子痫前期孕妇的血清尿酸水平对母胎妊娠结局的预测作用

【摘 要】 目的：探讨子痫前期孕妇分娩前1个月内的血清尿酸水平对预测母胎妊娠结局的价值。方法：选取2014年4月-2015年12月在上海市第六人民医院分娩的152例子痫前期孕妇进行回顾性分析。所有入选者根据子痫前期严重程度、发病孕周分别分为重度组（106例）、非重度组（46例）及早发型组（75例）、晚发型组（77例）。收集孕妇分娩前1个月内的血清尿酸，选取病情最严重时对应的数值；妊娠并发症如胸腹腔积液、肝肾功能不全；围生儿健康指标如新生儿出生体质量、Apgar评分。结果：早发型或重度子痫前期孕妇的血清尿酸水平分别比晚发型或轻度子痫前期孕妇的明显升高（P＜0.01）。通过二分类Logistics回归分析发现：血清尿酸水平升高是子痫前期不良母胎结局的危险因素之一。受试者工作特征（receiver operating characteristic，ROC）曲线进一步表明：血清尿酸水平升高达到388～440 μmol/L，对预测子痫前期不良母胎结局的发生差异有统计学意义（P＜0.01）。结论：血清尿酸水平对评估子痫前期孕妇的不良母胎结局、选择评估终止妊娠时机具有重要的预测价值，需要临床医师予以高度重视。

The Effect of Serum Uric Acid Level Forecasting on Maternal-fetal Pregnancy Outcomes with Pre-eclampsia

Objective:To investigate the value of serum uric acid level within 1 months before delivery on maternal-fetal pregnancy outcomes with pre-eclampsia.Methods:A retrospective study was conducted on 152 pregnant women with preeclampsia who had delivered in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University from April 2014 to December 2015.According to whether complicated with severe index and the onset gestational weeks,all selected patients with pre-eclampsia were divided into severe group (n=106),non severe group (n--46),early onset group (n=75) and late onset group (n=77).Indexes of pregnant women within one month before delivery contain serum uric acid (the above indicators were selected for the most serious condition);pregnancy complications such as pleural or peritoneal effusion,liver or kidney dysfunction;perinatal health indicators such as newborn birth weight,the Apgar score and the ratio of peak systolic to least diastolic flow velocity of fetal umbilical artery (S/D).Results:The serum uric acid level in early onset or severe pre-eclampsia was significantly higher than that in late onset or mild pre-eclampsia.The Logistics regression analysis showed that elevated level of serum uric acid might be one of risk factors for adverse maternal-fetal pregnancy outcomes with pre-eclampsia.According to receiver operating characteristic curves (ROC),we found that:when the serum uric acid level was increased to 388-440 μmol/L,there was statistical significance for forecasting adverse maternal-fetal pregnancy outcomes (P＜ 0.01).Conclusions:The serum uric acid level has important predictive value to patients with pre-eclampsia on maternal-fetal pregnancy outcomes and the opportunity of pregnancy termination.