慢性肾病孕妇肾脏超声异常与不良妊娠结局的相关性研究  

Study on the relationship between abnormal renal ultrasound image and adverse pregnant outcomes in pregnancies with chronic kidney disease

作　　者：庄旭[1] 丁立[2] 许丽[3] 张宁[1] 张羽[1] 林建华[1] Zhuang Xu;Ding Li;Xu Li;Zhang Ning;Zhang Yu;Lin Jianhua(Department of Obstetrics and Gynecology,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200127,China;Department of Nephrology,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200127,China;Department of Ultrasound,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200127,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]上海交通大学医学院附属仁济医院肾脏科,200127 [3]上海交通大学医学院附属仁济医院超声医学科,200127

出　　处：《中华产科急救电子杂志》2024年第2期100-105,共6页Chinese Journal of Obstetric Emergency（Electronic Edition）

基　　金：上海交通大学“交大之星”计划医工交叉研究基金(YG2021QN24)。

摘　　要：目的:探讨慢性肾病(chronic kidney disease,CKD)孕妇肾脏超声异常和肾脏功能及妊娠结局的相关性。方法:收集2017年1月至2021年12月于上海交通大学医学院附属仁济医院分娩的134例妊娠合并CKD患者的临床资料,根据孕16周前初次产检的肾脏超声结果分为肾脏超声正常100例(A组)和肾脏超声异常者34例(B组)。采用回顾性方法采集患者的临床信息、肾脏功能及妊娠结局等指标并进行分析。结果:(1)两组患者的收缩压分别为(125.6±15.2)mmHg vs(145.4±23.2)mmHg(t=-4.649),舒张压(79.4±11.7)mmHg vs(93.9±16.3)mmHg(t=-4.782),24 h蛋白尿880.8 mg vs 4519.5 mg(Z=-5.052),血清肌酐53.0μmol/L vs 96.0μmol/L(Z=-5.832),尿素氮3.7 mmol/L vs 6.2 mmol/L(Z=-4.938)和尿酸320.0μmol/L vs 452.0μmol/L(Z=-4.285),P值均<0.001,差异有统计学意义;(2)两组患者的血清β2-微球蛋白值分别为2.0 mg/L vs 3.7 mg/L(Z=-5.779),尿微量白蛋白255.5 mg/L vs 1425.0 mg/L(Z=-3.699),尿免疫球蛋白G 35.4 mg/L vs 112.5 mg/L(Z=-3.198),尿转铁蛋白21.6 mg/L vs 148.5 mg/L(Z=-4.132),尿α1-微球蛋白14.9 mg/L vs 34.4 mg/L(Z=-3.868),尿β2-微球蛋白0.4 mg/L vs 5.0 mg/L(Z=-5.439)和尿视黄醇结合蛋白0.4 mg/L vs 3.7 mg/L(Z=-4.960),P值均<0.001,差异有统计学意义;(3)B组子痫前期发生率70.6%(24/34),A组为20.0%(20/100),两组比较差异有统计学意义(χ^(2)=29.443,P<0.001);(4)B组患者胎儿生长受限或小于胎龄儿发生率为17.6%,而A组仅为2.0%(χ^(2)=8.454,P=0.004),差异有统计学意义;(5)经相关性分析,肾脏超声异常与血压、血清β2-微球蛋白、肌酐、尿酸、蛋白尿、子痫前期发生率、胸腹腔积液发生率呈正相关,与分娩时间和胎儿体重呈负相关。结论:肾脏超声检查的异常可能是CKD孕妇出现不良临床状态和妊娠结局的敏感信号之一,建议CKD孕妇应积极完善肾脏超声检查。Objective:To explore the impact of abnormal renal ultrasound image on renal function and pregnant outcome in pregnancies with chronic kidney disease(CKD).Methods:One hundred cases of pregnancies with CKD complicated with normal renal ultrasound image(group A)and thirty-four cases of patients complicated with abnormal renal ultrasound image(group B)were enrolled.The data on clinical features and pregnant outcomes were collected.Results:(1)Statistical analysis of these results revealed there were significant differences in the average systolic blood pressure[(125.6±15.2)mmHg vs(145.4±23.2)mmHg,t=-4.649]and diastolic blood pressure[(79.4±11.7)mmHg vs(93.9±16.3)mmHg,t=-4.782]and the media of 24-hour proteinuria[880.8 mg vs 4519.5 mg,Z=-5.052],serum creatinin[53.0μmol/L vs 96.0μmol/L,Z=-5.832],Blood urea nitrogen[3.7 mmol/L vs 6.2 mmol/L,Z=-4.938]and serum uric acid[320.0μmol/L vs 452.0μmol/L,Z=-4.285]between two groups(P<0.001).(2)There was a significant difference in the media of serumβ2-microglobulin[2.0 mg/L vs 3.7 mg/L,Z=-5.779]between the two group.For the urinary proteins,there were significant differences in the media of urinary microalbumin[255.5 mg/L vs 1425.0 mg/L,Z=-3.699],immunoglobulin G[35.4 mg/L vs 112.5 mg/L,Z=-3.198],transferrin[21.6 mg/L vs 148.5 mg/L,Z=-4.132],α1-microglobulin[14.9 mg/L vs 34.4 mg/L,Z=-3.868],β2-microglobulin[0.4 mg/L vs 5.0 mg/L,Z=-5.439]and retinol-binding protein[0.4 mg/L vs 3.7 mg/L,Z=-4.960]between two groups.(3)Over 70.6%(24/34)of patients in group B were superimposed with PE,while only 20%of patients in group A were superimposed with PE.And there was a significant difference between the two groups in the incidence of PE(χ^(2)=29.443,P<0.001).The mean delivery time for patients in group A was(35.9±6.1)gestational weeks,which had a highly significant difference from the mean delivery time for patients in group B of(31.8±6.9)gestational weeks(t=3.289,P=0.001).(4)In follow-up visits,media of fetal weight varied significantly between the two groups(Z=-3.906,P<0.001)

关 键 词：子痫前期 肾疾病 妊娠结局 超声检查 产前 

分 类 号：R714.2[医药卫生—妇产科学]