Departments of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Hypertension. 2010 Jan;55(1):189-93. doi: 10.1161/HYPERTENSIONAHA.109.143586. Epub 2009 Nov 30.
Neurological findings in preeclampsia fulfill diagnostic criteria of posterior reversible encephalopathy syndrome (PRES), which is related to cerebral autoregulation impairment associated with high blood pressure. In preeclampsia, PRES may occur without a significant increase in blood pressure. Our aim was to investigate the association between ophthalmic artery resistive index (OARI) and clinical evidence of PRES, defined as the presence of headache and blurred vision, in patients with severe preeclampsia. OARI and main clinical and laboratory parameters were obtained in 112 patients with severe preeclampsia. Differences in these parameters were analyzed in the function of clinical evidence of PRES with a 2-sample t test. The area under receiver operating characteristic curve for each of these parameters in the function of clinical evidence of PRES was obtained. Logistic regression models were established with parameters categorized by cutoff points obtained in receiver operating characteristic curves. Among 112 patients with severe preeclampsia, 46 (41%) presented clinical evidence of PRES. These patients presented lower OARI (P<0.0001), higher mean blood pressure at admission (P<0.0001), higher mean blood pressure elevation after the first trimester (P<0.0001), and higher lactate dehydrogenase (P<0.0001) than those without clinical evidence of PRES. OARI presented an area under receiver operating characteristic curve of 0.810+/-0.039 (95% CI: 0.742 to 0.895; P<0.0001). OARI <0.56 was associated with clinical evidence of PRES, with an odds ratio of 12.67 (95% CI: 4.08 to 39.39; P<0.0001). Data suggest that OARI is a relevant biomarker of PRES in severe preeclampsia.
先兆子痫的神经学发现符合后部可逆性脑病综合征 (PRES) 的诊断标准，其与与高血压相关的脑自动调节损害有关。在先兆子痫中，PRES 可能在血压没有显著升高的情况下发生。我们的目的是研究 112 例重度先兆子痫患者的眼动脉阻力指数 (OARI) 与 PRES 临床证据之间的关系，PRES 的临床证据定义为头痛和视力模糊。在 112 例重度先兆子痫患者中获得了 OARI 和主要临床及实验室参数。采用两样本 t 检验分析这些参数在 PRES 临床证据方面的差异。获得这些参数在 PRES 临床证据方面的受试者工作特征曲线下面积。根据受试者工作特征曲线获得的截断点对参数进行分类，建立逻辑回归模型。在 112 例重度先兆子痫患者中，46 例 (41%) 出现 PRES 临床证据。这些患者的 OARI 较低 (P<0.0001)、入院时平均血压较高 (P<0.0001)、孕早期后平均血压升高较高 (P<0.0001)、乳酸脱氢酶较高 (P<0.0001)。OARI 的受试者工作特征曲线下面积为 0.810+/-0.039 (95%CI：0.742 至 0.895；P<0.0001)。OARI<0.56 与 PRES 的临床证据相关，优势比为 12.67 (95%CI：4.08 至 39.39；P<0.0001)。数据表明，OARI 是重度先兆子痫 PRES 的一个相关生物标志物。
