Payne Beth, Magee Laura A, Côté Anne-Marie, Hutcheon Jennifer A, Li Jing, Kyle Phillipa M, Menzies Jennifer M, Peter Moore M, Parker Claire, Pullar Barbra, von Dadelszen Peter, Walters Barry N, von Dadelszen P, Magee L A, Douglas M J, Walley K R, Russell J A, Lee S K, Gruslin A, Smith G N, Côté A M, Moutquin J-M, Brown M A, Davis G, Walters B N, Sass N, Duan T, Zhou J, Mahajan S, Noovao A, McCowan L A, Kyle P, Moore M P, Bhutta S Z, Bhutta Z A, Steyn D W, Broughton Pipkin F, Loughna P, Robson S, de Swiet M, Walker J J, Grobman W A, Lindheimer M D, Roberts J M, Mark Ansermino J, Benton Samantha, Cundiff Geoff, Hugo Dany, Joseph K S, Lalji Sayrin, Li Jing, Lott Paula, Ouellet Annie B, Shaw Dorothy, Keith Still D, Tawagi George, Wagner Brenda, Biryabarema Christine, Mirembe Florence, Nakimuli Annettee, Tsigas Eleni, Merialdi Mario, Widmer Mariana
Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC.
Department of Obstetrics and Gynaecology, University of British Columbia Vancouver BC; CFRI Reproduction and Healthy Pregnancy Cluster, University of British Columbia Vancouver BC; Department of Health Care and Epidemiology, University of British Columbia Vancouver BC; Department of Medicine, University of British Columbia Vancouver BC.
J Obstet Gynaecol Can. 2011 Jun;33(6):588-597. doi: 10.1016/S1701-2163(16)34907-6.
To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes.
We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time). Models with AUC ≥ 0.70 were considered of interest. Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessments.
More women were proteinuric by urinary dipstick (≥ 2+, 61.4%) than by spot urine Pr/Cr (≥ 30 g/mol, 50.4%) or 24-hour urine collection (≥ 0.3g/d, 34.7%). Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods. No single method was predictive of adverse perinatal outcome.
The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia. Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events.
探讨三种不同蛋白尿评估方法（尿试纸法、随机尿蛋白：肌酐比值[Pr/Cr]和24小时尿收集法）预测不良妊娠结局的能力。
我们在加拿大、新西兰和澳大利亚的七个学术性三级产科中心进行了一项前瞻性多中心队列研究，即PIERS（先兆子痫风险综合评估），这些中心对远离足月的先兆子痫患者进行期待治疗。符合条件的女性是那些因先兆子痫入院且通过尿试纸法、随机尿Pr/Cr比值和/或24小时尿收集法至少进行过一次产前蛋白尿评估的患者。蛋白尿评估可在床边目视进行（通过尿试纸法），或由医院临床实验室对随机尿Pr/Cr和24小时尿收集进行检测。我们计算了每种蛋白尿方法以及每种合并的不良母体结局（48小时内）或不良围产儿结局（任何时间）的受试者操作特征曲线下面积（95%可信区间）。AUC≥0.70的模型被认为具有研究价值。对每种类型蛋白尿评估的所有女性以及进行了所有三种蛋白尿评估的一组女性（“所有测量方法”）进行了分析。
通过尿试纸法检测为蛋白尿（≥2+，61.4%）的女性多于通过随机尿Pr/Cr检测（≥30 g/mol，50.4%）或24小时尿收集检测（≥0.3g/d，34.7%）的女性。所评估的每种蛋白尿测量方法都有一定的鉴别能力，尿试纸法蛋白尿（分类）与其他方法表现相当。没有单一方法可预测不良围产儿结局。
对于先兆子痫女性，不应单独使用所测量的蛋白尿量来进行决策。尿试纸法蛋白尿在预测不良事件方面与其他评估蛋白尿的方法表现相当。
