Kyle P M, Clark S J, Buckley D, Kissane J, Coats A J, de Swiet M, Redman C W
Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, Headington, UK.
Br J Obstet Gynaecol. 1993 Oct;100(10):914-9. doi: 10.1111/j.1471-0528.1993.tb15106.x.
To assess the effectiveness of second trimester 24-hour ambulatory blood pressure measurement as a screening test for pre-eclampsia.
Prospective interventional study.
John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.
One hundred and sixty-two normotensive nulliparous women recruited at hospital booking clinics.
Ambulatory blood pressure was measured at 18 and 28 weeks gestation using the TM2420 monitor.
The development of pre-eclampsia.
Awake systolic and mean arterial pressures were significantly increased (P < 0.02) at 18 weeks in those who later developed pre-eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P < 0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake-sleep differences were similar in relation to each outcome. The group with incipient pre-eclampsia had a significantly faster heart rate at both 18 and 28 weeks (P < 0.002) The sensitivity in predicting pre-eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%, with a positive predictive value of 31%. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%, respectively.
Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre-eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre-eclampsia becomes available (commencing at 28 weeks gestation), then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.
评估孕中期24小时动态血压测量作为子痫前期筛查试验的有效性。
前瞻性干预研究。
牛津约翰拉德克利夫妇产医院以及伦敦夏洛特女王与切尔西医院。
在医院预约门诊招募的162名血压正常的未生育女性。
使用TM2420监测仪在妊娠18周和28周时测量动态血压。
子痫前期的发生情况。
后来发生子痫前期的女性在妊娠18周时清醒状态下的收缩压和平均动脉压显著升高（P<0.02）。这些差异在妊娠28周时更为明显，此时舒张压也升高了（P<0.01）。在妊娠的两个阶段，较高的读数在睡眠期间持续存在，因此清醒-睡眠差异与每个结果相似。早期子痫前期组在妊娠第18周和28周时心率均显著更快（P<0.002）。对于妊娠28周时平均动脉压≥85 mmHg预测子痫前期的敏感性为65%，阳性预测值为31%。对于平均动脉压≥85 mmHg且心率≥90次/分钟的联合检测，其敏感性和阳性预测值分别为53%和45%。
虽然后来发生子痫前期的女性在孕中期动态血压显著升高，但仅血压的预测价值较低。将清醒状态下的动态心率和血压测量结合起来可提高检测效率。如果有一种有效的预防子痫前期的方法可用（从妊娠28周开始），那么清醒状态下的动态血压和心率作为一种筛查试验可能具有一定的临床价值。
