中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
6期
405-411
,共7页
子痫前期%危险因素%高血压%糖尿病,妊娠%肾小球肾炎%甲状腺疾病
子癇前期%危險因素%高血壓%糖尿病,妊娠%腎小毬腎炎%甲狀腺疾病
자간전기%위험인소%고혈압%당뇨병,임신%신소구신염%갑상선질병
Pre-eclampsia%Risk factors%Hypertension%Diabetes,gestational%Glomerulonephritis%Thyroid diseases
目的 探讨母体合并内科疾病等子痫前期临床风险因素对子痫前期发病的影响,旨在提高和强化围孕期早期评估和识别高危人群的能力.方法 回顾性分析2008年11月至2011年1月间在北京大学第三医院住院的、合并内科疾病的子痫前期患者97例(M-PE组)及无内科疾病的单纯子痫前期患者203例(I-PE组)的临床资料,并分别与同期合并内科疾病未发生子痫前期孕妇183例及无内科疾病正常妊娠孕妇203例进行对比.结果 2008年11月至2011年1月本院子痫前期总体病例中,存在多胎及合并内科疾病等子痫前期临床风险因素者占43.1％ (159/369)；单胎妊娠中合并内科疾病者子痫前期发生率明显高于无内科合并症者,分别为15.0％ (97/646)、4.45％(210/4719),两者比较,差异有统计学意义(P＜0,05)；单胎妊娠子痫前期中合并内科疾病者占32.3％ (97/300).M-PE组孕妇比I-PE组的平均年龄[分别为(31.7±4.5)、(29.3±5.2)岁]、高龄孕妇比例[分别为29％( 28/97)、17.7％( 36/203)]、既往有子痫前期史孕妇比例[分别为11％ (11/97)、4.9％( 10/203)]、中晚孕期妊娠丢失史比例[分别为11％( 11/97)、3.0％ (6/203)]及早孕期体质指数(BMI)[分别为(26.0±5.6)、(23.3±3.7) kg/m2]、高BMI孕妇比例[分别为62％( 18/29)、33％ (18/55)]均明显增高,分别比较,差异均有统计学意义(P＜0.05).M-PE组比I-PE组诊断孕周中位数提前(分别为32.9、34.4周),发病孕周在32周之前者[分别为45％ (44/97)、34.0％( 69/203)]、在34周之前者[分别为54％ (52/97)、45.8％ (93/203)]及在孕32周前发生的重症病例所占比例[分别为45％ (44/97)、34.0％( 69/203)]均增加,分别比较,差异均有统计学意义(P＜0.05).以32孕周为界,I-PE组早发型患者平均早孕期BMI低于晚发型[分别为(20.9 ±2.0)、(23.4±3.8)kg/m2,P=0.269].以32孕周为早发型界定值,合并内科疾病是早发型子痫前期发病的独立影响因素(OR=1.718,95％ CI 为1.005 ～2.937,P=0.048)；无论以32孕周或34孕周界定早发型与晚发型,多因素回归分析显示,中晚孕期妊娠丢失史及不规律产前检查均是早发型子痫前期发病的独立影响因素(P均＜0.05).结论 存在内科疾病及多胎妊娠的子痫前期患者在同期子痫前期发生总人群中超过1/3;存在内科疾病的子痫前期患者其子痫前期发病孕周较早,是不容忽视的高危人群.单纯型子痫前期早发型患者早孕期BMI低于晚发型,早发型与晚发型子痫前期存在BMI方面的差异,提示两者可能存在母体异质性和不同的发病机制.中晚孕期妊娠丢失史及不规律产前检查均是早发型子痫前期发病的影响因素,应强化包括潜在内科疾病在内的临床风险因素的早期评估和产前检查.
