国际妇产科学杂志

国际妇产科学杂志 ›› 2016, Vol. 43 ›› Issue (4): 393-398.

• 论著 • 上一篇    下一篇

血清乳酸脱氢酶与子痫前期及妊娠不良结局的关系

陈大立，柴利强，彭兰，汪云，许慧，陈继明，周玉珍，高红，金蕾，汤在祥   

  1. 215000 江苏省苏州市，南京医科大学附属苏州医院产科（陈大立，柴利强，彭兰，汪云，许慧，陈继明）；江苏省苏州市中西医结合医院（周玉珍）；江苏省苏州市吴江第一人民医院（高红）；江苏省苏州市吴中人民医院（金雷）；苏州大学医学部公共卫生学院流行病与卫生统计系（汤在祥）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-08-15 发布日期:2016-08-15
  • 通讯作者: 汤在祥

Association between Serum Lactate Dehydrogenase and Pre-eclampsia, Adverse Outcomes of Pregnancy

CHEN Da-li，CHAI Li-qiang，PENG Lan，WANG Yun，XU Hui，CHEN Ji-ming，ZHOU Yu-zhen，GAO Hong，JIN Lei，TANG Zai-xiang   

  1. Department of Obstetrics，Affiliated Suzhou Hospital of Nanjing Medical University，Suzhou 215000，Jiangsu Province，China（CHEN Da-li，CHAI Li-qiang，PENG Lan，WANG Yun，XU Hui，CHEN Ji-ming）；Suzhou Combined Chinese and Western Medicine Hospital，Suzhou 215000，Jiangsu Province，China（ZHOU Yu-zhen）；Suzhou Wujiang First People′s Hospital，Suzhou 215000，Jiangsu Province，China（GAO Hong）；Suzhou Wuzhong People′s Hospital，Suzhou 215000，Jiangsu Province，China（JIN Lei）；Department of Epidemiology and Biostatistics，School of Public Health of Medical College of Suzhou University，Suzhou 215000，Jiangsu Province，China（TANG Zai-xiang）
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-08-15 Online:2016-08-15
  • Contact: TANG Zai-xiang

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摘要： 目的：探讨血清乳酸脱氢酶（LDH）与子痫前期及妊娠不良结局的关系，并分析其对子痫前期的预测价值。方法：采用回顾性研究，调查分析了江苏省苏州地区2 236例妊娠期高血压疾病患者血清LDH水平及其他临床资料，妊娠期高血压组（998例），子痫前期组（1 238例），子痫前期组内又分为轻度子痫前期组（305例），重度子痫前期组（933例）。采用Logistic回归方法分析血清LDH水平与子痫前期的关系，按照LDH水平四分位数进行分层，并初步探讨血清LDH水平与妊娠不良结局的关系。结果：①妊娠期高血压疾病患者的LDH水平为228.0（179.6～444.0）U/L，子痫前期组LDH水平高于妊娠期高血压组（P＜0.01），重度子痫前期组LDH水平高于轻度子痫前期组（P＜0.01）。②LDH水平与子痫前期发病风险：以LDH≤179.6 U/L为参照组，无论是调整前还是调整后，随着LDH水平的升高，子痫前期的发病风险显著升高，3种模型下LDH＞444.0 U/L组的发病风险相对参照组的OR（95%CI）为18.92（13.56～26.37），13.26（9.42～18.67）和7.97（5.37～11.84）。LDH水平与子痫前期发病风险之间存在剂量反应关系经趋势检验有统计学意义。③LDH水平与重度子痫前期发病风险：LDH＞547.0 U/L组，3种模型下的发病风险相对参照组（LDH水平≤200 U/L）的OR（95%CI）为11.56（6.74～19.83），7.30（4.20～12.71）和4.43（2.47～7.94）。LDH水平与重度子痫前期严重程度之间存在剂量反应关系。④进一步采用受试者工作特征曲线（ROC）分析，发现以血清LDH水平、LDH与白蛋白（ALB）比值、LDH与结合胆红素（DBIL）比值为分析指标，预测子痫前期或重度子痫前期的曲线下面积均低于0.8。上述指标在子痫前期或重度子痫前期的诊断预测价值一般。⑤按照中位数将LDH分组后，发现在重度子痫前期中，LDH高水平组母亲不良结局、胎儿不良结局以及新生儿不良结局的发生率高于低水平组（P＜0.05）。结论：血清LDH水平与子痫前期及妊娠不良结局存在紧密的关联，是子痫前期疾病严重程度的重要临床参考指标之一。在重度子痫前期中，发现血清LDH水平的明显升高应高度警惕母婴不良结局的发生，及时减少有效措施，对于减少妊娠不良结局的发生，保障母婴安全健康可能具有十分重要的意义。

