Department of Renal Medicine, Monash University, Box Hill, Victoria, Australia.
BJOG. 2011 Aug;118(9):1126-32. doi: 10.1111/j.1471-0528.2011.02960.x. Epub 2011 Apr 12.
To establish whether a spot urinary albumin: creatinine ratio (ACR) measured before 20 weeks of gestation can predict subsequent pre-eclampsia when urinary albumin is measured by high-performance liquid chromatography (HPLC).
Prospective exploratory study.
Antenatal clinic in a tertiary teaching hospital, Victoria, Australia.
A cohort of 265 women with a singleton pregnancy, normal renal function, and no evident proteinuria, attending antenatal clinics between 12 and 20 weeks of gestation.
The ACR was determined from a mid-stream urine (MSU) sample taken between 17 and 20 weeks of gestation. Intact urinary albumin was determined by HPLC; creatinine was measured by modified Jaffe's method.
Pre-eclampsia (primary); gestational hypertension, small for gestational age (SGA), gestational diabetes mellitus, gestational age at delivery, and prematurity (secondary).
The median ACR was 28 mg/mmol (IQR 16-46 mg/mmol). Women who subsequently developed pre-eclampsia had a significantly higher ACR (median 50 mg/mmol; IQR 33-90 mg/mmol) compared with women suffering from gestational hypertension (median 27 mg/mmol; IQR 8-35 mg/mmol), and compared with unaffected women (median 28 mg/mmol; IQR 16-46 mg/mmol). Mothers of SGA infants also had a significantly higher median ACR. By ROC analysis, the optimum ACR to predict pre-eclampsia was 35.5 mg/mmol: the relative risk of developing pre-eclampsia in women with a urinary ACR ≥ 35.5 mg/mmol was 7.8 times more than in those with a urinary ACR < 35.5 mg/mmol.
When urinary albumin is measured by HPLC, spot urinary ACR values are higher in early uncomplicated pregnancy compared with previously reported conventional methods. When measured early in the second trimester, an ACR ≥ 35.5 mg/mmol predicted pre-eclampsia well before the onset of clinical manifestations.
确定在 20 周妊娠前测量的点尿白蛋白：肌酐比值（ACR）是否可以预测随后用高效液相色谱法（HPLC）测量的尿白蛋白时发生先兆子痫。
前瞻性探索性研究。
澳大利亚维多利亚州一家三级教学医院的产前诊所。
265 名单胎妊娠、肾功能正常且无明显蛋白尿的孕妇，在妊娠 12 至 20 周期间就诊于产前诊所。
在妊娠 17 至 20 周期间，从中段尿液（MSU）样本中测定 ACR。完整的尿白蛋白通过 HPLC 确定；肌酐通过改良的 Jaffe 法测定。
中位 ACR 为 28 mg/mmol（IQR 16-46 mg/mmol）。随后发生子痫前期的女性 ACR 明显更高（中位数 50 mg/mmol；IQR 33-90 mg/mmol），与患有妊娠期高血压的女性（中位数 27 mg/mmol；IQR 8-35 mg/mmol）相比，与未受影响的女性相比（中位数 28 mg/mmol；IQR 16-46 mg/mmol）。SGA 婴儿的母亲 ACR 中位数也明显更高。通过 ROC 分析，预测子痫前期的最佳 ACR 为 35.5 mg/mmol：ACR≥35.5 mg/mmol 的女性发生子痫前期的相对风险是 ACR＜35.5 mg/mmol 的女性的 7.8 倍。
当用 HPLC 测量尿白蛋白时，与之前报道的常规方法相比，早期未合并的妊娠中尿 ACR 值更高。在妊娠中期早期测量时，ACR≥35.5 mg/mmol 在出现临床症状之前很好地预测了子痫前期。
