妊娠合并慢性肾病患者不良结局分析及预测模型建立  

Analysis of adverse outcomes and establishment of predictive models in pregnant women with chronic kidney disease

作　　者：袁健珊 张静怡 邱丽君 唐晓彤 贾素红[1] Yuan Jianshan;Zhang Jingyi;Qiu Lijun(Department of Obstetrics and Gynecology,Second Affiliated Hospital of Suzhou University,Suzhou 215000)

机构地区：[1]苏州大学附属第二医院妇产科,苏州215000 [2]南京医科大学第一附属医院妇产科,南京210000

出　　处：《现代妇产科进展》2024年第2期115-119,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨妊娠合并慢性肾病(CKD)患者不良结局的转归及相关预测因素。方法:选取2022年1月至2023年1月于苏州大学附属第二医院分娩的62例CKD产妇。根据肾小球滤过率(GFR)将62例孕妇分为轻度CKD组(42例)和中重度CKD组(20例),收集两组患者的一般情况,孕中孕晚期和产前实验室检验结果,围产期合并症和并发症,母儿转归情况。将差异有统计学意义的数据置于二元logistic回归方程中分析影响因素的主次关系。结果:孕中期,中重度CKD组患者的尿蛋白定性(2+)百分比明显高于轻度CKD组,差异有统计学意义(35.0%vs 7.1%,P=0.005)。孕晚期中重度CKD组中血肌酐值、尿蛋白定性(2+)比例、血清尿素含量、血清白蛋白量均显著高于轻度CKD组[63.4±11.9 vs 44.3±1.9,P=0.000;45.0%vs 16.7%vs,P=0.044;9.82(4.79,205.830)vs 3.56(2.99,4.19),P=0.024;38.0(33.0,38.7)vs 37.7(35.0,39.6),P=0.001],白蛋白/血肌酐均明显低于轻度CKD组(0.67±0.13 vs 0.90±0.04,P=0.033)。产前,中重度CKD患者检验结果进一步恶化,血肌酐值、人尿蛋白定性(2+)百分比、人尿红细胞定性(2+)百分比、肝酶(谷丙转氨酶,谷草转氨酶)和血清尿酸值均显著高于轻度CKD组,而血清白蛋白量和白蛋白/血肌酐均低于轻度CKD组,差异均有统计学意义(P<0.05)。中重度CKD组患者发生妊娠期高血压疾病风险显著增加。二元logistic分析结果显示,孕中期血肌酐值和孕中期血清白蛋白量(OR=1.214,95%CI为1.029~1.433,P=0.022;OR=0.582,95%CI为0.382~0.886,P=0.012)是预测CKD患者发生妊娠期高血压疾病的主要因素。血清肌酐值与妊娠期高血压疾病呈正相关,血清白蛋白与妊娠期高血压疾病呈负相关。中重度CKD组的新生儿体重远低于轻度CKD组,差异有统计学意义(P=0.007)。结论:中重度CKD患者肝肾功能随着孕周增加呈进行性恶化,且妊娠合并CKD患者易发妊娠期高血压疾病,导致母儿转归不良。因此,在孕期就应建立多学�Objective:To explorore the prognosis and related predictive factorors of adverse outcomes in patients with chronic kidney disease(CKD)during pregnancy.Methods:62 postpartum women with CKD who delivered from January 2022 to January 2023 at the Second Affiliated Hospital of Suzhou University were collected.According to the glomerular filtration rate(GFR),62 pregnant women were divided into a mild CKD group(42 cases)and a moderate to severe CKD group(20 cases).The general information,mid to late pregnancy and prenatal laboratory test results,perinatal complications and complications,and maternal and fetal outcomes of the two groups of patients were collected,and statistically significant data were placed in a binary logistic regression equation to analyze the primary and secondary relationships of influencing factors.Results:In the second trimester,the qualitative(2+)percentage of urine protein in patients with moderate to severe CKD was significantly higher than that in patients with mild CKD(35.0%vs 7.1%,P=0.005).The serum creatinine levels in the mid to severe CKD group in the later stages of pregnancy,the qualitative percentage of urinary protein(2+),urea content and serum albumin were significantly higher in the mild CKD group[63.4±11.9 vs 44.3±1.9,P=0.000;45.0%vs 16.7%vs,P=0.044;9.82(4.79,205.830)vs 3.56(2.99,4.19),P=0.024;38.0(33.0,38.7)vs 37.7(35.0,39.6),P=0.001],and albumin/creatinine levels were significantly lower in the mild CKD group(0.67±0.13 vs 0.90±0.04,P=0.033).Before delivery,compared to the mild CKD group,the test results of patients with moderate to severe CKD further deteriorated,with significant increases in blood creatinine value,percentage of urine protein qualitative(2+),percentage of urine red blood cell qualitative(2+),liver enzymes(ALT,AST),and uric acid value.However,serum albumin level and white protein/blood creatinine levels were lower than those in the mild CKD group,and the differences in the above factors were statistically significant(P<0.05).In addition,the risk of developing

关 键 词：妊娠合并慢性肾脏病 妊娠期高血压疾病 实验室指标 母儿转归 

分 类 号：R714.4[医药卫生—妇产科学]