合并慢性肾脏疾病孕妇妊娠早期临床指标对妊娠结局的预测价值  

Clinical predictors in early pregnancy for adverse pregnancy outcomes in women complicated with chronic nephropathy

作　　者：赫英东[1] 黄禾[1] 刘婧[1] 刘培昊[1] 陈倩[1] 

机构地区：[1]北京大学第一医院妇产科,100034

出　　处：《中华围产医学杂志》2015年第7期516-520,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨合并慢性肾脏疾病（chronic kidney disease，CKD）的孕产妇妊娠早期临床指标对不良妊娠结局的预测价值。方法回顾性分析2005年1月至2014年1月于北京大学第一医院妇产科进行产前保健且资料完整的合并CKD的产妇184例（病例组）的临床资料。随机选取同时期在本院规律行产前保健并分娩的、未合并肾脏疾病的产妇200例作为对照组。分析2组的临床资料，观察妊娠早期临床指标对不良围产期结局（包括孕产妇死亡、并发重度子痫前期、产妇肾功能恶化、早期早产、极低出生体重儿和妊娠20周后胎儿死亡）的预测价值。采用t检验、χ^2检验和多因素回归分析进行统计学处理。结果病例组和对照组活产例数分别为174例和197例。病例组中，最常见的肾病类型为IgA肾病（38．6％，71／184）。病例组早期早产[9．8％（17／174）与3．0％（6／197），χ^2=7．184]、低出生体重儿[18．4％（32／174）与7．1％（14／197），χ^2=9．813]、极低出生体重儿[5．7％（10／174）与1．5％（3／197），χ^2=4．536]、妊娠20周后胎儿死亡[5．4％（10／184）与1．5％（3／200），χ^2=4．536]及重度子痫前期[17．9％（33／184）与1．5％（3／200），χ^2=33．544]发生率均明显高于对照组，差异有统计学意义（P值均〈0．05）。妊娠早期24h尿蛋白含量增高和平均动脉压升高是发生不良妊娠结局的危险因素（OR=1．84，95％CI：1．36～2．50，P=0．001；OR=1．04，95％CI：1．00～1．07，P=0．027）。分析同时发现，妊娠早期CKD分期较高的患者，妊娠期间肾功能恶化的风险明显升高（OR=6．50，95％CI：3．34～8．21，P〈0．01）。妊娠并发子痫前期是发生胎儿不良预后（早期早产或极低出生体重儿）的独立危险因素（OR=11．10，95％CI：4．48～27．20，P〈0．01）。妊娠早期24h尿蛋白含量≥1g的产妇（58例，活产52例�Objective To investigate clinical predictors in early pregnancy for adverse pregnancy outcomes in women complicated with chronic nephropathy. Methods One hundred and eighty-four pregnancies complicated with chronic nephropathy who delivered between January~ 2005 and January, 2014 in Peking University First Hospital were retrospectively analyzed. Two hundred pregnant women without chronic nephropathy were selected as the control group. Pregnancy outcomes were compared between the two groups. Relationships between clinical predictors in early pregnancy [age, history of kidney disease, drugs used before pregnancy （in three months）, results of renal biopsy, blood pressure, serum creatinine, urea nitrogen, 24 h urinary protein, estimated glomerular filtration rate, stage of chronic nephropathy] and adverse pregnancy outcomes [maternal mortality; pregnancy complicated by severe preeclampsia; renal function decline, early preterm birth, very low birth weight infants, fetal loss after 20 weeks of pregnancy] were assessed by logistic regression analysis. T-test, Chi-square test and multivariate regressions were used for statistical analysis. Results There were 174 and 197 livebirths in the study and the control groups, respectively. The most popular type of chronic nephropathy in pregnant women was IgA nephropathy （38.6%, 71/184）. Compared with the control group, the risk of premature labor [9.8%（17/174） vs 3.0%（6/197）, χ^2=7.184], low birth weight infants[18.4%（32/174） vs 7.1%（14/197）, χ^2=9.813], very low birth weight infants [5.7%（10/174） vs 1.5%（3/197）, χ^2=4.536], fetal loss after 20 weeks of pregnancy [5.7%（10/184） vs 1.5%（3/200）, χ^2=4.536] and severe preeclampsia [17.9%（33/184） vs 1.5%（3/200）, χ^2=33.544] increased significantly in the study group （all P 〈 0.05）. Twenty-four-hour urinary protein content （OR=1.84, 95%CI： 1.36-2.50, P=0.001） and mean arterial pressure （OR=1.04, 95%CI： 1.00- 1.07, P=0.027） in early pregnancy were risk factors for

关 键 词：妊娠 并发症 肾功能不全 慢性 妊娠初期 妊娠结局 预后 

分 类 号：R714.2[医药卫生—妇产科学]