Udenze I C, Arikawe A P, Makwe C C, Olowoselu O F
Department of Clinical Pathology, College of Medicine, University of Lagos, Lagos, Nigeria.
Department of Physiology, College of Medicine, University of Lagos, Lagos, Nigeria.
Niger J Clin Pract. 2017 Jun;20(6):741-745. doi: 10.4103/1119-3077.208948.
Early detection of preeclampsia will help reduce the morbidities and mortalities associated with the disorder. Late-onset preeclampsia was the predominant presentation in this cohort. The search for biomarkers for predicting preeclampsia is still ongoing. Mean arterial blood pressure (MABP), which has the advantage of presenting a single cutoff value compared with the use of systolic and diastolic blood pressure measurements, merits evaluation.
The study aims to evaluate the clinical utility of second trimester MABP in the prediction of preeclampsia.
This was a prospective cohort study of 155 normotensive, nonproteinuric pregnant women without prior history of gestational hypertension. The women were booked patients attending the antenatal clinic at the Lagos University Teaching Hospital and were all in their second trimesters of pregnancy. The outcome measures were systolic blood pressure, diastolic blood pressure, and MABP. The end point of the study was the development of preeclampsia. The diagnosis of preeclampsia was made by the attending obstetrician. The data were analyzed using the IBM SPSS statistical software. Statistical significance was set at P < 0.05.
One hundred and fifty-five pregnant women participated in the study. Eleven (7.1%) of the women developed preeclampsia after 34 weeks gestation and 144 (92.9%) had normal pregnancy. The mean gestational age at the time of assessment was 18.88 ± 3.15 weeks with a range of 14 weeks to 27 completed weeks. There was a statistically significant increase in the systolic blood pressure, diastolic blood pressure, and MABP values in the group of women who later developed preeclampsia, P = 0.005, 0.001, and <0.001, respectively. At a false-positive rate of 10%, MABP value of 88.33 mmHg predicted preeclampsia with a specificity of 90% and a sensitivity of 45.5%, P <0.05. The area under the receiver-operative characteristics curve (AUC) was 0.732 (95% confidence interval, 0.544-0.919, P = 0.011). The negative predictive value (NPV) was 88.88% and the positive predictive value (PPV) was 45.45%, P < 0.05. At an MABP cutoff of 88.33 mmHg, preeclampsia was predicted with a relative risk of 4.44 and a positive likelihood ratio of 6.46, P < 0.05.
With an AUC of 0.732, MABP performed moderately (considering that excellent performance has an AUC of 1.0) in the prediction of late-onset preeclampsia in Nigerian women. Its high NPV suggests a strong ability to rule out preeclampsia and help to appropriate management.
子痫前期的早期检测有助于降低与该疾病相关的发病率和死亡率。晚发型子痫前期是该队列中的主要表现形式。寻找预测子痫前期的生物标志物的工作仍在进行中。平均动脉血压（MABP）与使用收缩压和舒张压测量相比，具有呈现单一临界值的优势，值得评估。
本研究旨在评估孕中期MABP在预测子痫前期中的临床效用。
这是一项对155名无妊娠期高血压病史的血压正常、无蛋白尿孕妇的前瞻性队列研究。这些女性是拉各斯大学教学医院产前诊所的预约患者，均处于妊娠中期。观察指标为收缩压、舒张压和MABP。研究的终点是子痫前期的发生。子痫前期的诊断由主治产科医生做出。使用IBM SPSS统计软件对数据进行分析。设定统计学显著性为P<0.05。
155名孕妇参与了研究。其中11名（7.1%）女性在妊娠34周后发生子痫前期，144名（92.9%）妊娠正常。评估时的平均孕周为18.88±3.15周，范围为14周至27足周。后来发生子痫前期的女性组中，收缩压、舒张压和MABP值有统计学显著升高，P值分别为0.005、0.001和<0.001。在假阳性率为10%时，MABP值88.33 mmHg预测子痫前期的特异性为90%，敏感性为45.5%，P<0.05。受试者工作特征曲线（AUC）下的面积为0.732（95%置信区间，0.544 - 0.919，P = 0.011）。阴性预测值（NPV）为88.88%，阳性预测值（PPV）为45.45%，P<0.05。在MABP临界值为88.33 mmHg时，预测子痫前期的相对风险为4.44，阳性似然比为6.46，P<0.05。
AUC为0.732，MABP在预测尼日利亚女性晚发型子痫前期方面表现中等（考虑到优秀表现的AUC为1.0）。其高NPV表明有很强的排除子痫前期的能力，并有助于进行适当的管理。
