目的：探讨妊娠期高血压患者随机尿蛋白/肌酐比值（ ACR）水平与不良妊娠结局的关系。方法选取2014年3—6月浙江省宁波市妇女儿童医院收治的妊娠期高血压患者58例，检测其血液生化及随机尿蛋白、肌酐等指标，将随机ACR水平30 mg/mmol作为界点，﹤30 mg/mmol为低危组（n＝25），≥30 mg/mmol为高危组（n＝33）。比较两组患者入院时一般情况、孕期并发症情况、新生儿窒息及围生儿死亡率、新生儿出生体质量等妊娠结局的差异。结果两组患者在年龄〔（29±6）岁比（30±5）岁〕、体质指数〔（27.2±4.3） kg/m2比（29.6±5.8） kg/m2〕、产次〔（1.4±0.7）次比（1.5±0.6）次〕及正规产检率〔68.0％（17/25）比63.6％（21/33）〕上差异无统计学意义（P﹥0.05）。高危组患者收缩压〔（163±17）mm Hg比（152±16）mm Hg〕、舒张压〔（115±10）mm Hg比（100±9）mm Hg〕、24 h尿蛋白定量〔（2.72±2.37）g比（0.18±0.08）g〕均高于低危组，差异有统计学意义（P﹤0.05）；孕期并发症及新生儿不良结局的发生率较低危组有较高趋势，其中低蛋白血症发生率升高〔60.6％（20/33）比0〕，新生儿出生体质量减低〔（2106±962）g比（3096±781）g〕，差异有统计学意义（P﹤0.05）。此外高危组患者妊娠期高血压发病孕周〔（32.1±4.2）周比（35.8± 3.1）周〕及终止孕周〔（35.8± 3.9）周比（37.3± 2.7）周〕早于低危组，差异有统计学意义（ P﹤0.05）。结论随机ACR≥30 mg/mmol妊娠期高血压患者较﹤30 mg/mmol者有较差的妊娠结局，ACR监测对早期诊治干预妊娠期高血压有重要临床意义。%Objective To investigate the relationship between random albuminuria/creatinine ratio ( ACR ) and adverse pregnancy outcomes in patients with gestational hypertension. Methods We enrolled 58 patients with gestational hypertension who were admitted into Ningbo Women and Children's Hospital from March to June in 2014. Tests were made on indicators of blood biochemistry,random albuminuria and creatinine. We determined a boundary point in random ACR ratio as 30 mg/mmol to assign patients with ACR﹤30 mg/mmol as low-risk group(n=25)and patients with ACR≥30 mg/mmol as high-risk group(n =33). The two groups were compared by general clinical situation on admission,pregnancy complications, neonatal asphyxia,mortality of perinatal infant and birth weight. Results There were no statistical differences between the two groups in age〔(29 ±6)vs. (30 ± 5)〕,body mass index〔(27. 2 ± 4. 3)kg/m2 vs. (29. 6 ± 5. 8)kg/m2〕,times of delivery〔(1. 4 ±0. 7)vs. (1. 5 ± 0. 6)〕,rate of receiving standard antenatal care〔68. 0%(17/25)vs. 63. 6%(21/33)〕(P﹥0. 05). High-risk group was higher than low-risk group in systolic pressure〔(163 ± 17)mm Hg vs. (152 ±16)mm Hg〕,diastolic pressure〔(115 ±10)mm Hg vs. (100 ±9)mm Hg〕and 24 h urine protein quantity〔(2. 72 ±2. 37)g vs. (0. 18 ±0. 08)g〕(P ﹤0. 05). Low -risk group was higher in incidence of pregnancy complications and adverse outcomes of newborn;significant differences existed in the incidence of hypoproteinemia〔60. 6%(20/33) vs. 0〕and birth weight〔(2 106 ± 962)g vs. (3 096 ± 781)g〕(P ﹤0. 05). Besides,high -risk group had significantly earlier gestational week of hypertension onset〔(32. 1 ± 4. 2) vs. (35. 8 ± 3. 1)〕and termination〔(35. 8 ± 3. 9) vs. (37. 3 ± 2. 7)〕( P﹤0. 05 ) . Conclusion Patients with random ACR ≥30 mg/mmol tend to have worse pregnancy outcomes, which is an important clinical reference for early diagnosis and intervention of gestational hypertension.
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