Han Lican, Liu Lin, Meng Lanlan, Su Shaofei, Lu Yifan, Xu Zhengwen, Tang Guodong, Wang Jing, Zhu Hongyuan, Zhang Yue, Zhai Yanhong, Cao Zheng
Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.
Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.
Pract Lab Med. 2023 Oct 16;37:e00342. doi: 10.1016/j.plabm.2023.e00342. eCollection 2023 Nov.
In this study, we aimed to establish the trimester-specific RIs of renal function tests (RFTs) in singleton pregnant women and investigate the associations between adverse perinatal outcomes and abnormal renal function laboratory results.
The results of RFTs and the associated medical records were retrieved from 16489 singleton pregnant women who underwent first- and third-trimester prenatal screening and gave a live birth at out institute between August 2018 and December 2019. The RFTs were performed on the automated immunochemistry platform ARCHITECT ci16200 (Abbott Laboratories Ltd, Abbott Park, Illinois, US) in the clinical laboratory of our institute. The nonparametric 2.5th-97.5th percentile intervals and the indirect Hoffmann methods were used to define the trimester-specific RIs. The associations between abnormal RFTs and adverse pregnancy outcomes was assessed statistically by logistic regression.
There was no significant difference between the direct observational and the indirect Hoffmann methods in establishing RIs of RFTs. Compared with RFTs in the first trimester, the concentrations of serum BUN and Crea were slightly decreased ( < 0.001), and the serum UA and Cys C levels were significantly elevated in the third trimester ( < 0.001). In the logistic regression analysis, high concentrations of UA, Crea, and Cys C in late pregnancy were associated with an increased risk of postpartum hemorrhage. Meanwhile, early pregnancy UA was associated with a modestly increased risk of GDM, GH, and PE.
It is necessary to establish trimester-specific RIs for RFTs, in order to appropriately interpret laboratory results and to identify women with high risks of developing various adverse outcomes.
在本研究中，我们旨在建立单胎妊娠妇女肾功能检查（RFTs）的孕龄特异性参考区间（RIs），并研究围产期不良结局与肾功能实验室检查异常结果之间的关联。
从2018年8月至2019年12月在我院接受早孕期和孕晚期产前筛查并顺产的16489名单胎妊娠妇女中获取RFTs结果及相关病历。RFTs在我院临床实验室的全自动免疫化学平台ARCHITECT ci16200（美国雅培实验室有限公司，伊利诺伊州雅培公园）上进行。采用非参数第2.5百分位数至第97.5百分位数区间和间接霍夫曼方法来定义孕龄特异性RIs。通过逻辑回归对异常RFTs与不良妊娠结局之间的关联进行统计学评估。
在建立RFTs的RIs方面，直接观察法和间接霍夫曼法之间无显著差异。与早孕期的RFTs相比，血清尿素氮（BUN）和肌酐（Crea）浓度略有下降（P<0.001），而孕晚期血清尿酸（UA）和胱抑素C（Cys C）水平显著升高（P<0.001）。在逻辑回归分析中，妊娠晚期高浓度的UA、Crea和Cys C与产后出血风险增加相关。同时，早孕期UA与妊娠期糖尿病（GDM）、妊娠期高血压（GH）和子痫前期（PE）风险适度增加相关。
有必要建立RFTs的孕龄特异性RIs，以便正确解读实验室结果并识别有发生各种不良结局高风险的女性。