目的 探討母體閤併內科疾病等子癇前期臨床風險因素對子癇前期髮病的影響,旨在提高和彊化圍孕期早期評估和識彆高危人群的能力.方法 迴顧性分析2008年11月至2011年1月間在北京大學第三醫院住院的、閤併內科疾病的子癇前期患者97例(M-PE組)及無內科疾病的單純子癇前期患者203例(I-PE組)的臨床資料,併分彆與同期閤併內科疾病未髮生子癇前期孕婦183例及無內科疾病正常妊娠孕婦203例進行對比.結果 2008年11月至2011年1月本院子癇前期總體病例中,存在多胎及閤併內科疾病等子癇前期臨床風險因素者佔43.1％ (159/369)；單胎妊娠中閤併內科疾病者子癇前期髮生率明顯高于無內科閤併癥者,分彆為15.0％ (97/646)、4.45％(210/4719),兩者比較,差異有統計學意義(P＜0,05)；單胎妊娠子癇前期中閤併內科疾病者佔32.3％ (97/300).M-PE組孕婦比I-PE組的平均年齡[分彆為(31.7±4.5)、(29.3±5.2)歲]、高齡孕婦比例[分彆為29％( 28/97)、17.7％( 36/203)]、既往有子癇前期史孕婦比例[分彆為11％ (11/97)、4.9％( 10/203)]、中晚孕期妊娠丟失史比例[分彆為11％( 11/97)、3.0％ (6/203)]及早孕期體質指數(BMI)[分彆為(26.0±5.6)、(23.3±3.7) kg/m2]、高BMI孕婦比例[分彆為62％( 18/29)、33％ (18/55)]均明顯增高,分彆比較,差異均有統計學意義(P＜0.05).M-PE組比I-PE組診斷孕週中位數提前(分彆為32.9、34.4週),髮病孕週在32週之前者[分彆為45％ (44/97)、34.0％( 69/203)]、在34週之前者[分彆為54％ (52/97)、45.8％ (93/203)]及在孕32週前髮生的重癥病例所佔比例[分彆為45％ (44/97)、34.0％( 69/203)]均增加,分彆比較,差異均有統計學意義(P＜0.05).以32孕週為界,I-PE組早髮型患者平均早孕期BMI低于晚髮型[分彆為(20.9 ±2.0)、(23.4±3.8)kg/m2,P=0.269].以32孕週為早髮型界定值,閤併內科疾病是早髮型子癇前期髮病的獨立影響因素(OR=1.718,95％ CI 為1.005 ～2.937,P=0.048)；無論以32孕週或34孕週界定早髮型與晚髮型,多因素迴歸分析顯示,中晚孕期妊娠丟失史及不規律產前檢查均是早髮型子癇前期髮病的獨立影響因素(P均＜0.05).結論 存在內科疾病及多胎妊娠的子癇前期患者在同期子癇前期髮生總人群中超過1/3;存在內科疾病的子癇前期患者其子癇前期髮病孕週較早,是不容忽視的高危人群.單純型子癇前期早髮型患者早孕期BMI低于晚髮型,早髮型與晚髮型子癇前期存在BMI方麵的差異,提示兩者可能存在母體異質性和不同的髮病機製.中晚孕期妊娠丟失史及不規律產前檢查均是早髮型子癇前期髮病的影響因素,應彊化包括潛在內科疾病在內的臨床風險因素的早期評估和產前檢查.
목적 탐토모체합병내과질병등자간전기림상풍험인소대자간전기발병적영향,지재제고화강화위잉기조기평고화식별고위인군적능력.방법 회고성분석2008년11월지2011년1월간재북경대학제삼의원주원적、합병내과질병적자간전기환자97례(M-PE조)급무내과질병적단순자간전기환자203례(I-PE조)적림상자료,병분별여동기합병내과질병미발생자간전기잉부183례급무내과질병정상임신잉부203례진행대비.결과 2008년11월지2011년1월본원자간전기총체병례중,존재다태급합병내과질병등자간전기림상풍험인소자점43.1％ (159/369)；단태임신중합병내과질병자자간전기발생솔명현고우무내과합병증자,분별위15.0％ (97/646)、4.45％(210/4719),량자비교,차이유통계학의의(P＜0,05)；단태임신자간전기중합병내과질병자점32.3％ (97/300).M-PE조잉부비I-PE조적평균년령[분별위(31.7±4.5)、(29.3±5.2)세]、고령잉부비례[분별위29％( 28/97)、17.7％( 36/203)]、기왕유자간전기사잉부비례[분별위11％ (11/97)、4.9％( 10/203)]、중만잉기임신주실사비례[분별위11％( 11/97)、3.0％ (6/203)]급조잉기체질지수(BMI)[분별위(26.0±5.6)、(23.3±3.7) kg/m2]、고BMI잉부비례[분별위62％( 18/29)、33％ (18/55)]균명현증고,분별비교,차이균유통계학의의(P＜0.05).M-PE조비I-PE조진단잉주중위수제전(분별위32.9、34.4주),발병잉주재32주지전자[분별위45％ (44/97)、34.0％( 69/203)]、재34주지전자[분별위54％ (52/97)、45.8％ (93/203)]급재잉32주전발생적중증병례소점비례[분별위45％ (44/97)、34.0％( 69/203)]균증가,분별비교,차이균유통계학의의(P＜0.05).이32잉주위계,I-PE조조발형환자평균조잉기BMI저우만발형[분별위(20.9 ±2.0)、(23.4±3.8)kg/m2,P=0.269].이32잉주위조발형계정치,합병내과질병시조발형자간전기발병적독립영향인소(OR=1.718,95％ CI 위1.005 ～2.937,P=0.048)；무론이32잉주혹34잉주계정조발형여만발형,다인소회귀분석현시,중만잉기임신주실사급불규률산전검사균시조발형자간전기발병적독립영향인소(P균＜0.05).결론 존재내과질병급다태임신적자간전기환자재동기자간전기발생총인군중초과1/3;존재내과질병적자간전기환자기자간전기발병잉주교조,시불용홀시적고위인군.단순형자간전기조발형환자조잉기BMI저우만발형,조발형여만발형자간전기존재BMI방면적차이,제시량자가능존재모체이질성화불동적발병궤제.중만잉기임신주실사급불규률산전검사균시조발형자간전기발병적영향인소,응강화포괄잠재내과질병재내적림상풍험인소적조기평고화산전검사.
