[Diagnostic value of radom spot albuminuria to creatinine ratio in women with preeclampsia].

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, urea 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 24 hours 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.

[Prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong province].

OBJECTIVE: To investigate the prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong province. METHODS: Data from 169 218 pregnant women in different regions of Guangdong province from January 2005 to June 2010 were analyzed retrospectively. The prevalence and epidemiological characteristics of thromboembolic disease during pregnancy or puerperium were investigated. RESULTS: Of the studied population, (1) 201 cases (1.3‰) suffered from thromboembolic disease during pregnancy or puerperium including 128 cases of deep vein thrombosis (DVT), 68 cases of cerebral venous thrombosis (CVT) and 5 pulmonary embolism, the prevalence rates were 0.8‰, 0.4‰, and 0.02‰ respectively. (2) Risk factors in different regions showed that, in the Pearl River Delta area, the major risk factors for DVT would include previous or family history of thrombosis, pregnancy complications, with medically involved diseases, prolonged bed rest and pregnancy weight gain>15 kg etc. While in eastern, western, northern parts of Guangdong, the major risk factors for DVT would include pregnancy weight gain>15 kg, prolonged bed rest, preeclampsia, cesarean section and complications during pregnancy. In Pearl River Delta region, the major risk factors for CVT would include eclampsia, preeclampsia, pregnancy complications, prolonged bed rest>3 days, past history or family history of thrombosis. While eclampsia, preeclampsia, advanced age or younger age, pregnancy weight gain>15 kg, complications during pregnancy were the major risk factors for CVT in the eastern, western or northern parts of Guangdong. CONCLUSION: Prevalence and major risk factors of peripartum thromboembolic disease in different regions of Guangdong were different. It was crucial to take effective measures in pregnant women with different epidemiological characteristics and risk factors to prevent and reduce the incidence of peripartum thromboembolic disease.

The application of serum cystatin C in estimating the renal function in women with preeclampsia.

OBJECTIVE: Serum cystatin C (Cys-C) is known to reflect the glomerular filtration rate (GFR) more precisely in native kidney diseases and renal dysfunctions secondary to other diseases. This study investigated the serum Cys-C in estimating the renal function in preeclamptic women. METHODS: A total of 96 patients with normal pregnancy (controls) and 48 cases of severe preeclampsia were recruited in this study. We measured the 24-hour creatinine clearance (CrCl), serum creatinine, Cys-C, uric acid (UA), and beta trace protein (BTP) concentrations on all the pregnant women in the second trimester and third trimester and in the postpartum of the patients with severe preeclampsia. Multiple comparisons and correlation analysis were used to analyze the indexes estimating the GFR. RESULTS: In the normal pregnancies, the concentrations of serum creatinine, UA, and BTP were significantly higher in the third trimester compared to the second trimester, however with no significant differences in the serum Cys-C levels. Comparison between the second and third trimester in patients with severe preeclampsia indicated that significant difference existed in the serum Cys-C, with higher concentration in third trimester. Correlation analyses demonstrated that significant negative correlations could be detected between Cys-C and 24-hour CrCl in the second trimester and third trimester of all the 144 pregnant women and in the postpartum of the patients with severe preeclampsia, and better correlations in normal participants than in participants with preeclampsia. CONCLUSIONS: Serum Cys-C seems to reflect the GFR precisely in women with severe preeclampsia and can be a good marker to monitor the renal function from antepartum to postpartum.