| Background: Preeclampsia is a special disease of pregnant women,and it is also the main cause of harm to the health of pregnant women.It can lead to maternal and perinatal death.Prediction of preeclampsia is an important means to improve the prognosis of mother and infant.However,there is no reliable and mature prediction method to deal with the occurrence of eclampsia at this stage.How to predict the occurrence of eclampsia by relevant means is also an urgent problem.Hypertension and proteinuria are the most common indicators in many symptoms of preeclampsia,especially in the dynamic observation of the frontal condition of early preeclampsia.Ambulatory blood pressure monitoring can reflect the day and night changes of blood pressure and the characteristics of blood pressure variability.The data is accurate and objective.In the diagnosis of preeclampsia,blood pressure and detection in family clinics can not be replaced.The measurement of proteinuria,especially for the patients with eclampsia,can provide a more accurate diagnosis for the quantitative value of 24-hour urine protein and the ratio of urine protein to urine creatinine.Therefore,in this study,24 h urine protein quantification was combined with dynamic blood pressure monitoring to evaluate patients with preeclampsia,so as to investigate its clinical value in the prognosis of patients with eclampsia and the prediction of pregnancy outcome.Objective: To explore the predictive effect of ambulatory blood pressure monitoring combined with 24-hour urine protein quantitative monitoring on the outcome of preeclampsia and pregnancy.Methods: The clinical data of preeclampsia patients who were hospitalized and delivered in our hospital from January 2017 to December 2018 were analyzed retrospectively.,there were 85 cases,during the same period,dynamic blood pressure monitoring and urine protein quantitative examination were conducted for 24 hours.Analyzing the clinical data of the patients,according to whether there is adverse pregnancy outcome in mother and infant,the patients included were divided into study group(45 cases)with adverse pregnancy outcome and control group(40 cases)without adverse pregnancy outcome.The 24-hour ambulatory blood pressure related indexes and 24-hour urine protein quantitative value were compared between the two groups.The correlation between 24-hour ambulatory blood pressure related indexes and FBW,LDH and 24-hour urine protein quantitative was analyzed,and the correlation between 24-hour urine protein quantitative value and FBW and LDH was analyzed.Results:(1)The gestational weeks of delivery were earlier in the study group than in the control group(P<0.001),there was no difference in patients' age,cesarean section and general data of primiparas between the two groups.(2)The FBW of the study group was 2163.54g-2519.65 g,with an average of 2316.57 ± 179.59 g,and that of the control group was 2640.73-2879.68 g,with an average of 2845.63 ± 171.43 g.The FBW of the study group was lower than that of the control group,with a statistically significant difference(t = 13.848,P < 0.001).(3)The day and night average DBP in both groups was higher than normal,the day and night average SBP increased in the study group,while the night SBP increased in the control group.The highest systolic pressure and diastolic pressure in 24 hours in the study group were higher than those in the control group,and the difference was statistically significant(P < 0.05).The d SBP,d DBP,n SBP,n DBP,24 h SBP,24 h DBP,d MAP,n MAP and 24 h MAP in the study group were higher than those in the control group,and the difference was statistically significant(P < 0.05).(4)The rate of nocturnal systolic blood pressure decline and nocturnal diastolic blood pressure decline in both groups were lower than normal.there was no significant difference between the two groups(P > 0.05).However,it was found that the 24-hour systolic blood pressure variability and 24-hour diastolic blood pressure variability of the study group were lower than those of the control group,the difference was statistically significant(P < 0.05).(5)The average 24-hour urine protein quantity of the study group was 3263.07 ± 1814.53 g,the average 24-hour urine protein quantity of the control group was 1318.62±542.58 g,the average 24-hour urine protein quantity of the study group was higher than that of the control group,the difference between the two groups was statistically significant(P<0.001).(6)The correlation analysis of 24-hour ABPM and FBW showed that DBP,ddbp,nsbp,ndbp,24 hsbp,24hdbp,DMAP,nmap and 24 hmap were negatively correlated with FBW,and the difference was statistically significant(P < 0.05);in addition,the decrease rate of night systolic blood pressure,the decrease rate of night diastolic blood pressure,the variation of 24-hour systolic blood pressure and the variation of 24-hour diastolic blood pressure were negatively correlated with FBW The difference was statistically significant(P < 0.05).(7)The correlation analysis of 24-hour ABPM parameters and 24-hour urine protein quantitative results showed that d SBP?d DBP?n SBP?n DBP?24h SBP?24h DBP?d MAP?n MAP and 24 h MAP were positively correlated with the average 24-hour urine protein quantity,and the difference was statistically significant(P < 0.05);in addition,the decrease rate of night systolic pressure,the decrease rate of night diastolic pressure,the variation of 24-hour systolic pressure and the variation of 24-hour diastolic pressure There was no correlation with the results of 24-hour urinary protein quantification,and the difference was not statistically significant(P > 0.05).(8)The correlation analysis between the parameters of 24-hour ABPM included in the study and LDH results showed that d SBP?d DBP?n SBP?n DBP?24h SBP?24h DBP?d MAP?n MAP and 24 h MAP were not correlated with LDH,and the difference was not statistically significant(P > 0.05);in addition,the decrease rate of night systolic pressure,the decrease rate of night diastolic pressure,the variation of 24-hour diastolic pressure and LDH results There was no significant difference between the two groups(P > 0.05).(9)Correlation analysis shows: there was a negative correlation between urine protein quantification and FBW at 24h(P<0.05),there was a positive correlation between urinary protein quantification and LDH at 24h(P<0.05).Conclusion: the mean 24-hour ABPM blood pressure is related to the adverse pregnancy outcome of preeclampsia patients;the decrease rate of nighttime systolic blood pressure and nighttime diastolic blood pressure,24-hour systolic blood pressure variability and 24-hour diastolic blood pressure variability have a certain risk role in the adverse pregnancy outcome,it is associated with fetal growth retardation and low birth weight.24-hour urine protein quantitative value is related to the adverse pregnancy outcome of preeclampsia patients.Thus it can be inferred that: elevated blood pressure and abnormal increase of urinary protein have certain effects on fetal growth.As a result,dynamic blood pressure monitoring combined with 24-hour urine protein quantitative monitoring can play an important role in predicting the outcome of preeclampsia patients,and provide important reference data for ensuring the health of mothers and infants. |
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