Proteinürisi Olan ve Olmayan Gebelerde Beyin Omurilik Sıvısı Protein Değerlerinin İncelenmesi
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Tarih
2024
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Proteinürisi olan ve olmayan gebelerin beyin omurilik sıvısı protein değerinin
perinatal sonuçlarla ilişkisinin incelenmesi
Yöntem: Çalışmamız prospektif randomize kontrollü olup Mart 2023-Ekim 2023 ayları
arasında Necmettin Erbakan Üniversitesi Kadın Hastalıkları ve Doğum servisine başvuran
spinal anestezi uygulanarak sezaryen ile doğum yapan dahil olma kriterlerine uygun 31
proteinüri negatif 30 proteinüri pozitif toplamda 61 gebe dahil edilmiştir. Çalışmamızda
hastadan alınan beyin omurilik sıvısı (BOS) örnekleri biyokimya laboratuvarında Roche
Cobas 8000 Modelinin C 702 serisinde türbidimetrik yöntem kullanılarak çalışıldı. Elde
edilen veriler SPSS Statistics 26 programına kaydedilerek analiz edildi.
Bulgular: Gruplar arasında sosyodemografik özellikler açısından istatistiksel olarak anlamlı
farklılık saptanmamıştır (p>0,05). Proteinüri ile BOS protein değerleri arasında istatiksel
olarak anlamlı bir korelasyon izlenmemiştir (r=-0,014, p=0,912). Spot idrardaki protein/
kreatinin oranının 0.86 kesme noktasında yenidoğan yoğun bakım yatışının, duyarlılık
%47.06, özgüllük %93.18, PPV (pozitif prediktif değer) %72.73, NPV (negatif prediktif
değer) %82, AUC (eğrinin altındaki alan) 0.715’dir. Spot idrardaki proteinüri saptanan
gebelerde FGR (fetal büyüme kısıtlılığı) görülme riski 3.9 kata kadar artmıştır (p=0,024),
yenidoğan yatışı gerektiren hasta sayısı ile proteinürisi olan gebelerde spot idrardaki protein
değerleri arasında anlamlı bir korelasyon bulunmuştur (r=0,468, p=0,001). Proteinüri pozitif
olan hastaların %23,3’ünde (7 hasta) preeklampsi (p=0,004) ve %16,7’sinde (5 hasta) FGR
(p=0,018) izlenmiştir. Kreatinin (p=0,035) ve üre (p=0,004) değerleri açısından, proteinüri
pozitif olan hastalarda daha yüksek izlenmiştir. Yaş ile Spot idrar protein değerleri arasında
anlamlı bir korelasyon bulunmamıştır (r=0,224, p=0,083).
Sonuç: Spot idrarda bakılan proteinürinin ile BOS proteini arasında korelasyon yoktur.
İdrarda protein değerlendirmesi gebelerde rutin bakılması gerektiği gibi sadece preeklampsi
açısından değil fetal sağlık hakkında da bilgi verebilir. Proteinüri tespit edilen gebeler fetal
büyüme kısıtlılığı açısından dikkatlice takip edilmeli ve yenidoğan yoğun bakım ünitesine
ihtiyaç duyulabileceği unutulmamalı, bu gereksinime göre hazırlıklar yapılmalıdır.
