孕前尿石症与子痫前期的纵向研究:孕早期高尿酸血症的中介效应  

A longitudinal study on the relationship between pre-pregnancy urolithiasis and pre-eclampsia:the mediating effect of hyperuricemia in early pregnancy

作　　者：陈烨 孙梦婷 李子业 邹琪 彭辕 阮霄睿 罗曼君 王婷婷[1] 秦家碧[1] Chen Ye;Sun Mengting;Li Ziye;Zou Qi;Peng Yuan;Ruan Xiaorui;Luo Manjun;Wang Tingting;Qin Jiabi(Department of Epidemiology and Health Statistics,Xiangya School of Public Health,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅公共卫生学院流行病与卫生统计学系,长沙410013

出　　处：《中华流行病学杂志》2025年第1期140-146,共7页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(82073653,81803313);湖南省杰出青年基金(2022JJ10087)。

摘　　要：目的探讨孕前尿石症与孕期发生子痫前期(PE)风险之间的关联,并评价孕早期高尿酸血症(HUA)在二者关联中的中介作用。方法选取2014年8月至2019年12月于湖南省7所妇幼保健医院进行产检的孕妇构建孕早期队列。采用纸质问卷收集孕妇人口学资料、孕前疾病史、生活习惯等情况,从医院电子病历系统导出孕早期实验室检查和妊娠结局。采用logistic回归模型分析孕前尿石症和PE之间的关联,再采用因果中介分析探讨孕早期HUA在二者关联中所起的中介作用。结果共纳入33579例自然受孕单胎孕妇进行分析,其中3230例(9.6%)孕早期出现HUA,666例(2.0%)出现PE。多因素logistic回归分析结果显示,孕前尿石症增加孕期PE的发病风险(OR=2.65,95%CI:1.56~4.51)。中介分析表明,控制混杂因素后,孕早期HUA可以介导孕前尿石症与PE发病的关联,中介效应比例为46%(P<0.05)。结论孕前尿石症是孕期发生PE的独立危险因素,孕早期HUA在二者之间存在一定中介效应。Objective To evaluate the association between pre-pregnancy urolithiasis and pre-eclampsia and to further explore the mediating effect of hyperuricemia in early pregnancy on the relationship between urolithiasis and pre-eclampsia.MethodsPregnant women attending prenatal care in early pregnancy at 7 Maternal and Child Health Hospitals in Hunan Province from August 2014 to December 2019 were recruited to construct a cohort of early pregnancy.The paper questionnaire collected demographic data on pregnant women,pre-pregnancy disease history,and living habits,etc.Besides,the early pregnancy laboratory examination and pregnancy outcome for this pregnancy were derived from the hospital's electronic medical record system.Logistic regression models were used to analyze the association between pre-pregnancy urolithiasis and pre-eclampsia,and causal mediation analysis was used to investigate the mediating role and magnitude of hyperuricemia in early pregnancy in the association pathway between pre-pregnancy urolithiasis and pre-eclampsia.ResultsA total of 33579 naturally conceived singleton pregnant women were included in the analysis,of which 3230 cases(9.6%)had hyperuricemia in early pregnancy,and 666 cases(2.0%)had pre-eclampsia.The multivariate logistic regression analysis indicated that pre-pregnancy urolithiasis increased the risk of pre-eclampsia(OR=2.65,95%CI:1.56-4.51).Mediation analysis showed that after controlling for confounders,hyperuricemia in early pregnancy could mediate the association between pre-pregnancy urolithiasis and pre-eclampsia,with a mediation effect proportion of 46%(P<0.05).ConclusionsPre-pregnancy urolithiasis is an independent risk factor for pre-eclampsia,and early pregnancy hyperuricemia has a certain mediating effect between urolithiasis and pre-eclampsia.

关 键 词：尿石症 子痫前期 高尿酸血症 中介分析 

分 类 号：R71[医药卫生—妇产科学]