Lauszus F F, Rasmussen O W, Lousen T, Klebe T M, Klebe J G
Gynecological/Obstetrical Department Y, Skejby Hospital, Aarhus, Denmark.
Acta Obstet Gynecol Scand. 2001 Dec;80(12):1096-103. doi: 10.1034/j.1600-0412.2001.801204.x.
Twenty-four-hour ambulatory blood pressure was evaluated as a predictor of preeclampsia in women with insulin-dependent diabetes mellitus with respect to urinary albumin excretion rate and glycemic regulation.
One hundred and fifty-one women with insulin-dependent diabetes mellitus were consecutively recruited from the outpatient maternity ward for 24 hour ambulatory blood pressure measurement with a portable monitor (SpaceLab 90207). Blood pressure was measured three times during pregnancy and once after delivery. Evaluation was performed with receiver-operator-characteristics curves in primiparous women. Stratified analysis and multiple regression was applied with respect to urinary albumin excretion rate, HbA1c, age, duration of diabetes mellitus, uric acid, and BMI.
The incidence of preeclampsia was significantly associated with increasing urinary albumin excretion rate, primiparity, and ambulatory blood pressure. Ambulatory blood pressure was associated with HbA1c throughout pregnancy adjusted for urinary albumin excretion rate. The ambulatory blood pressure was higher from first trimester throughout pregnancy in women developing preeclampsia compared to women who did not have preeclampsia. The best sensitivity and specificity for predicting preeclampsia in primiparous women were at cut-off values of systolic and diastolic day ambulatory blood pressure above 122 and 74 mmHg, respectively. The relative risk of preeclampsia was significantly higher when ambulatory blood pressure was above the cut-off values and increased further with higher urinary albumin excretion rate.
The relationship between ambulatory blood pressure and preeclampsia is not confined to women with macroalbuminuria but is also present in women with normo- and microalbuminuria. Poor glycemic control and increased urinary albumin excretion rate is associated with preeclampsia when ambulatory blood pressure is above cut-off values of 122/74 mmHg (systole/diastole). Ambulatory blood pressure is a reliable measurement for prediction of preeclampsia in primiparous women with insulin-dependent diabetes mellitus.
针对胰岛素依赖型糖尿病女性，就尿白蛋白排泄率和血糖调节情况而言，评估24小时动态血压作为子痫前期预测指标的价值。
从门诊产科病房连续招募151名胰岛素依赖型糖尿病女性，使用便携式监测仪（太空实验室90207）进行24小时动态血压测量。孕期测量血压3次，产后测量1次。对初产妇采用受试者工作特征曲线进行评估。针对尿白蛋白排泄率、糖化血红蛋白（HbA1c）、年龄、糖尿病病程、尿酸和体重指数（BMI）进行分层分析和多元回归分析。
子痫前期的发生率与尿白蛋白排泄率升高、初产和动态血压显著相关。在调整尿白蛋白排泄率后，整个孕期动态血压与HbA1c相关。与未发生子痫前期的女性相比，发生子痫前期的女性从孕早期到整个孕期的动态血压更高。预测初产妇子痫前期的最佳敏感性和特异性分别为收缩压和舒张压日间动态血压截断值高于122 mmHg和74 mmHg时。当动态血压高于截断值时，子痫前期的相对风险显著更高，且随着尿白蛋白排泄率升高进一步增加。
动态血压与子痫前期之间的关系不仅限于大量蛋白尿女性，正常白蛋白尿和微量白蛋白尿女性也存在这种关系。当动态血压高于122/74 mmHg（收缩压/舒张压）截断值时，血糖控制不佳和尿白蛋白排泄率增加与子痫前期相关。动态血压是预测胰岛素依赖型糖尿病初产妇子痫前期的可靠指标。
