Preaklampsi tanısında 12 saatlik idrarda protein tayini ve spot idrarda albumin/kreatinin oranının 24 saatlik idrardaki protein miktarıyla ilişkisi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: preeklampsi (PE) açısından değerlendirilen hastalarda spot idrardaki protein/kreatinin oranı (PKO) ve albumin/kreatinin oranı (AKO)'nun ve 24 saatlik idrar proteini atılımı arasındaki ilişkiyi ve PE'li hastalarda anlamlı proteinüri öngörmedeki değerini incelemektir. Bu çalışmada ayrıca 24 saatlik tetkik yerine, 12 saatlik idrar biriktirme tekniğide analiz edilecektir. Gereç ve Yöntem: Çalışmamız toplamda 70 gebe (30 PE, 40 kontrol) ile prospektif olarak gerçekleştirildi Vaka ve kontrol gruplarının demografik özellikleri, önceki ve mevcut gebelik özellikleri, tansiyon yüksekliğine ait özellikleri, kan tetkikleri, idrar kültürü sonuçları ve idrarda protein miktarları incelenerek kıyaslandı. Spot idrardaki PKO ve AKO'nun 24 saatlik idrar, ilk ve ikinci 12 saatlik idrar sonuçlarındaki protein miktarları ile arasındaki ilişki incelendi. Bulgular: Vaka ve kontrol grupları arasında yaş, eğitim düzeyi, komorbidite, insulin kullanımı, sigara alışkanlığı, risk faktörü, antihipertansif kullanımı, anti agregan kullanımı, gestasyonel hafta, gebe kalma yöntemi, gravide, parite, abortus, canlı doğum sayıları, idrar kültürü sonuçları, tansiyon yüksekliğinin saptandığı hafta ve tansiyon değerleri, idrardaki kantitatif protein düzeyleri arasında farklılık saptanmadı (p>0,05). Vaka grubunda magnezyum sülfat (MGSO4) kullanımı ve ödem sıklığı yüksekti (p<0,05). Vaka ve kontrol grubu arasında hemoglobin, platelet, keratinin, aspartat aminotrasferaz (AST), albümin ve c-reaktif protein (CRP) düzeyleri arasında farklılık saptanmadı (p>0,05). Vaka grubunda üre, alanine aminotransferaz (ALT) ve laktat dehidrogenaz (LDH) değerleri anlamlı olarak yüksek saptandı (p<0,05). Vaka grubunda spot idrardaki PKO, spot idrarda AKO, 24 saatlik idrarda protein/gün oranı, 12 saatlik idrarda protein/gün ve ikinci 12 saatlik idrarda protein/gün oranı anlamlı olarak yüksek saptandı (p<0,001). Çalışmamızda vaka grubunda spot idrardaki PKO ve AKO'nun; 24 saatlik idrar, ilk 12 saat ve son 12 saatlik idrarlardaki protein düzeyleri ile arasında pozitif yönlü güçlü korelasyon saptandı (p<0,05). Kontrol grubunda ise spot idrardaki PKO ve AKO'nun; 24 saatlik idrar, ilk 12 saat ve son 12 saatlik idrarlardaki protein düzeyleri ile arasında korelasyon saptanmadı (p<0,05). Spot idrarda PKO için eğri altındaki alan (EAA) 0,787 cm2, cut-off değeri 0,21, bu kesim değerinde sensitivite %80 ve spesifite %75 olarak saptandı. Spot idrarda AKO için EAA 0,780 cm2, uygun kesim değeri 0,19, bu kesim değerinde sensitivite %83,3 ve spesifite %60 olarak saptandı. Vaka grubumuzun doğum haftası anlamlı olarak kısa saptandı (p<0,05). Gruplar arasında doğum şekli açısından farklılık saptanmadı (p>0,05). Vaka grubunda acil olarak doğum sonlandırılma sıklığı anlamlı olarak yüksek saptandı (p<0,05). Hipertansiyona bağlı doğum endikasyonu sıklığı vaka grubunda anlamlı olarak yüksek saptandı (p<0,05). Gerek vaka gerekse kontrol grubunda hiçbir olguda dekolman saptanmadı. Gruplar arasında intrauterine gelişme geriliği (IUGG) açısından farklılık saptanmadı (p>0,05). Sonuç olarak, spot idrardaki PKO ve AKO PE'li grupta anlamlı olarak yüksek saptandı. Her ne kadar sensitivitesi ve spesifitesi günlük protein miktarının ölçümü kadar yüksek olmasa da, şüpheli ve acil olgularda tanıyı desteklemek için kullanılabilir bir yöntemdir. Kullanımı daha rahat olduğundan, tekrarlanarak tanıdaki spesifite ve sensitivite artırılabilir. 24 saatlik idrar biriktirilmesine kıyasla 12 saatlik idrar toplamanın oldukça yüksek sensitivite ve spesifiteye sahip olması sebebiyle şüpheli olgularda kullanılabilecek bir yöntemdir.
