Ambulatory Blood Pressure Monitoring Research In Preeclampsia Application

ObjectivePass study the characteristics of ABPM in pregnancy with preeclampsia, the rela-tionship between the pregnancy with preeclampsia ABPM parameters and24h urine protein、fetal birth weight, and study ABPM index effectiveness of diagnosis and predictive value to preeclampsia, discuss the value of ambulatory blood pressure monitoring (ABPM) apply to pregnancy with preeclampsia.Methods1.To collected132cases of pregnancy with preeclampsia who Outpatient prenatal and delivered at the Fujian Maternity and Children Health Hospital from October2009to December2012.132cases of pregnant women according to the serious degree were divided into mild preeclampsia group (46例) and severe preeclampsia group (86例) During the same period collected95cases normal pregnant women as control group1,67cases of gestational hypertension as control group2.2.Enumeration data between the groups of two two compared using LSD test after analysis of variance, drawing the24h blood pressure and heart rate dynamic curve, analysis of each group of24h blood pressure and heart rate changes in rhythm. Using the partial correlation analysis the relationship between ABPM and24h urine protein、 fetal birth weight, Using ROC curve, establish the best ABPM reference value for diagnosis of preeclampsia, and the Bayes formula count positive predictive value.Results1.Pregnancy with Severe preeclampsia group were delivered earlier than mild preeclampsia group, control group1and group2, the difference has statistically significant (P<0.05), compared mild preeclampsia group、control group1and group2, the difference is no statistically significant (P>0.05); compared groups of pregnant women’s age, pregnancy time, production time, the difference is no statistically significant (P>0.05). 2. Severe and mild preeclampsia groups pregnancy each ABPM index was higher than the control group, the difference was statistically significant (P<0.05); Severe preeclampsia groups pregnancy part ABPM index was higher than the mild preeclampsia group, in addition to the nocturnal diastolic pressure (n DBP) nocturnal diastolic pressure load (n DBP load)、24h heart rate (24h HR)、heart rate during the day(d HR), the residual difference was statistically significant (P<0.05); Control group2pregnancy part ABPM index was higher than the control group1, in addition to24h heart rate (24h HR)、heart rate during the day(d HR), the residual difference was statistically significant (P<0.05).3.Severe preeclampsia group pregnancy24h blood pressure is in "non dipper type change, nocturnal blood pressure almost no fall, circadian rhythm disappeared; mild preeclampsia group pregnancy24h blood pressure is in "non dipper" type change, the nocturnal blood pressure drop extent and fall time is less than the control group1and control group2, but circadian rhythm exists; control group1and control group2pregnancy24h blood pressure are in "dipper" type change, nocturnal blood pressure decreased obviously, circadian rhythm exists.4. Severe preeclampsia group pregnancy24h heart rate is in "non dipper" type change, the heart rate at night has no obvious drop, lose the normal circadian rhythmicity; mild preeclampsia group、control group1and group2pregnancy24h heart rate are in "dipper" type change, heart rate significantly decreased at night, circadian rhythm exists.5.Severe and mild preeclampsia groups pregnancy24h systolic blood pressure (24h SBP),24h diastolic blood pressure (24h DBP), Systolic blood pressure during the day(d SBP), diastolic pressure during the day (d DBP), systolic blood pressure at night (n SBP), diastolic blood pressure at night(n DBP), mean arterial pressure (MAP) are positively correlated with24h urine protein.6.Severe and mild preeclampsia groups24h SBP、24hSBP、d DBP、d SBP、n SBP、 n DBP、MAP are negatively correlated with fetal birth body mass. Gestational hypertension group of pregnant women24h DBP, d DBP, n DBP are negatively correlated with fetal birth body mass.7.The best diagnostic reference for preeclampsia,24h SBP、24h DBP、d SBP、d DBP、n SBP、n DBP respectively:127mmHg (area under curve (AUC)=0.941, the positive predictive value (PV)+=81.8%),80mmHg(AUC=0.907, PV+=85.6%),133mmHg (AUC=0.938, PV+=85.4%),84mmHg(AUC=0.898, PV+=77.9%),124mmHg (AUC=0.871, PV+=71.7%),78mmHg (AUC=0.806, PV+=76.8%).Conclusions1.The circadian rhythm changes of blood pressure and heart rate may be the first expression of preeclampsia pathogenesis, especially of severe preeclampsia.2.Rised of Ambulatory blood pressure monitoring index in preeclampsia patients may be contributes to24h urine protein increased and fetal birth body mass loss.3.Ambulatory blood pressure monitoring index Of preeclampsia has good diagnostic performance and predictive value.Above all, ambulatory blood pressure monitoring application in preeclampsiacan provide a lot of valuable information, can be used as important monitoring items during preeclampsia patients with expectation treatment, can predict preeclampsia, Helps to condition assessment and follow-up, thereby reduce the occurrence of preeclampsia and severe complications, reduce or avoid adverse pregnancy outcomes.