Objective To investigate the effect of clinical risk factors including maternal underlying medical conditions on the development of preeclampsia (PE) in order to improve and strengthen the early assessment of high clinical risk population of PE.Methods Clinical.observational data of patients with PE in Peking University Third Hospital from November 2008 to January 2011 were analyzed.Comparative analysis was made among medical conditions with PE (M-PE) sub-group and isolated PE (I-PE) sub-group and non-PE pregnancy with or without medical conditions (control group).Results Totally 159 cases,43.09％ (159/369) of total cases of PE had high clinical risk factors (multiple pregnancy and medical conditions) and 32.3％ (97/300) of singleton PE accompanied with medical conditions.The incidence of PE in singleton pregnancies with medical conditions was significantly higher than those without medical conditions [ 15.0％ (97/646) versus 4.45％ (210/4719),P ＜ 0.05 ].In M-PE sub-group,the average age [ ( 31.7 ± 4.5 ) versus ( 29.3 ± 5.2) year-old] and body mass index (BMI) in first trimester [ (26.0 ±5.6) versus (23.3 ± 3.7) kg/m2],the proportion with previous preeclampsia [ 11％ (11/97) versus 4.9％ (10/203) ] and pregnancy loss in third trimester [ 11％ ( 11/97 ) versus 3.0％ ( 6/203 ) ],were higher than those of I-PE sub-group ( all P ＜ 0.05 ).The onset of preeclampsia in M-PE sub-group was earlier than I-PE ( 32.9 versus 34.4 gestation weeks,P ＜ 0.05 ).The proportion serious cases of PE occurring before 32 gestational weeks were higher in M-PE than that of I-PE sub-group [ 45％ (44/97)versus 34.0％ (69/203),P ＜0.05].Multivariate regression analysis showed that previous history of late pregnancy loss and irregular prenatal care were clinical risk factors for early-onset PE whether early-onset was defined as ＜ 34 or ＜ 32 gestational weeks respectively (all P ＜ 0.05) ; medical conditions were risk factors for PE if early-onset was defined as ＜ 32 gestational weeks ( OR =1.718,95％ CI:1.005 - 2.937,P =0.048).Conclusions Multiple pregnancies and pregnancies with medical conditions exceed one-third of total subjects of PE.The onset of PE in subjects with maternal underlying medical conditions was earlier which is the subgroup should not be ignored.The difference of early pregnancy BMI may show the maternal heterogeneity in early onset and late onset of preeclampsia.Assessment of clinical risk factors including the underlying medical disorders for preeclampsia in early trimester should be strengthened.
