Correlations of CALLY index in early pregnancy with the onset and severity of preeclampsia
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摘要:目的
探讨妊娠早期CALLY指数与子痫前期发病及其严重程度的相关性。
方法前瞻性选取987例孕妇作为研究对象, 42例在随访过程中失访, 最终纳入945例。依据随访过程中是否发生子痫前期及其严重程度，将孕妇分为子痫前期组47例、重度子痫前期组49例和正常组849例。收集所有孕妇的一般资料和实验室检查结果，并计算CALLY指数。采用Pearson相关性分析法探讨CALLY指数与子痫前期病情严重程度(平均动脉压)的相关性; 绘制受试者工作特征(ROC)曲线，分析各指标对子痫前期的预测效能; 采用Cox回归分析探讨子痫前期发生的影响因素。
结果重度子痫前期组孕妇的平均动脉压、24 h尿蛋白水平高于子痫前期组和正常组，且子痫前期组高于正常组，差异有统计学意义(P < 0.05); 重度子痫前期组孕妇的CALLY指数低于子痫前期组和正常组，且子痫前期组低于正常组，差异有统计学意义(P < 0.05)。Pearson相关性分析结果显示, CALLY指数与平均动脉压呈负相关(r=-0.571, P < 0.001)。ROC曲线显示, CALLY指数预测子痫前期的AUC为0.941(95%CI: 0.900~0.981); 多因素Cox回归分析显示, CALLY指数升高是子痫前期发生的独立保护因素(HR=0.185, 95%CI: 0.092~0.374, P < 0.001)。
结论CALLY指数与子痫前期病情严重程度呈负相关，且是子痫前期发病的独立影响因素，可作为评估孕妇子痫前期发病及其严重程度的辅助指标。
Abstract:ObjectiveTo investigate the correlations of CALLY index in early pregnancy with the onset and severity of preeclampsia.
MethodsA total of 987 pregnant women were prospectively enrolled as study subjects, with 42 lost during follow-up, resulting in a final inclusion of 945 subjects. Based on the occurrence and severity of preeclampsia during follow-up, the pregnant women were divided into preeclampsia group (n=47), severe preeclampsia group (n=49), and normal group (n=849). General information and laboratory test results were collected from all pregnant women, and the CALLY index was calculated. The Pearson correlation analysis was used to explore the correlation between CALLY index and severity of preeclampsia (mean arterial pressure); the receiver operating characteristic (ROC) curve was plotted to analyze the predictive efficacy of each indicator for preeclampsia; Cox regression analysis was used to explore the influencing factors for the onset of preeclampsia.
ResultsThe mean arterial pressure and 24-hour urine protein levels were higher in the severe preeclampsia group than those in the preeclampsia group and normal group, and higher in the preeclampsia group than those in the normal group (P < 0.05). The CALLY index was lower in the severe preeclampsia group than in the preeclampsia group and normal group, and lower in the preeclampsia group than in the normal group (P < 0.05). Pearson correlation analysis showed a negative correlation between CALLY index and mean arterial pressure (r=-0.571, P < 0.001). The ROC curve showed that the area under the curve (AUC) of CALLY index for predicting preeclampsia was 0.941 (95%CI, 0.900 to 0.981). Multivariate Cox regression analysis showed that an increased CALLY index was an independent protective factor for the onset of preeclampsia (HR=0.185, 95%CI, 0.092 to 0.374, P < 0.001).
ConclusionThe CALLY index is negatively correlated with the severity of preeclampsia and is an independent influencing factor for the onset of preeclampsia, which can be used as an auxiliary indicator to assess the onset and severity of preeclampsia in pregnant women.
