Department of Obstetrics, CHU Lille, Lille, France.
Perinatal Growth and Health, University of Lille, Lille, France.
Int J Gynaecol Obstet. 2020 Apr;149(1):76-81. doi: 10.1002/ijgo.13094. Epub 2020 Feb 3.
To determine the diagnostic accuracy and optimal threshold of the spot protein-to-creatinine ratio (PCR) compared to the gold standard, 24-hour proteinuria (24HP) in patients with suspected pre-eclampsia.
A prospective observational study was performed from June 2015 to May 2017 consisting of patients hospitalized for suspected pre-eclampsia in a tertiary care referral center. To compare the two diagnostic tests, a spot urine sample was obtained to perform the PCR before starting the collection of the 24HP. Only patients who had both tests were analyzed.
In total, 148 patients (216 samples) were included. The two tests were highly correlated (r=0.80, P<0.001). The receiver operating characteristic curve analysis and the area under the curve (AUC=0.92) highlighted the accuracy of PCR in diagnosing significant proteinuria and thus pre-eclampsia. The optimal cut-off using the Liu method was 56.9 mg/mmol (sensitivity=79.3%, specificity=91.5%).
The results suggest that PCR could replace 24HP when diagnosing proteinuria in pre-eclampsia. Moreover, it is a simple test, easy to realize and standardize, and cheap with no need for systematic hospitalization. The best cut-off should be chosen by thinking about the risks for adverse maternal and/or fetal outcomes. The test may help to optimize medical care in pre-eclampsia worldwide.
确定斑点蛋白与肌酐比值（PCR）与金标准 24 小时尿蛋白（24HP）相比在疑似子痫前期患者中的诊断准确性和最佳阈值。
本前瞻性观察性研究于 2015 年 6 月至 2017 年 5 月在一家三级转诊中心对疑似子痫前期住院患者进行。为了比较两种诊断试验，在开始收集 24HP 之前，采集了一份尿液标本以进行 PCR。仅对同时进行了这两项检查的患者进行了分析。
共纳入 148 例患者（216 份标本）。这两种检测方法高度相关（r=0.80，P<0.001）。受试者工作特征曲线分析和曲线下面积（AUC=0.92）强调了 PCR 在诊断大量蛋白尿（进而子痫前期）中的准确性。Liu 法的最佳截断值为 56.9mg/mmol（敏感性=79.3%，特异性=91.5%）。
结果表明 PCR 可以替代 24HP 诊断子痫前期中的蛋白尿。此外，PCR 是一种简单、易于实现和标准化、经济实惠的检测方法，无需系统住院。最佳截断值的选择应考虑到母婴不良结局的风险。该检测可能有助于优化全球子痫前期的医疗保健。
