Objective: To explore the clinical warning value of ischemic modified albumin (IMA) and IMA to human serum albumin (HSA) ratio (IMAR) in the development of pre-eclampsia (PE) and its severity. Methods: A total of 156 pregnant women with PE admitted to the Haidian District Maternal and Child Health Hospital of Beijing from April 2022 to March 2023 were collected as the PE group, and 156 healthy pregnant women with the same age and gestational age were matched as the control group. PE pregnant women were further divided into severe PE group (78 cases) and non-severe PE group (78 cases). Severe PE pregnant women were divided into emergency group (42 cases) and non-emergency group (36 cases) according to the disease progression time.All pregnant women were stratified according to their HSA levels (<30 g/L, 30-32 g/L, ≥32 g/L), and the peripheral blood IMA, HSA, and IMAR of pregnant women in different periods and subgroups were compared, and also the difference of IMA levels in umbilical artery blood. Bivariate correlation analysis was used to explore the correlation between severe PE and IMA or IMAR, and receiver operating characteristic (ROC) curves was used to analyze the diagnostic value of IMA, HSA, and IMAR for PE and severe PE. Results: (1) The IMA level and IMAR in peripheral serum of pregnant women in the PE group at diagnosis, and the IMA level in umbilical artery blood at delivery, and peripheral serum at 2 days after delivery were higher than those in the control group. The HSA level in peripheral serum was lower than that in the control group at diagnosis, and the differences were statistically significant (all P<0.001). (2) The IMA level and IMAR in the peripheral serum of pregnant women with severe PE were higher than those in the non-severe PE group at diagnosis, while the HSA level were lower than those in the non-severe PE group. The differences were statistically significant (all P<0.05). At diagnosis, the IMA level and IMAR in peripheral serum of pregnant women in the emergency group were higher than those in the non-emergency group, while the HSA level was lower than that in the non-emergency group. The differences were statistically significant (all P<0.05). When diagnosed, the peripheral serum IMA levels of pregnant women in the PE group were compared between subgroups with HSA<30 g/L, 30-32 g/L, ≥32 g/L, and there was no statistically significant difference (F=0.366, P=0.694). However, the IMAR was compared between the three subgroups, and the difference was statistically significant (F=28.544, P<0.001), which increased with the decrease of HSA levels. In the subgroup with HSA≥32 g/L, the peripheral serum IMA level and IMAR of pregnant women in the PE group were higher than those in the control group at diagnosis, and the differences were statistically significant (all P<0.001). (3) The severe PE manifestations positively correlated with peripheral serum IMAR at diagnosis include systolic blood pressure (r=0.279), mean arterial pressure (r=0.212), and urinary protein quantification (r=0.277), while the severe PE manifestations negatively correlated include HSA levels (r=-0.644) and newborn birth weight (r=-0.305), all of which were significantly correlated (P<0.05). (4) The area under curve (AUC) for IMAR diagnosis of PE was 0.875 (95%CI: 0.833-0.916), with the highest diagnostic efficiency at a cutoff value of 2.06, sensitivity of 72.5%, and specificity of 85.1%. The AUC for diagnosing severe PE was 0.871 (95%CI: 0.822-0.919), with the highest diagnostic efficacy at a cutoff value of 2.18, sensitivity of 72.3%, and specificity of 88.3%. The diagnostic efficacy of IMAR for PE and severe PE were higher than those of IMA and HSA levels. Conclusions: The level of IMA and IMAR in pregnant women with PE are higher than those in normal pregnant women. IMA and IMAR are correlated with the severity of PE, with IMAR changes occurring earlier and more significantly. IMAR could be considered as one of the evaluation indicators for the development of PE, or as a more sensitive PE severity warning indicator than HSA.
目的： 初步探讨缺血修饰白蛋白（IMA）及IMA/血清白蛋白（HSA）比值（IMAR）在子痫前期（PE）及其向重症发展中的临床预警价值。 方法： 收集2022年4月至2023年3月北京市海淀区妇幼保健院收治的PE孕妇156例为PE组，以同期年龄及孕周匹配的健康孕妇156例为对照组，进一步将PE孕妇分为重度PE组（78例）与非重度PE组（78例），重度PE孕妇根据诊断时限分为急骤组（42例）与非急骤组（36例），按照HSA水平分别将PE组和对照组孕妇进行分层（<30 g/L、30~<32 g/L、≥32 g/L亚组），分别比较不同亚组孕妇外周血IMA、HSA、IMAR，以及分娩时脐动脉血IMA水平的差异。采用双变量相关性分析方法探讨PE重度表现与IMA、IMAR的相关性，并用受试者工作特征（ROC）曲线分析IMA、HSA、IMAR对PE、重度PE的诊断价值。 结果： （1）PE组孕妇诊断时外周血IMA水平、IMAR，分娩时脐动脉血、分娩后2 d外周血中的IMA水平均高于对照组，诊断时外周血HSA水平低于对照组，分别比较，差异均有统计学意义（P均<0.001）。（2）重度PE组孕妇诊断时外周血IMA水平、IMAR高于非重度PE组，HSA水平低于非重度PE组，分别比较，差异均有统计学意义（P均<0.05）。急骤组孕妇诊断时外周血IMA水平、IMAR高于非急骤组，HSA水平低于非急骤组，分别比较，差异均有统计学意义（P均<0.05）。PE组孕妇诊断时外周血IMA水平在HSA<30 g/L、30~<32 g/L、≥32 g/L亚组之间比较，差异无统计学意义（F=0.366，P=0.694），但是IMAR在3个亚组之间比较，差异有统计学意义（F=28.544，P<0.001），且随HSA水平的升高而下降。HSA≥32 g/L亚组中，PE组孕妇诊断时外周血IMA水平、IMAR均高于对照组，分别比较，差异均有统计学意义（P均<0.001）。（3）与诊断时外周血IMAR呈正相关的PE重度表现包括收缩压（r=0.279）、平均动脉压（r=0.212）、尿蛋白定量（r=0.277），呈负相关的PE重度表现包括HSA水平（r=-0.644）、新生儿出生体重（r=-0.305），均呈显著相关性（P均<0.05）。（4）IMAR诊断PE的曲线下面积（AUC）为0.875（95%CI为0.833~0.916），截断值为2.06时诊断效能最高，敏感度为72.5%，特异度为85.1%；IMAR诊断重度PE的AUC为0.871（95%CI为0.822~0.919），截断值为2.18时诊断效能最高，敏感度为72.3%，特异度为88.3%；IMAR对PE及重度PE的诊断效能均高于IMA水平（诊断PE的AUC为0.706，诊断重度PE的AUC为0.695）和HSA水平（诊断PE的AUC为0.832，诊断重度PE的AUC为0.849）。 结论： PE孕妇的IMA水平及IMAR较正常孕妇升高，IMA水平、IMAR与PE病情的严重程度相关，尤以IMAR的改变更早、更显著，可考虑作为PE病情发展的评估指标之一，可能成为较HSA水平更为敏感的PE重症预警指标。.