早发与晚发子痫前期高危因素的对比分析  

Comparative analysis of high risk factors between early-onset pre-eclampsia and late-onset pre-eclampsia

作　　者：吕鑫 张为远[2] 张靖霄[3] 魏玉茜 郭晓丽 崔世红[6] 颜建英[7] 张孝艳[8] 乔宠[9] 周容 顾蔚蓉 陈先侠 杨孜[13] 李笑天 林建华[1] Lyu Xin;Zhang Weiyuan;Zhang Jingxiao;Wei Yuqian;Guo Xiaoli;Cui Shihong;Yan Jianying;Zhang Xiaoyan;Qiao Chong;Zhou Rong;Gu Weirong;Chen Xianxia;Yang Zi;Li Xiaotian;Lin Jianhua(Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Department of Obstetrics and Gynecology,the Fourth Hospital of Shijiazhuang,Shijiazhuang 050035,China;Department of Obstetrics and Gynecology,Affiliated Hospital of Jining Medical University,Jining 272007,China;Department of Obstetrics,Changzhi Maternity and Child Health Care Hospital of Shanxi Province,Changzhi 046000,China;Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450015,China;Department of Obstetrics,Fujian Maternity and Child Health Care Hospital,Fuzhou 350005,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 117004,China;Department of Obstetrics,West China Second University Hospital,Sichuan University,Chengdu 610044,China;Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200082,China;Department of Obstetrics,Anhui Province Maternity and Child Health Hospital,Hefei 230001,China;Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,200127 [2]首都医科大学附属北京妇产医院产科,100026 [3]石家庄市第四医院妇产科,050035 [4]济宁医学院附属医院妇产科,272007 [5]山西省长治市妇幼保健院产科,046000 [6]郑州大学第三附属医院妇产科,450015 [7]福建省妇幼保健院产科,福州350005 [8]郑州大学第一附属医院妇产科,450052 [9]中国医科大学附属盛京医院妇产科,沈阳117004 [10]四川大学华西第二医院产科,成都610044 [11]复旦大学附属妇产科医院产科,上海200082 [12]安徽省妇幼保健院产科,合肥230001 [13]北京大学第三医院妇产科,100191

出　　处：《中华妇产科杂志》2021年第11期760-766,共7页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨早发和晚发子痫前期高危因素的差异,提高对子痫前期高危因素的认识。方法回顾性分析2018年我国160家医疗机构子痫前期孕妇的临床资料,共21000例,其中早发子痫前期8031例(早发组),晚发子痫前期12969例(晚发组)。比较早发组与晚发组孕妇各高危因素及不同体质指数(BMI)、年龄分层的占比情况。结果(1)高危因素的单因素分析:早发组与晚发组各高危因素的占比分别比较,差异均有统计学意义(P均<0.05);其中,早发组的初产妇、多胎妊娠占比均显著低于晚发组,高龄、未规律产前检查、肥胖、高血压家族史、子痫前期史、糖尿病、慢性肾脏疾病、免疫系统疾病、辅助生殖技术受孕的占比均显著高于晚发组。(2)BMI分层分析:早发组BMI≥24 kg/m^(2)孕妇占比[分别为48.2%(2828/5872)和45.5%(4177/9181),P=0.001]及BMI≥28 kg/m^(2)孕妇占比[分别为19.5%(1143/5872)和18.0%(1656/9181),P=0.028]均显著高于晚发组。(3)年龄分层分析:早发组35~39岁孕妇占比[分别为21.8%(1752/8023)和17.6%(2118/12068),P<0.01]、40~44岁孕妇占比[分别为6.8%(545/8023)和5.4%(649/12068),P<0.01]、≥45岁孕妇占比[分别为0.7%(58/8023)和0.5%(57/12068),P=0.021]均显著高于晚发组。(4)多因素分析:高龄(≥35岁)、多胎妊娠、未规律产前检查或由外院转入、高血压家族史(包括父系、母系及父母两系)、既往子痫前期史、慢性肾脏疾病、免疫系统疾病(系统性红斑狼疮、抗磷脂抗体综合征)以及辅助生殖技术受孕均是影响子痫前期严重程度的风险因素(P均<0.05)。结论有年龄≥35岁、孕前BMI≥24 kg/m^(2)、高血压家族史、既往子痫前期病史、慢性肾脏疾病、免疫系统疾病(主要包括系统性红斑狼疮及抗磷脂抗体综合征)、辅助生殖技术受孕这些高危因素的孕产妇更易发生早发子痫前期。Objective To explore the difference of high-risk factors between early-onset and late-onset pre-eclampsia,and to further understand high-risk factors of pre-eclampsia.Methods Clinical data of pre-eclampsia pregnant women in 160 medical institutions in China in 2018 were retrospectively analyzed,including 8031 cases of early-onset pre-eclampsia and 12969 cases of late-onset pre-eclampsia.The proportion of high-risk factors,different body mass index(BMI)and age stratification between early-onset group and late-onset group were compared.Results(1)Univariate analysis of high-risk factors:the proportions of high-risk factors in early-onset group and late-onset group were compared,and the differences were statistically significant(all P<0.05).Among them,the proportions of primipara and multiple pregnancy in early-onset group were lower than those in late-onset group,while the proportions of pregnant women with advanced age,irregular antenatal examination,obesity,family history of hypertension,pre-eclampsia,diabetes,kidney diseases,immune system diseases and assisted reproductive technology were higher than those in late-onset group.(2)Hierarchical analysis of BMI:the proportion of pregnant women with BMI≥24 kg/m^(2) in early-onset group[48.2%(2828/5872)vs 45.5%(4177/9181),respectively;P=0.001]and the proportion of pregnant women with BMI≥28 kg/m^(2) in early-onset group[19.5%(1143/5872)vs 18.0%(1656/9181),respectively;P=0.028]were significantly higher than those in late-onset group.(3)Age stratification analysis:the proportion of pregnant women aged 35-39 years in the early-onset group[21.8%(1748/8023)vs 17.5%(2110/12068),respectively;P<0.01],the proportion of pregnant women 40-44 years old[6.8%(544/8023)vs 5.4%(648/12068),respectively;P<0.01],and the proportion of pregnant women≥45 years old[0.7%(58/8023)vs 0.5%(57/12068),respectively;P=0.021]were significantly higher than those in the late-onset group.(4)Multivariate analysis:advanced age(≥35 years old),multiple pregnancy,irregular antenatal examination or tr

关 键 词：先兆子痫 危险因素 回顾性研究 

分 类 号：R714.244[医药卫生—妇产科学]