Abstract: Objective：To explore the relationship between serum lactate dehydrogenase （ＬＤＨ） level and pre-eclampsia, adverse outcomes of pregnancy, and to confirm the predictive value of serum LDH level on pre-eclampsia. Methods：A retrospective study was performed in the present study which involved 2 236 patients with hypertensive disorders in Suzhou area of Jiangsu Province in China. The number of patients in gestational hypertension, mild and severe pre-eclampsia groups were 998, 305 and 933. Logistic regression was used to analyze the association between serum LDH and pre-eclampsia, the serum LDH and clinical records were investigated, and chi-square test was used to analyze the association between serum LDH and adverse outcomes of pregnancy. Results：①The level of LDH in group gestational hypertension was 228.0（１79.6-444.0） U/L. Significant difference （Ｐ＜０．０１） was revealed in serum LDH level between the gestational hypertension and pre-eclampsia groups, also between mild and severe pre-eclampsia groups. ②Patients were stratified according to quartiles of serum LDH. Compared the lowest quartiles （≤１７９．６ Ｕ/L）, the risk of pre-eclampsia increased significantly than the other three groups. Three models were used in logistic analysis, unadjusted model, adjusted model for tradition factors and adjusted model for selected factors by multiple regression. The odds ratｉｏ （ＯＲ） ａnd 95% confidence interval （９５％ＣＩ） for the three models were 18.92 （13.56-26.37）, 13.26 （９.42-18.6７） and 7.97 （５.37-11.8４） ｉn the highest quartiles （ＬDH＞444.0 U/L）, respectively. An obvious dose-response relationship was also showed in three models. ③For mild and severe pre-eclampsia patients, compared with the lowest quartiles （≤200 U/L）, the OR and 95%CI for the three models mentioned above were 11.5６ （６．７４－１９．８３）, 7.30 （４．２０－１２．７１） and 4.43 （2.47-7.94） for the highest quartiles （LDH＞547.0 U/L）, respectively. The pathogenesis risk increased with the LDH level elevation. ④The further ROC analysis showed that, the area under curve （ＡＵＣ） of serum LDH level, the ratio of LDH/albumin, and the ratio of LDH/bilirubin for the diagnosis prediction of pre-eclampsia or severe pre-eclampsia were lower than 0.8. The predictive value of the indexes above on pre-eclampsia or severe pre-eclampsia diagnosis was limited. ⑤When patients were stratified according to median of serum LDH, the elevation of serum LDH level was significantly （Ｐ＜０．０５） ｃorrelated to the adverse results of the pregnant women, fetuses and neonates in severe pre-eclampsia group. Conclusions：An obvious dose-response relationship was present between LDH level and pre-eclampsia, and LDH was an important reference biochemical marker in clinical practice, which reflected the severity of pre-eclampsia. In severe pre-eclampsia, the obvious elevation of serum LDH level might indicate the occurrence of maternal and infant adverse outcomes. Timely and effective measures might have very important significance to reduce the incidence of adverse outcomes of pregnancy, and protect the security and health of the maternal and children.