慢性肾脏病患者妊娠的母婴结局及危险因素分析  

Maternal and infant outcomes of pregnancy in patients with chronic kidney disease and risk factors

作　　者：胡敏杰 林芙君[1] 黄海东[1] 蒋更如[1] 陆玮[1] HU Minjie;LIN Fujun;HUANG Haidong;JIANG Gengru;LU Wei(Department of Renal and Rheumatology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院肾脏风湿免疫科,上海200092

出　　处：《上海医学》2022年第5期336-342,共7页Shanghai Medical Journal

基　　金：国家自然科学基金(82070697),上海市科学技术委员会科研计划项目西医引导类项目(19411968000)。

摘　　要：目的探讨CKD患者妊娠的母婴结局,并分析其相关危险因素。方法回顾性分析上海交通大学医学院附属新华医院2010年1月—2020年12月收治的146例CKD妊娠期女性患者的临床资料。根据患者妊娠早期估算的肾小球滤过率(eGFR)进行CKD分期,其中CKD 1期130例、CKD 2~5期16例,比较两组患者的肾功能转归及母婴结局,分析母婴不良结局的相关危险因素。结果与CKD 1期患者相比,CKD 2~5期患者血尿酸、血尿素氮(BUN)、血肌酐(sCr)水平及平均动脉压显著升高,24 h尿蛋白定量显著增加,eGFR、妊娠次数、孕周、血红蛋白(Hb)值则均显著降低(P<0.05或0.01)。CKD 1期和CKD 2~5期患者妊娠晚期sCr、血尿酸、尿蛋白定量及平均动脉压水平均较妊娠早期显著增高(P值均<0.01)。CKD 1期患者妊娠晚期eGFR较妊娠早期无显著变化,CKD 2~5期患者妊娠晚期eGFR则较妊娠早期显著降低(P<0.01)。与CKD 1期相比,CKD 2~5期患者CKD分期增加、子痫前期、新发高血压、尿蛋白翻倍、妊娠期贫血的比例显著增高(P<0.05或0.01)。CKD 1期患者中有11例(8.46%)于妊娠晚期发生肾功能恶化;CKD 2~5期有8例(8/16)于妊娠晚期发生肾功能恶化。CKD 2~5期患者胎儿活产、足月产的比例,以及新生儿体重、出生后1 min Apgar评分均显著低于CKD 1期(P值均<0.01),而中期引产、早产、低出生体重儿(LBWF)/极低出生体重儿(VLBWF)的比例显著高于CKD 1期(P值均<0.01)。多因素logistic回归分析显示,高血压是患者妊娠晚期CKD分期进展(OR=0.105,95%CI为0.021~0.521,P=0.006)和24 h尿蛋白定量翻倍(OR=0.361,95%CI为0.177~0.735,P=0.005)的独立危险因素;妊娠期高血压(OR=0.303,95%CI为0.094~0.983,P=0.047)则是剖宫产的独立危险因素。Cox回归分析显示,24 h尿蛋白定量增多(OR=1.000,95%CI为1.000~1.001,P<0.01)和eGFR降低(OR=0.984,95%CI为0.970~0.997,P=0.018)是早产的独立危险因素。结论CKD患者妊娠的母婴不良结局发生风险较高,并�Objective To investigate maternal and infant outcomes of pregnancy in patients with chronic kidney disease(CKD)and related risk factors.Methods A retrospective analysis was performed in 146 CKD pregnant women admitted to Shanghai Xinhua Hospital between January 2010 and December 2020.CKD was staged according to the estimated glomerular filtration rate(eGFR)in early pregnancy,and there were 130 patients at CKD stage 1 and 16 patients at CKD stage 2-5.Renal function,maternal and fetal outcomes and the risk factors for adverse outcomes were compared between CKD stage 1 group and CKD stage 2-5 group.Results Compared with CKD stage 1 patients,CKD stage 2 to 5 patients had increased blood uric acid,blood urea nitrogen(BUN),serum creatinine(sCr),mean arterial pressure and 24-hour urine protein quantification,and decreased eGFR,number of pregnancies,gestational weeks and hemoglobin(Hb)level(P<0.05 or 0.01).sCr,uric acid,urine protein quantification and mean arterial pressure in late pregnancy were significantly higher than those in early pregnancy in both groups(all P<0.01).eGFR in late pregnancy was not significantly different from that in early pregnancy in CKD stage 1 patients.eGFR in late pregnancy was significantly lower than that in early pregnancy in CKD stage 2 to 5 patients(P<0.01).The proportions of patients who had increased CKD stage,preeclampsia,new-onset hypertension,doubling of urinary protein and anemia during pregnancy were significantly higher in CKD stage 2-5 group than those in CKD stage 1 group(P<0.05 or 0.01).Renal function deterioration occurred in late pregnancy in 11(8.46%)patients at CKD stage 1 and in 8 patients(8/16)at CKD stage 2 to 5.The live birth rate,full-term birth rate,newborn weight,and Apgar 1-minute score in CKD stage 2-5 group were significantly lower than those in CKD stage 1 group(P<0.01),while the incidence of mid-term induction of labor,premature birth and LBWF/VLBWF in CKD stage 2-5 group were significantly higher than those in CKD stage 1 group(P<0.01).Multivariate logistic re

关 键 词：慢性肾脏病 妊娠 肾功能 母婴结局 

分 类 号：R714.258[医药卫生—妇产科学]