妊娠期哮喘患者病情控制与妊娠结局的临床分析  

Clinical analysis of disease control and pregnancy outcome in asthmatic patients during pregnancy

作　　者：余兵[1] 马艳良[1] 张彤[1] 高占成[1] 何权瀛[1] YU Bing;MA Yanliang;ZHANG Tong;GAO Zhancheng;HE Quanying(Department of Respiratory and Critial Care Medicine,Peking University People’s Hospital,Beijing 100044,P.R.China)

机构地区：[1]北京大学人民医院呼吸与危重症医学科,北京100044

出　　处：《中国呼吸与危重监护杂志》2022年第3期178-184,共7页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨妊娠期哮喘患者的孕期病情变化、体重增加、嗜酸性粒细胞水平等因素对妊娠结局的影响。方法收集2010年10月—2020年10月于北京大学人民医院产科住院生产的妊娠期哮喘患者病历记录,并查阅孕期前(怀孕前)和生产前孕期相应的门诊电子病历记录。根据病情控制情况(有无非计划呼吸门诊、急诊或住院情况)分为孕期平稳组和孕期波动组,回顾性分析比较两组病例一般资料、孕期前病情控制、孕期体重增加情况、嗜酸性粒细胞水平等情况;孕期波动组(亚组分析)的哮喘发作诱因,临床特点及发作时间的孕周分布;孕期平稳组(亚组分析)不同孕期的嗜酸性粒细胞水平分析。结果纳入单胎自然怀孕的妊娠期哮喘124例,年龄(32.3±3.9)岁,孕期平稳组71例,孕期波动组53例。孕期波动组孕期前病情不稳定比例高于孕期平稳组(P<0.05),孕期波动组孕期前间断用药比例高于孕期平稳组(P<0.05),在临产时外周血嗜酸性粒细胞计数及外周血嗜酸性粒细胞计数≥0.15×10^(9)/L例数的比较中,孕期波动组高于孕期平稳组(均P<0.05),两组在孕期体重指数、孕期体重增加值及伴随过敏性鼻炎比例的比较中差异无统计学意义(均P>0.05);母胎结局方面,孕期波动组的妊高症病例比例、胎儿宫内窘迫比例高于孕期平稳组(均P<0.05)。孕期波动组中,普通感冒在哮喘发作诱发因素中较为常见(38.2%,29例次/76例次),妊娠期哮喘发作多发生于孕13~36周(65.8%,50例次/76例次);对于孕期稳定组亚组的分析,外周血嗜酸性粒细胞计数的比较中,孕早期(P<0.05)和孕中期(P<0.05)高于临产前;嗜酸性粒细胞计数>0.15×10^(9)/L例数比较中,孕中期高于临产前(P<0.05)。结论妊娠期哮喘病情波动和母胎不良结局有关,妊娠期哮喘患者孕期前(怀孕前)的哮喘病情控制、孕期体重管理、嗜酸性粒细胞的监测意义重大,妊娠期哮喘患者的孕�Objective To explored the influence of disease changes,weight gain,eosinophil levels and other factor in pregnancy women with asthma.Methods Case records of gestational asthma patients produced in the obstetrics department of Peking University People's Hospital from October 2010 to October 2020 were collected,and refer to electronic medical records of clinics(pre-pregnancy and pregnancy).According to the disease control(asthma related unplanned respiratory clinics,emergency or hospitalization),patients were divided into pregnancy stable group and pregnancy fluctuation group.The basic characteristics,pre-pregnancy asthma control,weight gain during pregnancy and peripheral blood eosinophil level before labor were retrospectively analyzed.The cause of asthma attacks,clinical characteristics and distribution of gestational time in pregnancy fluctuations were described.Peripheral blood eosinophil levels in different period during pregnancy in the stable group were analyzed.Results Totally 124 cases of natural pregnancy singleton were enrolled in the study.The age was(32.3±3.9)years old.There were 71 patients in stable group and 53 patients in fluctuation group.The proportion of pre-pregnancy instability in the fluctuating pregnancy group was higher than that in the stable pregnancy group(P<0.05).The proportion of intermittent medication before pregnancy was higher in the fluctuating pregnancy group than in the stable pregnancy group(P<0.05).Peripheral blood eosinophil count before labor and the number of cases with eosinophil count≥0.15×10^(9)/L before labor were higher in the fluctuation group(all P<0.05).The proportion of hypertentive diseases in pregnancy and fetal distress in uterus were higher in the fluctuation group(all P<0.05).The common cold was the common trigger factor(38.2%)and asthma recurrences occur between 13 and 36 weeks of gestation(65.8%)in fluctuation group.In further analysis of subgroup(the stable group),peripheral blood eosinophil count in early pregnancy(P<0.05)and pregnant metaphase(P<0.05

关 键 词：妊娠期哮喘 体重增加 嗜酸性粒细胞水平 妊娠结局 

分 类 号：R714.253[医药卫生—妇产科学]