先兆子痫及蛋白尿对孕产妇和围生儿结局的影响研究  

Study on the effects of preeclampsia and proteinuria on pregnant and perinatal outcomes

作　　者：张文玉[1] 苑薇[1] 李金萍[1] 韩鹦赢[1] 常文秀[1] 

机构地区：[1]天津市第一中心医院肾内科,天津300192

出　　处：《中国妇幼保健》2016年第22期4647-4650,共4页Maternal and Child Health Care of China

基　　金：天津市卫生局科技基金项目(2013KZ024)

摘　　要：目的探讨先兆子痫及其蛋白尿对孕产妇和围生儿结局的影响。方法选取692例孕产妇为研究对象,按病情状况分为3组,242例先兆子痫病患为研究组,208例妊娠期高血压病患为PIH组,242例正常妊娠孕妇为正常对照组;研究组又根据蛋白尿程度分为轻度组120例,中度组79例,重度组43例。对比分析各组指标,探讨先兆子痫及其蛋白尿对孕产妇和围生儿结局的影响。结果研究组孕妇的血压、尿酸、剖宫产率、血肌酐、围生儿早产、胎儿窘迫、死胎死产、新生儿窒息发生率等均高于PIH组和正常对照组,血清白蛋白、EGFR、新生儿出生体质量、身长、Apgar评分等均低于PIH组和正常对照组,差异均有统计学意义(P<0.05)。重度组孕妇血肌酐、剖宫产率、尿酸、胎儿窘迫、胎儿宫内生长迟缓发生率等均高于轻度组,血清白蛋白、分娩孕周、EGFR、新生儿出生体质量等均低于轻度组,差异均有统计学意义(P<0.05)。研究组病患中24 h尿蛋白量与血清白蛋白水平、EGFR呈负相关(P<0.05),与血压、血肌酐呈正相关(P<0.05)。大量蛋白尿是先兆子痫不良妊娠结局的危险因素(OR=2.671,P<0.05)。结论先兆子痫孕产妇和围生儿总体结局较差,大量蛋白尿是先兆子痫孕妇不良妊娠结局的危险因素,尿蛋白可作为预测妊娠结局的重要指标之一。Objective To explore the effects of preeclampsia and proteinuria on pregnant and perinatal outcomes. Methods A total of 692 pregnant women were selected and divided into study group （242 cases with preeclampsia） , hypertensive disorder complicating pregnan- cy （HDCP） group （208 cases with HDCP） , and normal control group （242 normal pregnant women） according to patient＇s condition. The cases in study group were divided into mild group （ 120 cases） , moderate group （79 cases） , and severe group （43 eases） according to the degree of proteinuria. The indexes in different groups were compared and analyzed, the effects of preeclampsia and proteinuria on pregnant and perinatal outcomes were analyzed. Results Blood pressure, uric acid level, cesarean section rate, blood ereatinine level, the incidence rates of premature birth, fetal distress, fetal death and stillbirth, neonatal asphyxia in study group were higher than those in HDCP group and normal control group, serum albumin level, eGFR level, neonatal birth weight, height, Apgar score in study group were lower than those in HDCP group and normal control group, there were statistically significant differences （P〈O. 05） . Serum creatinine level, cesarean section rate, uric acid level, the incidence rates of fetal distress and intrauterine growth retardation in severe group were statistically significantly low- er than those in mild group （P〈0. 05） . In study group, 24-hour urinary protein level was negatively correlated with maternal serum albumin level and eGFR （ P〈0. 05 ） and positively correlated with blood pressure and serum creatinine （P〈0. 05 ） . A large number of proteinu- ria was a risk factor for adverse pregnancy OUtcome of preeclampsia patients （ OR = 2. 671, P〈0. 05 ） . Conclusion The overall outcome of preeclampsia pregnant women and perinatal infants is poor, a large number of proteinuria is a risk factor for adverse pregnancy outcome of preeclampsia patients, urinary protein can be used as one

关 键 词：先兆子痫 蛋白尿 妊娠结局 妊娠期高血压 

分 类 号：R714.245[医药卫生—妇产科学]