Hermida R C, Ayala D E, Mojón A, Fernández J R, Silva I, Ucieda R, Iglesias M
Bioengineering Laboratory, E.T.S.I. Telecomunicación, University of Vigo, Campus Universitario, Spain.
Hypertension. 1998 Jan;31(1):83-9. doi: 10.1161/01.hyp.31.1.83.
We have examined prospectively whether the combined approach of establishing tolerance intervals for the circadian variability of blood pressure (BP) as a function of gestational age, and then determining the so-called hyperbaric index (area of BP excess above the upper limit of the tolerance interval) by comparison of any patient's BP profile (obtained by ambulatory monitoring) with those intervals provides a high sensitivity test for the early detection of pregnant women who subsequently will develop gestational hypertension or preeclampsia. We analyzed 657 BP series from 92 women with uncomplicated pregnancies and 378 series from 60 women who developed gestational hypertension or preeclampsia. BP was sampled for about 48 hours once every 4 weeks after the first obstetric consultation. Circadian 90% tolerance limits were determined as a function of trimester of gestation from 497 series previously sampled from a reference group of 189 normotensive pregnant women. The hyperbaric index was then determined for each individual BP series in the validation sample. Sensitivity of this test for diagnosing gestational hypertension was 93% for women sampled during the first trimester of gestation and increased up to 99% in the third trimester. The positive and negative predictive values were above 96% in all trimesters. Despite the limitations of ambulatory monitoring, the approach presented here, now validated prospectively, represents a reproducible, noninvasive, and high sensitivity test for the very early identification of subsequent gestational hypertension and preeclampsia, on the average, 23 weeks before the clinical confirmation of the disease.
我们前瞻性地研究了一种联合方法，即根据孕周确定血压（BP）昼夜变异性的耐受区间，然后通过将任何患者的血压曲线（通过动态监测获得）与这些区间进行比较来确定所谓的高压指数（血压超过耐受区间上限的面积），该方法是否能为早期检测出随后会发生妊娠期高血压或先兆子痫的孕妇提供高灵敏度检测。我们分析了92例无并发症妊娠妇女的657个血压序列以及60例发生妊娠期高血压或先兆子痫妇女的378个序列。首次产科会诊后，每4周采集一次血压样本，持续约48小时。根据孕周，从189例血压正常的孕妇参考组先前采集的497个序列中确定昼夜90%耐受极限。然后在验证样本中为每个个体血压序列确定高压指数。该检测对诊断妊娠期高血压的灵敏度在妊娠早期采样的妇女中为93%，在妊娠晚期增至99%。所有孕周的阳性和阴性预测值均高于96%。尽管动态监测存在局限性，但本文介绍的方法现已通过前瞻性验证，是一种可重复、无创且高灵敏度的检测方法，平均可在疾病临床确诊前23周非常早期地识别出随后的妊娠期高血压和先兆子痫。
