Hirshberg Adi, Draper Jennifer, Curley Cara, Sammel Mary D, Schwartz Nadav
Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA , USA and.
J Matern Fetal Neonatal Med. 2014 Dec;27(18):1834-8. doi: 10.3109/14767058.2014.905769. Epub 2014 Apr 9.
Data surrounding the use of a random urine protein:creatinine ratio (PCR) in the diagnosis of preeclampsia is conflicting. We sought to determine whether PCR in early pregnancy can replace the 24-hour urine collection as the primary screening test in patients at risk for baseline proteinuria.
Women requiring a baseline evaluation for proteinuria supplied a urine sample the morning after their 24-hour collection. The PCR was analyzed as a predictor of significant proteinuria (≥150 mg). A regression equation to estimate the 24-hour protein value from the PCR was then developed.
Sixty of 135 subjects enrolled completed the study. The median 24-hour urine protein and PCR were 90 mg (IQR: 50-145) and 0.063 (IQR: 0.039-0.083), respectively. Fifteen patients (25%) had significant proteinuria. PCR was strongly correlated with the 24-hour protein value (r = 0.99, p < 0.001) and highly predictive of significant proteinuria (AUC = 0.86). A PCR cut-point of 0.079 yielded a sensitivity of 93.3% and a specificity of 57.8%. The resulting regression equation [total protein = 46.5 + 904.2*PCR] accurately estimates the actual 24-hour protein (95% CI: ±88 mg).
A random urine PCR accurately estimates the 24-hour protein excretion in the first half of pregnancy and can be used as the primary screening test for baseline proteinuria in at-risk patients.
关于随机尿蛋白肌酐比值（PCR）用于子痫前期诊断的数据存在矛盾。我们试图确定孕早期的PCR是否可以替代24小时尿蛋白收集，作为基线蛋白尿风险患者的主要筛查试验。
需要进行蛋白尿基线评估的女性在24小时尿蛋白收集后的次日早晨提供一份尿样。分析PCR作为显著蛋白尿（≥150mg）的预测指标。然后建立一个从PCR估计24小时蛋白值的回归方程。
135名入组受试者中有60名完成了研究。24小时尿蛋白中位数和PCR分别为90mg（四分位数间距：50 - 145）和0.063（四分位数间距：0.039 - 0.083）。15名患者（25%）有显著蛋白尿。PCR与24小时蛋白值高度相关（r = 0.99，p < 0.001），对显著蛋白尿具有高度预测性（曲线下面积 = 0.86）。PCR切点为0.079时，敏感性为93.3%，特异性为57.8%。所得回归方程[总蛋白 = 46.5 + 904.2×PCR]能准确估计实际24小时蛋白（95%可信区间：±88mg）。
随机尿PCR能准确估计孕早期的24小时蛋白排泄量，可作为风险患者基线蛋白尿的主要筛查试验。
