417.5.The sensitivity was 0.780,and the specificity was 0.829.The area under the curve of 24 h urinary protein was 0.763.The best diagnostic threshold of 24 h urinary protein was 1.2.The sensitivity was 0.640,and the specificity was 0.857.The area under the curve of umbilical artery S/D was0.759.The optimal diagnostic threshold of umbilical artery S/D was 2.3.The sensitivity was0.78,and the specificity was 0.686.(11)Combined indexes were used to construct ROC curve.The AUC of combination1(NT-pro BNP and uric acid)was 0.895.The sensitivity was 0.947,and the specificity was0.730.The AUC of combination 2(NT-pro BNP and 24 h urinary protein)was 0.861.The sensitivity was 0.842,and the specificity was 0.757.The AUC of combination 3(NT-pro BNP and umbilical artery S/D)was 0.888.The sensitivity was 0.877,and the specificity was 0.730.The AUC of combination 4(uric acid and 24 h urine protein)was 0.826.The sensitivity was0.825,and the specificity was 0.811.Conclusion:(1)The study found that the blood NT-pro BNP level in patients with severe PE was significantly higher than that in patients with PE.Meanwhile,this study also concluded that in patients with preeclampsia,when NT-pro BNP≥112ng/ml,it is more suggestive in predicting severe PE.At the same time,this study also concluded that the blood level of NTpro BNP in patients with early-onset PE was higher than that in patients with late-onset PE.(2)Umbilical artery S/D can reflect the condition of fetus in utero and is related to pregnancy outcome.In this study,when S/D≥2.34,it is more suggestive of severe PE.Meanwhile,the umbilical artery S/D of early-onset PE was higher than that of late-onse PE.(3)NT-pro BNP,uric acid,24 h urinary protein and umbilical artery S/D all had a certain predictive effect on severe PE.The combination between them(NT-pro BNP combined with uric acid,NT-pro BNP combined with 24 h urinary protein,NT-pro BNP combined with S/D,uric acid combined with 24 h urinary protein)can better suggest severe PE. |
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