尿E/C比值测定临床意义的客观评价

探讨我院１６年检测尿Ｅ／Ｃ比值与胎儿预后的关系及分娩方式对低Ｅ／Ｃ比值胎儿预后的影响，并对其临床意义进行客观评价。收集１９７９～１９９４年在我院分娩并测定尿Ｅ／Ｃ比值者，其中资料完整者４６１７例。尿Ｅ／Ｃ比值测定取１２ｈ夜尿，其正常值为≥１５，可疑值为＞１０～＜１５，危险值为≤１０。在正常妊娠中有２０．３０％～２４．４３％尿Ｅ／Ｃ比值为低值，在高危妊娠中，重度妊高征和过期妊娠低Ｅ／Ｃ比值率最高，分别为４４．９５％和３２．５１％。尿Ｅ／Ｃ比值低者胎儿窘迫，低Ａｐｇａｒ评分和围产儿死亡率明显增高（Ｐ＜０．０１），连续测定表明Ｅ／Ｃ比值下降者低Ａｐｇａｒ评分与围产儿死亡率明显高于上升型和水平型者（Ｐ＜０．０１），在尿Ｅ／Ｃ比值低值、羊水≤２ｃｍ和ＮＳＴ阳性的孕妇中，低Ａｐｇａｒ评分和围产儿死亡率最高，分别为６３．４２％和１４．６３％。当低Ｅ／Ｃ比值时，产程延长和急诊剖宫产者胎儿预后不良的发生率明显增高（Ｐ＜０．０１）。检测孕妇尿Ｅ／Ｃ比值对监护高危妊娠、筛选胎盘功能不全、预测胎儿预后方面具有重要的临床意义。主张连续测定或多指标联合测定，可提高判定胎儿预后的准确性。

Objective evaluation on clinical significance in measurement of urinary estrogen/creatinine (E/C) ratio

This paper reported that measurement of urinary estrogen/creatinine (E/C) ratio related with fetal prognosis and delivery methods had an influence on fetal prognosis with lower E/C ratio in 16 years,and then its clinical significance was objectively evaluated.We collected 4 617 cases whose materials were complete in our hospital in 1979￣1994 and measured the urinary E/C ratio of 12 hour night urinary.Normal E/C levels were ≥15,critical levels were >10￣<15,risk levels were ≤10.The results suggest that in the normal pregnancy,low E/C ratio was 20.30%￣24.43%,in the high risk pregnancy,serious pregnancy induced hypertension and post term pregnancy had the much lower E/C ratio,which were 44.95% and 32.51%,respectively.The incidence of fetal distress,low Apgar score and perinatal death significantly increased in patients with low E/C ratio (P<001).In continuous measurement,the results indicated that low Apgar score and perinatal death of decreasing type of E/C ratio were higher than that of increasing type and parallel type (P<001);in patients with low E/C ratio,amniotic fluid ≤2 cm and NST positive,incidence of low Apgar score and perinatal death was the hightest,63.42% and 14.64%,respectively.During low E/Cratio,incidence of fetal distress,low Apgar score and perinatal death significantly increaced in patients with prolonged labour and emergent caesarean section (P<001).The results indicate that measurement of urinary E/C ratio would be the important clinical significance in monitoring high risk pregnancies,screening placental insufficiency,and calculating fetal prognosis.We suggest that measurement of urinary E/C ratio must be the continuous detection or the united measurement of many indexes,which may improve accuracy of determining fetal prognosis.