Objective: To asses the association between protein/creatinine ratio (PCR), albumin/creatinine ratio (ACR) in spot urine and protein excretion in 24-hour urine sample of the patients evaluated for preeclampsia (PE), and to review the value of such association for prediction of proteinuria in the patients with PE. Furthermore, 12-hour urine collection technique instead of 24-hour urine collection shall be analysed in the present study. Material and Method: The study was carried out with 70 pregnant women (30 patients with PE, 40 pregnant women for control). Demographic features, previous and current pregnancy characteristics, high blood pressure statys, blood analyses, urine culture results and urine protein quantities of the case and control groups were reviewed and compared. The association of PCR and ACR in spot urine sample with protein quantity in 24-hour urine, primary and secondary 12-hour urine samples were reviewed. Findings: There was not any difference detected between the case and control groups for age, education level, co-morbidity, insulin use, smoking habit, risk factor, antihypertensive use, anti-aggregant use, gestational week, conception method, gravida, parity, abort state, number of live births, urine culture results, the week that high blood pressure was detected and blood pressure levels, and quantitative protein levels in urine (p>0.05). Use of magnesium sulphate (MgSO4) and incidence of oedema were higher in the case group (p<0.05). No difference was detected between the case and control groups in terms of levels of haemoglobin, platelet, creatinine, aspartate aminotransfrease (AST), albumin and c-reactive protein (CRP) levels (p>0.05). Urea, alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) values were significantly higher in the case group (p<0.05). In the case group, PCR in the spot urine, ACR in the spot urine, protein/day ratio in 24-hour urine, protein/day ratio in 12-hour urine and in secondary 12-hour urine were significantly higher (p<0.001). A positive and strong correlation was detected between PCR and ACR in the spot urine sample, and protein levels of 24-hour, 12-hour and secondary 12-hour urine in the case group of the present study (p<0.05). There was not any correlation was detected between PCR and ACR in the spot urine sample, and protein levels of 24-hour, 12-hour and secondary 12-hour urine in the control group (p<0.05). The area under the curve (AUC) for PCR in the spot urine was 0.787cm2 with a cut-off value of 0.21, sensitivity and specifity values of 80% and 75%, respectively. The AUC for ACR in the spot urine was 0.780 cm2 with a cut-off value of 0.19, sensitivity and specifity values of 83.3% and 60%, respectively. Gestational week at birth was significantly lower in the case group (p<0.05). There was not any difference between the groups for mode of delivery (p>0.05). The incidence of emergency termination of the pregnancy was significantly higher in the case group (p<0.05). The incidence of emergency termination of the pregnancy was significantly higher in the case group (p<0.05). Placental abruption was not detected both in the case and control groups. There was not any difference between the groups for intrauterine growth retardation (IUGR) (p>0.05). Consequently, ACR and PCR in the spot urine were detected significantly higher in the patients with PE. Although sensitivity and specificity is not as higher as daily protein quantity measurement, it may be used to support the diagnosis in suspected and urgent cases. Since it is a feasible method, specificity and sensitivity values for diagnosis may be increased through repeated measurements. Since 12-hour urine collection is associated with higher sensitivity and specificity rather than 24-hour urine collection, this method may be used for suspected cases.
Objective: To asses the association between protein/creatinine ratio (PCR), albumin/creatinine ratio (ACR) in spot urine and protein excretion in 24-hour urine sample of the patients evaluated for preeclampsia (PE), and to review the value of such association for prediction of proteinuria in the patients with PE. Furthermore, 12-hour urine collection technique instead of 24-hour urine collection shall be analysed in the present study. Material and Method: The study was carried out with 70 pregnant women (30 patients with PE, 40 pregnant women for control). Demographic features, previous and current pregnancy characteristics, high blood pressure statys, blood analyses, urine culture results and urine protein quantities of the case and control groups were reviewed and compared. The association of PCR and ACR in spot urine sample with protein quantity in 24-hour urine, primary and secondary 12-hour urine samples were reviewed. Findings: There was not any difference detected between the case and control groups for age, education level, co-morbidity, insulin use, smoking habit, risk factor, antihypertensive use, anti-aggregant use, gestational week, conception method, gravida, parity, abort state, number of live births, urine culture results, the week that high blood pressure was detected and blood pressure levels, and quantitative protein levels in urine (p>0.05). Use of magnesium sulphate (MgSO4) and incidence of oedema were higher in the case group (p<0.05). No difference was detected between the case and control groups in terms of levels of haemoglobin, platelet, creatinine, aspartate aminotransfrease (AST), albumin and c-reactive protein (CRP) levels (p>0.05). Urea, alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) values were significantly higher in the case group (p<0.05). In the case group, PCR in the spot urine, ACR in the spot urine, protein/day ratio in 24-hour urine, protein/day ratio in 12-hour urine and in secondary 12-hour urine were significantly higher (p<0.001). A positive and strong correlation was detected between PCR and ACR in the spot urine sample, and protein levels of 24-hour, 12-hour and secondary 12-hour urine in the case group of the present study (p<0.05). There was not any correlation was detected between PCR and ACR in the spot urine sample, and protein levels of 24-hour, 12-hour and secondary 12-hour urine in the control group (p<0.05). The area under the curve (AUC) for PCR in the spot urine was 0.787cm2 with a cut-off value of 0.21, sensitivity and specifity values of 80% and 75%, respectively. The AUC for ACR in the spot urine was 0.780 cm2 with a cut-off value of 0.19, sensitivity and specifity values of 83.3% and 60%, respectively. Gestational week at birth was significantly lower in the case group (p<0.05). There was not any difference between the groups for mode of delivery (p>0.05). The incidence of emergency termination of the pregnancy was significantly higher in the case group (p<0.05). The incidence of emergency termination of the pregnancy was significantly higher in the case group (p<0.05). Placental abruption was not detected both in the case and control groups. There was not any difference between the groups for intrauterine growth retardation (IUGR) (p>0.05). Consequently, ACR and PCR in the spot urine were detected significantly higher in the patients with PE. Although sensitivity and specificity is not as higher as daily protein quantity measurement, it may be used to support the diagnosis in suspected and urgent cases. Since it is a feasible method, specificity and sensitivity values for diagnosis may be increased through repeated measurements. Since 12-hour urine collection is associated with higher sensitivity and specificity rather than 24-hour urine collection, this method may be used for suspected cases.
Açıklama
Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
