再发子痫前期相关因素及母子转归的单中心临床研究  

Risk factors of recurrent preeclampsia and its relation to maternal and offspring outcome

作　　者：张坚贞[1,2] 贺晶[1] 

机构地区：[1]浙江大学医学院附属妇产科医院产科,浙江杭州310006 [2]嘉兴市妇幼保健院产科,浙江嘉兴314000

出　　处：《浙江大学学报（医学版）》2015年第3期258-263,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：卫生行业科研专项(201402006)

摘　　要：目的：探讨再发子痫前期发病相关危险因素，观察再发子痫前期发病特征及远期母子预后。方法：选择2009年1月至2013年12月在浙江大学医学院附属妇产科医院住院分娩的有子痫前期史孕妇153人，其中可获得完整病史资料及随访资料者共115人，将其按是否再发子痫前期分为再发组和非再发组，分析病史、再发子痫前期病情和母子随访资料。结果：115例有子痫前期病史的孕妇再次妊娠时再发子痫前期82例（71．3％），发病年龄、妊娠间隔时间、是否正规产检、孕期体质量增加、体质量指数（ BMI）、高脂血症、胎儿生长受限、母系家族史与子痫前期再发密切相关（均P ＜0．05）。 Logistic回归分析结果提示：妊娠间隔时间（ OR＝1．349，P＝0．004）、BMI （ OR ＝1．249， P ＝0．004）、胎儿生长受限（ OR ＝9．642，P＝0．009）是预测子痫前期复发的主要危险因素。与第一次妊娠时子痫前期比较，再发子痫前期孕妇发病孕周、妊娠终止孕周更早，血压更高，尿蛋白达＋＋及以上例数增加，并发症发生例数增加（均P＜0．05）；再发子痫前期子代早产（特别是小于34周的早产）发生例数增加，新生儿出生体质量更低（均P＜0．05）。随访结果，孕妇产后发生远期高血压病例数再发组（47．5％）多于非再发组（23．3％， P＜0．05）；初次妊娠获得子代发生体质量过大例数再发组（31．25％）多于非再发组（6．70％，P＜0．05）。结论：发病年龄、妊娠间隔时间、是否正规产检、孕期体质量增加、BMI、高脂血症、胎儿生长受限和母系家族史与子痫前期再发有密切相关，妊娠间隔时间、BMI和胎儿生长受限是预测子痫前期复发的主要危险因素，再发子痫前期具有更严重的临床结局，母子近期和远期并发症高，需重视预防。Objective：To investigate the risks of recurrent preeclampsia and observe the incidence and long-term prognosis of recurrent preeclampsia . Methods： One hundred and fifteen women with preeclampsia history admitted in Women ’s Hospital , Zhejiang University School of Medicine from January 2009 to December 2013 were enrolled in the study .The clinical data were retrospectively analyzed .Results：Among 115 women with preeclampsia , 82 cases （ 71 .3%） had recurrent preeclampsia .The onset age, the pregnant interval time , regular prenatal check-up, weight gain during pregnancy, body mass index （BMI）, hyperlipidemia, fetal growth restriction（FGR）, maternal family history were closely associated with recurrent preeclampsia （ P 〈0.05）.Logistic regression analysis showed that the pregnant interval time , BMI, FGR were independent risk factors for preeclampsia recurrence . Compared with the preeclampsia in first pregnancy , the mather had earlier onset and termination of pregnancy , higher blood pressure , higher rate of urine protein≥2＋and higher rate of complications in recurrent preeclampsia .The offspring had higher rate of preterm birth , especially the time of birth for 34 weeks or earlier and lower birth weight （ P〈0.05） . The incidence of chronic hypertension in recurrent preeclampsia group was higher than that in no recurrence group （47.5%vs 23.3%, P〈0.05）;the overweight rate of first pregnant offspring in recurrence group was higher than that in no recurrence group （31.25%vs 6.70%, P〈0.05）.Conclusion： The onset age, time interval, regular prenatal check-up, weight gain during pregnancy , BMI, hyperlipidemia , FGR, maternal family history are closely associated with recurrent preeclampsia , and the pregnant interval time , BMI, FGR are independent risk factors for preeclampsia recurrence . Recurrent preeclampsia has more serious clinical outcome and complications, and prevention need to be emphasized .

关 键 词：子痫 妊娠并发症 发病年龄 胎儿生长迟缓 妊娠结局 人体质量指数 高脂血症 随访研究 

分 类 号：R714.244[医药卫生—妇产科学]