Objectives: To investigate the association between cerebrospinal fluid (CSF) protein levels and perinatal outcomes in pregnant women with and without proteinuria. Methods: Our study is a prospective randomised controlled trial. A total of 61 pregnant women, 31 proteinuria-negative and 30 proteinuria-positive, 31 proteinuria-negative and 30 proteinuria-positive, who gave birth by caesarean section with spinal anaesthesia between March 2023 and October 2023 and who applied to Necmettin Erbakan University Obstetrics and Gynaecology Department were included in the study. In our study, cerebrospinal fluid samples obtained from the patients were analysed in the biochemistry laboratory using the turbidimetric method in the C 702 series of the Roche Cobas 8000 model. The data obtained were recorded and analysed using SPSS Statistics 26 software. Results: No statistically significant difference was found between the groups in terms of socio-demographic characteristics (p>0.05). There was no statistically significant correlation between proteinuria and CSF protein levels (r=-0.014, p=0.912). The sensitivity, specificity, PPV (positive predictive value) 72.73%, NPV (negative predictive value) 82%, AUC (area under the curve) 0.715, sensitivity 47.06%, specificity 93.18%, PPV (positive predictive value) 72.73%, NPV (negative predictive value) 82%, and AUC (area under the curve) 0.715 for neonatal intensive care unit hospitalisation at the cut-off point of 0.86 for spot urine protein/creatinine ratio. The risk of FGR (fetal growth restriction) increased up to 3.9 times in pregnant women with spot urine proteinuria (p=0.024). A significant correlation was found between the number of patients requiring neonatal hospitalisation and spot urine protein levels in pregnant women with proteinuria (r=0.468, p=0.001). Pre-eclampsia was observed in 23.3% (7 patients) and FGR in 16.7% (5 patients) of the patients with positive proteinuria. Higher levels of creatinine and urea were observed in patients with positive proteinuria (p=0.035 and p=0.004, respectively). There was no significant correlation between age and spot urine protein levels (r=0.224, p=0.083). Conclusions: There is no correlation between spot urine proteinuria and CSF protein. Urine protein testing should be performed routinely in pregnant women and can provide information not only about pre-eclampsia but also about fetal health. Pregnant women with proteinuria should be followed closely for fetal growth restriction and should be considered for neonatal intensive care unit requirements.
Objectives: To investigate the association between cerebrospinal fluid (CSF) protein levels and perinatal outcomes in pregnant women with and without proteinuria. Methods: Our study is a prospective randomised controlled trial. A total of 61 pregnant women, 31 proteinuria-negative and 30 proteinuria-positive, 31 proteinuria-negative and 30 proteinuria-positive, who gave birth by caesarean section with spinal anaesthesia between March 2023 and October 2023 and who applied to Necmettin Erbakan University Obstetrics and Gynaecology Department were included in the study. In our study, cerebrospinal fluid samples obtained from the patients were analysed in the biochemistry laboratory using the turbidimetric method in the C 702 series of the Roche Cobas 8000 model. The data obtained were recorded and analysed using SPSS Statistics 26 software. Results: No statistically significant difference was found between the groups in terms of socio-demographic characteristics (p>0.05). There was no statistically significant correlation between proteinuria and CSF protein levels (r=-0.014, p=0.912). The sensitivity, specificity, PPV (positive predictive value) 72.73%, NPV (negative predictive value) 82%, AUC (area under the curve) 0.715, sensitivity 47.06%, specificity 93.18%, PPV (positive predictive value) 72.73%, NPV (negative predictive value) 82%, and AUC (area under the curve) 0.715 for neonatal intensive care unit hospitalisation at the cut-off point of 0.86 for spot urine protein/creatinine ratio. The risk of FGR (fetal growth restriction) increased up to 3.9 times in pregnant women with spot urine proteinuria (p=0.024). A significant correlation was found between the number of patients requiring neonatal hospitalisation and spot urine protein levels in pregnant women with proteinuria (r=0.468, p=0.001). Pre-eclampsia was observed in 23.3% (7 patients) and FGR in 16.7% (5 patients) of the patients with positive proteinuria. Higher levels of creatinine and urea were observed in patients with positive proteinuria (p=0.035 and p=0.004, respectively). There was no significant correlation between age and spot urine protein levels (r=0.224, p=0.083). Conclusions: There is no correlation between spot urine proteinuria and CSF protein. Urine protein testing should be performed routinely in pregnant women and can provide information not only about pre-eclampsia but also about fetal health. Pregnant women with proteinuria should be followed closely for fetal growth restriction and should be considered for neonatal intensive care unit requirements.
Açıklama
Anahtar Kelimeler
Proteinüri, Proteinuria, BOS protein değeri, CSF protein level, pre-eclampsia, preeklampsi, FGR, yenidoğan yoğun bakım ünitesi, neonatal intensive care unit
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Erdoğan, A. C. (2024). Proteinürisi Olan ve Olmayan Gebelerde Beyin Omurilik Sıvısı Protein Değerlerinin İncelenmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Kadın Hastalıkları ve Doğum Anabilim Dalı, Konya.
