目的 通过分析子痫前期孕妇随机尿白蛋白/肌酐比值与24h尿蛋白定量的相关性,探讨随机尿白蛋白/肌酐比值诊断轻度和重度子痫前期的最佳值.方法 选择2010年10月至2011年6月南方医科大学南方医院收治的轻度子痫前期孕妇28例,重度子痫前期孕妇22例.常规方法检测孕妇血清中胱抑索、尿酸、尿素氮、肌酐和白蛋白水平.采用免疫比浊法检测孕妇24h尿蛋白定量.采用DCA2000型自动分析仪检测并计算孕妇尿白蛋白/肌酐比值,并进行孕妇尿白蛋白/肌酐比值与24h尿蛋白定量的相关性分析；应用受试者工作特征(ROC)曲线得出轻度和重度子痫前期孕妇的尿白蛋白/肌酐比值的最佳诊断值.结果 (1)血清生化指标:轻度子痫前期孕妇血清中胱抑素和尿酸水平分别为(1.3±0.3) mg/L、( 359±114) μmol/L,重度子痫前期孕妇分别为(1.6±0.5)mg/L、(450±132) μmol/L,轻、重度孕妇比较,差异有统计学意义(P＜0.05).轻度子痫前期孕妇血尿素氮、血肌酐水平分别为(3.6±1.6) mmol/L、(52±38) μmol/L,重度子痫前期孕妇分别为(6.2±3.1) mmol/L、(78±59) μmol/L,轻、重度孕妇比较,差异无统计学意义(P＞0.05).轻度子痫前期孕妇血白蛋白水平为(33±3) g/L,重度子痫前期孕妇为(29±6) g/L,两者比较,差异无统计学意义(P＞0.05).(2)24h尿蛋白定量及尿白蛋白/肌酐比值:轻度子痫前期孕妇平均24h尿蛋白为(700±160)mg,尿白蛋白/肌酐比值为(72.7±12.4) mg/mmol;重度子痫前期孕妇平均24h尿蛋白为(4800±2200)mg,尿白蛋白/肌酐比值为(401±245) mg/mmol,两者比较,差异有统计学意义(P＜0.05).(3)尿白蛋白/肌酐比值与24h尿蛋白定量的相关性:轻度及重度子痫前期孕妇尿白蛋白/肌酐比值与24h尿蛋白定量均有高度线性正相关性(r均=0.938,P＜0.05).(4)尿白蛋白/肌酐比值诊断子痫前期的最佳值:轻度子痫前期孕妇24h尿蛋白定量为300 mg时,曲线下面积为0.903,敏感度为82.4％,特异度为99.4％,尿白蛋白/肌酐比值为22.8 mg/mmol；重度子痫前期孕妇24h尿蛋白定量为2000 mg时,曲线下面积为0.956,敏感度为88.6％,特异度为91.3％,尿白蛋白/肌酐比值为155.6 mg/mmol.结论 随机尿白蛋白/肌酐比值与24h尿蛋白定量有显著相关性,用于临床更为快捷、简便,有望代替24h尿蛋白定量作为子痫前期病情严重程度的诊断标准.尿白蛋白/肌酐比值诊断轻度子痫前期的最佳值为22.8 mg/mmol,诊断重度子痫前期的最佳值为155.6 mg/mmol.%Objective To investigate the correlation between spot albuminuria to creatinine ratio (ACR) and 24 h urinary protein excretion in women with preeclampsia and determine the optimal cut-off values of spot ACR in mild preeclampsia and severe preeclampsia.Methods Twenty-eight women with mild preeclampsia and 22 with severe preeclampsia at Nanfang Hospital,Southern Medical University between October 2010 and June 2011 were recruited.Maternal serum cystatin,uric acid,mea nitrogen,creatinine and albumin levels were collected and analyzed.Twenty-four hours urinary protein excretion was measured with immunoturbidimetric assay and ACR with automatic analyzer DCA2000.The correlation between ACR and 24 hours urinary protein excretion was explored.And the optimal cut-off values of the spot ACR for mild and severe preeclampsia were determined with receiver operating characteristic curve.Results ( 1 )Maternal serum biochemical parameters:uric acid levels in mild and severe preeclampsia were (359 ± 114)μmol/L and (450 ± 132) μmol/L,while cystatin levels were ( 1.3 ±0.3) mg/L and ( 1.6 ±0.5) mg/L respectively.The differences were statistically significant ( P ＜ 0.05 ).Serum urea nitrogen,creatinine and albumin in mild preeclampsia were(3.6 ± 1.6) mmol/L,(52 ± 38 ) μmol/L and ( 33 ± 3 ) g/L,while in severe preeclampsia were( 6.2 ± 3.1 ) mmol/L,( 78 ± 59 ) μmol/L and ( 29 ± 6 ) g/L respectively.There were no statistical significant differences ( P ＞ 0.05 ).(2) Twenty-four hours urinary protein excretion and ACR:24 hours urinary protein levels in mild and severe preeclampsia was (700 ± 160) mg and (4800 ±2200) mg (P＜0.05).ACR in mild and severe preeclampsia was (72.7 ± 12.4) mg/mmol and (401 ±245) mg/mmol respectively (P ＜ 0.05 ).(3) There was a strong correlation between the spot ACR and 24hours urine protein excretion ( r =0.938 ; P ＜ 0.05 ).( 4 ) The optimal spot ACR cut-off point for the diagnosis of preeclampsia:the optimal spot ACR cut-off point was 22.8 mg/mmol for 300 mg/24 hours of protein excretion in mild preeclampsia,the area under curve was 0.956,with a sensitivity,specificity of 82.4％,99.4％ respectively.And the optimal spot ACR cut-off point was 155.6 mol for 2000 mg/24 hours of protein excretion in severe preeclampsia,the area under curve was 0.956,with a sensitivity,specificity of 88.6％,91.3％ respectively.Conclusions Compared with 24 hours urinary protein excretion,the spot ACR may be a simple,convenient and accurate indicator of early diagnosis of preeclampsia.Spot ACR may be used as a replacement for 24 hours urine protein excretion in assessment of preeclampsia.The optimal spot ACR cut off points were 22.8 mg/mmol for mild preeclampsia and 155.6 mg/mmol for severe preeclampsia.
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