孕晚期血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系研究  

Correlation of Serum Uric Acid and Serum Uric Acid/Creatinine Ratio Levels with Adverse Pregnancy Outcomes in Late Pregnancy

作　　者：赵茹 韩晨 黄泽宇 王茜[2] 胡君 葛智娟 毕艳[2] 沈山梅[1,2] ZHAO Ru;HAN Chen;HUANG Zeyu;WANG Qian;HU Jun;GE Zhijuan;BI Yan;SHEN Shanmei(Department of Endocrinology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210003,China;Department of Endocrinology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210003,China;Department of Health Management Center,Huadong Sanatorium,Wuxi 214121,China)

机构地区：[1]南京医科大学鼓楼临床医学院内分泌科,江苏省南京市210003 [2]南京大学医学院附属鼓楼医院内分泌科,江苏省南京市210003 [3]华东疗养院健康管理科,江苏省无锡市214121

出　　处：《中国全科医学》2024年第9期1074-1081,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(82030026)。

摘　　要：背景孕期血清尿酸代谢紊乱与不良妊娠结局相关,但目前分析并比较血清尿酸及血清尿酸/肌酐水平在孕期不良妊娠结局中的关系研究较少。目的分析孕妇孕晚期血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系。方法选取2015—2022年于南京大学医学院附属鼓楼医院常规产检及生产的单胎活产孕妇743例为研究对象。根据是否发生不良妊娠结局,将孕妇分为正常组344例和不良结局组399例。分别以四分位数将血清尿酸及血清尿酸/肌酐分为3个水平:Q1(血清尿酸<257μmol/L)、Q2(血清尿酸257~359μmol/L)、Q3(血清尿酸>359μmol/L)和q1(血清尿酸/肌酐<5.88)、q2(血清尿酸/肌酐5.88~7.94)、q3(血清尿酸/肌酐>7.94)。根据孕妇中位年龄,将孕妇分为年龄<30岁亚组(341例)及年龄≥30岁亚组(402例)。根据既往孕产次情况,将孕妇分为初产妇亚组(539例)及经产妇亚组(194例)。采用多因素Logistic回归分析探讨血清尿酸及血清尿酸/肌酐水平与不良妊娠结局的关系。结果不良结局组孕妇年龄、BMI、血清尿酸、血清尿酸/肌酐、三酰甘油高于正常组(P<0.05)。校正混杂因素后,血清尿酸、血清尿酸/肌酐对不良妊娠结局影响的多因素Logistic回归分析结果显示,与Q1水平血清尿酸相比,Q3水平时子痫前期(AOR=4.41,95%CI=2.16~8.99)、宫内生长受限(AOR=3.59,95%CI=1.08~11.96)的发生风险增加(P<0.05);与q1水平血清尿酸/肌酐相比,q2、q3水平时子痫前期(AOR=2.33,95%CI=1.13~4.79;AOR=3.56,95%CI=1.68~7.56)的发生风险增加,q3水平时早产(AOR=2.76,95%CI=1.33~5.71)、宫内生长受限(AOR=5.15,95%CI=1.39~19.14)的发生风险增加,而q3水平时巨大儿(AOR=0.43,95%CI=0.19~0.98)、大于胎龄儿(AOR=0.38,95%CI=0.15~0.96)的发生风险降低(P<0.05)。血清尿酸、血清尿酸/肌酐在不同年龄亚组对子痫前期、早产的影响结果显示,与Q1水平血清尿酸相比,Q3水平在两个年龄亚组中子痫前期的发生�Background The disorder of serum uric acid metabolism during pregnancy is associated with adverse pregnancy outcomes,while few studies have analyzed and compared the correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes.Objective To explore the correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes in late pregnancy.Methods A total of 743 pregnant women with singleton live births who were routinely examined and delivered at Nanjing Drum Tower Hospital from 2015 to 2022 were selected.Based on the occurrence of adverse pregnancy outcomes,pregnant women were divided into normal group(344 cases)and adverse outcome group(399 cases).Serum uric acid and serum uric acid/creatinine ratio were divided into three levels by quartiles,respectively,including Q1(serum uric acid<257μmol/L),Q2(serum uric acid 257-359μmol/L),Q3(serum uric acid>359μmol/L)and q1(serum uric acid/creatinine ratio<5.88),q2(serum uric acid/creatinine ratio 5.88-7.94),q3(serum uric acid/creatinine ratio>7.94).According to the median age of pregnant women,they were divided into the age subgroup<30 years old(341 cases)and age subgroup≥30 years old(402 cases).Based on previous pregnancies and deliveries,they were divided into the primiparous subgroup(539 cases)and multiparous subgroup(194 cases).The correlation of serum uric acid and serum uric acid/creatinine ratio levels with adverse pregnancy outcomes was analyzed by using multivariate Logistic regression.Results Pregnant women in adverse outcomes group were older with higher levels of BMI,serum uric acid,serum uric acid/creatinine ratio and triglycerides than those in the normal group(P<0.05).After adjustment for confounders,the multivariate Logistic regression results of the effect of serum uric acid and serum uric acid/creatinine ratio on adverse pregnancy outcomes showed that,compared to Q1 serum uric acid level,the risk of preeclampsia(AOR=4.41,95%CI=2.16-8.99)and intrauterine growth restric

关 键 词：孕妇 妊娠结局 尿酸 尿酸/肌酐 不良结局 影响因素分析 

分 类 号：R339.2[医药卫生—人体生理学]