Shi J M, Yang Z, Li F Q, Wang G J
Department of Obstetrics, Haidian Maternal and Child Health Hospital, Beijing 100080, China.
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Jan 25;55(1):29-35. doi: 10.3760/cma.j.issn.0529-567X.2020.01.006.
To observe the dynamic changes of human serum albumin (HSA) level during pregnancy and study the early warning significance of HSA level on the onset of preeclampsia (PE) . Totally 369 PE pregnant women (PE group) and 309 normal pregnant women (control group) without PE who admitted in Haidian Maternal and Child Health Hospital from January 2013 to December 2017 were selected. HSA levels were tested before meeting the criterion of PE in the first trimester, the early-third trimester and the late-third trimester, the difference between the two groups were compared. The relationship between the HSA level and the incidence of complications in PE patients was analyzed. (1)The mean values of HSA level in PE group and control group were (41.9±3.1) versus (40.0±2.2) g/L, (34.2±2.7) versus (35.4±2.7) g/L and (33.7±2.9) versus (36.7±3.3) g/L in the first trimester,the early-third trimester and the late-third trimester respectively,the difference in the first trimester was no significance (>0.05), while the differences in the early-third trimester and the late-third trimester were both significant (all <0.05). (2) The HSA level during pregnancy of PE group showed a continuous downward trend, while the control group was V-shaped trend. The receiver operating characteristic (ROC) curve analysis showed that PE could be early warned by the decrease of HSA level in PE group [area under curve (AUC)=0.742, cut-off value=5.97 g/L, sensitivity 70.8%, specificity 62.8%], the same result was in severe PE (AUC=0.756, cut-off value=6.85 g/L, sensitivity 70.8%, specificity 72.0%). The level of HSA was negatively correlated with the incidence of complications (-0.19, 0.01). Excessive decrease of HSA level is an early warning factor for PE onset. The higher the baseline of HSA level and the greater the extent of pregnancy decline, the risk of PE in pregnant women is higher. The lower of HSA level in PE, the incidence of complications is higher. The excessive decrease of HSA level may be the first clinical manifestation before the onset of clinical symptoms of PE, so it may be the warning factor and one of the laboratory indicators in the PE sub-clinical stage.
观察孕期人血清白蛋白(HSA)水平的动态变化,研究HSA水平对子痫前期(PE)发病的预警意义。选取2013年1月至2017年12月在海淀妇幼保健院收治的369例PE孕妇(PE组)和309例未患PE的正常孕妇(对照组)。分别在孕早期、孕中期和孕晚期PE诊断标准出现前检测HSA水平,比较两组间差异。分析PE患者HSA水平与并发症发生率的关系。(1)PE组和对照组在孕早期、孕中期和孕晚期HSA水平的均值分别为(41.9±3.1)与(40.0±2.2)g/L、(34.2±2.7)与(35.4±2.7)g/L、(33.7±2.9)与(36.7±3.3)g/L,孕早期差异无统计学意义(>0.05),而孕中期和孕晚期差异均有统计学意义(均<0.05)。(2)PE组孕期HSA水平呈持续下降趋势,而对照组呈V形趋势。受试者工作特征(ROC)曲线分析显示,PE组HSA水平下降可早期预警PE[曲线下面积(AUC)=0.742,截断值=5.97 g/L,灵敏度70.8%,特异度62.8%],重度PE结果相同(AUC=0.756,截断值=6.85 g/L,灵敏度70.8%,特异度72.0%)。HSA水平与并发症发生率呈负相关(-0.19,P=0.01)。HSA水平过度下降是PE发病的预警因素。HSA水平基线越高且孕期下降幅度越大,孕妇发生PE的风险越高。PE患者HSA水平越低,并发症发生率越高。HSA水平过度下降可能是PE临床症状出现前的首个临床表现,因此可能是PE亚临床阶段的预警因素及实验室指标之一。