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Keywords:
- preeclampsia /
- CALLY index /
- mean arterial pressure /
- C-reactive protein /
- albumin /
- lymphocytes
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表 1 3组孕妇一般资料比较(x±s)[n(%)]
指标 正常组(n=849) 子痫前期组(n=47) 重度子痫前期组(n=49) F/χ2 P 年龄/岁 30.45±4.20 30.70±4.48 30.57±4.28 0.113 0.914 孕次/次 1.71±0.69 1.68±0.72 1.63±0.70 0.214 0.610 孕前BMI/(kg/m2) 23.69±1.17 24.55±1.23 24.49±1.25 6.376 < 0.001 既往史 吸烟史 79(9.31) 4(8.51) 5(10.20) 0.623 0.854 饮酒史 75(8.83) 4(8.51) 4(8.16) 产次 初产 401(47.23) 26(55.32) 24(48.98) 0.711 0.604 经产 448(52.77) 21(44.68) 25(51.02) BMI: 体质量指数。 
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表 2 3组孕妇实验室检查指标、CALLY指数及平均动脉压水平比较(x±s)
指标 正常组(n=849) 子痫前期组(n=47) 重度子痫前期组(n=49) F P 白细胞/(×109/L) 6.02±0.88 6.00±0.98 6.08±0.84 0.090 0.914 淋巴细胞/(×109/L) 1.74±0.27 1.80±0.23 1.79±0.20 2.813 0.063 TG/(mmol/L) 1.89±0.43 1.86±0.45 1.87±0.38 2.321 0.104 TC/(mmol/L) 5.61±0.88 5.55±0.91 5.63±0.92 2.012 0.141 LDL-C/(mmol/L) 3.09±0.59 3.11±0.55 3.14±0.71 1.032 0.453 ALT/(U/L) 24.23±4.58 25.12±6.21 24.83±4.60 2.112 0.132 AST/(U/L) 19.02±3.41 19.78±4.22 19.85±4.32 1.983 0.212 24 h尿蛋白/g 0.11±0.08 1.08±0.41 4.52±0.56 35.246 < 0.001 白蛋白/(g/L) 40.43±4.83 40.13±4.77 40.20±4.67 0.058 0.943 CRP/(mg/L) 1.56±0.39 1.55±0.27 1.57±0.31 2.209 0.113 CALLY指数 1.96±0.33 1.60±0.16 0.81±0.32 263.300 < 0.001 平均动脉压/mmHg 96.34±5.80 108.17±5.42 124.96±5.00 360.818 < 0.001 TG: 甘油三酯; TC: 总胆固醇; LDL-C: 低密度脂蛋白胆固醇; ALT: 丙氨酸氨基转移酶; AST: 天门冬氨酸氨基转移酶; CRP: C反应蛋白。24 h尿蛋白为孕20周以后测量结果。
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表 3 不同指标对子痫前期的预测效能
指标 曲线下面积 95%CI P 白蛋白 0.485 0.389~0.582 0.770 淋巴细胞 0.548 0.455~0.642 0.336 白细胞 0.546 0.451~0.641 0.363 CRP 0.626 0.533~0.719 0.058 CALLY指数 0.941 0.900~0.981 < 0.001
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表 4 子痫前期的多因素Cox回归分析结果
因素 β SE Wald P HR 95%CI 年龄 0.186 0.109 2.908 0.088 1.204 0.973~1.492 孕次 -0.051 0.926 0.003 0.956 0.950 0.155~5.838 产次 -0.468 1.424 0.108 0.743 0.626 0.038~10.211 孕前BMI 2.135 0.873 5.981 0.014 8.457 1.528~46.809 吸烟史 1.124 0.966 1.354 0.245 3.077 0.463~20.437 饮酒史 2.025 0.896 5.108 0.024 7.576 1.308~43.687 CALLY指数 -1.685 0.358 22.153 < 0.001 0.185 0.092~0.374 白蛋白 -0.572 0.418 1.873 0.171 0.564 0.249~1.281 白细胞 1.316 0.727 3.277 0.070 3.728 0.897~15.501 淋巴细胞 -2.159 1.910 1.278 0.258 0.115 0.003~4.877 CRP 0.906 0.624 2.108 0.147 2.474 0.728~8.407
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