重度子痫前期患者临床发病前预警信息分析
중도자간전기환자림상발병전예경신식분석
Early warning signs of severe preeclampsia
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2009年 5期 337-340 ,共4页

    史峻梅%杨孜%陈蕾%王伽略

    사준매%양자%진뢰%왕가략

    先兆子痫%水肿%高血压%蛋白尿%体重增长 先兆子癇%水腫%高血壓%蛋白尿%體重增長
    선조자간%수종%고혈압%단백뇨%체중증장
    Pre-eclampsia%Edema%Hypertension%Proteinuria%Weight gain
    目的 探讨重度子痫前期孕妇临床病程进展中的预警信息.方法 选择2002年1月至2007年12月从早、中孕期起即在北京大学第三医院妇产科进行规律产前检查的47例重度子痫前期患者作为研究组.采用1∶ 2病例对照研究方法取同期正常单胎妊娠94例孕妇为对照组.记录并分析两组孕妇的临床资料,包括体重指数及体重变化、水肿情况、高血压前期表现、血浆白蛋白及尿蛋白情况.结果 (1)体重指数:研究组孕妇基础体重指数为(23.27±4.31)kg/m2,对照组为(21.52±3.09)kg/m2,两组比较,差异无统计学意义(P>0.05).(2)体重指数增长幅度:研究组孕妇在重度子痫前期发病前孕期体重指数增长为(5.60±2.17)kg/m2,对照组为(4.85±1.52)kg/m2,两组比较,差异有统计学意义(P<0.05).研究组孕妇发病前每周体重指数增加为(0.74±0.41)kg/m2, 对照组孕妇为(0.23±0.18)kg/m2,两组比较,差异有统计学意义(P<0.01).以体重指数每周增长0.39 kg/m2作为界值预测重度子痫前期发病的敏感度为84%,特异度为81%;以0.41 kg/m2为界值,其敏感度为79%,特异度为91%.(3)体重:研究组孕妇在孕晚期(＞28周)发病前每周体重平均增加为(0.93±0.70)kg,对照组为(0.63±0.20)kg,两组比较,差异有统计学意义(P<0.01).研究组体重过度增加(体重每周增长＞0.50 kg)者25例(60%,25/42),对照组53例(63%,53/84),两组比较,差异无统计学意义(P>0.05),但两组孕妇体重增加的幅度比较,差异有统计学意义(P<0.01).(4)高血压前期表现:研究组有8例孕妇(17%,8/47)在发病前有高血压前期表现,对照组仅有5例(5%,5/94),两组比较,差异有统计学意义(P<0.01).(5)水肿:研究组有25例孕妇(25/47,53%)在发病前出现水肿,对照组整个孕期有17例孕妇(17/94,18%)出现水肿,两组比较,差异有统计学意义(P<0.01).(6)低蛋白血症:研究组中有8例孕妇在孕晚期发病前存在低蛋白血症,平均血浆白蛋白水平为(32.6±1.6)g/L,对照组孕妇平均为(38.4±2.1)g/L,只有1例发生低蛋白血症,两组比较,差异有统计学意义(P<0.01). (7)蛋白尿:研究组中有10例孕妇(21%)发病前有单项蛋白尿出现;对照组只有4例孕妇(4%)蛋白尿出现,两组比较,差异有统计学意义(P<0.01). (8)多因素回归分析显示,水肿[OR=6.16,95%可信区间(CI)为2.29～16.57]、单项尿蛋白(OR=9.68,95%CI为1.86～50.30)、高血压前期表现(OR=6.21,95%CI为1.56～24.77)及孕晚期每周体重增加>0.85 kg(OR=11.60,95%CI为3.54～37.97)对重度子痫前期发病有显著影响.结论 水肿、过度体重增加、高血压前期表现和低蛋白血症是重度子痫前期发生的预警信息,具备这些预警信息者应纳入重点产前检查范围.
    목적 탐토중도자간전기잉부림상병정진전중적예경신식.방법 선택2002년1월지2007년12월종조、중잉기기즉재북경대학제삼의원부산과진행규률산전검사적47례중도자간전기환자작위연구조.채용1∶ 2병례대조연구방법취동기정상단태임신94례잉부위대조조.기록병분석량조잉부적림상자료,포괄체중지수급체중변화、수종정황、고혈압전기표현、혈장백단백급뇨단백정황.결과 (1)체중지수:연구조잉부기출체중지수위(23.27±4.31)kg/m2,대조조위(21.52±3.09)kg/m2,량조비교,차이무통계학의의(P>0.05).(2)체중지수증장폭도:연구조잉부재중도자간전기발병전잉기체중지수증장위(5.60±2.17)kg/m2,대조조위(4.85±1.52)kg/m2,량조비교,차이유통계학의의(P<0.05).연구조잉부발병전매주체중지수증가위(0.74±0.41)kg/m2, 대조조잉부위(0.23±0.18)kg/m2,량조비교,차이유통계학의의(P<0.01).이체중지수매주증장0.39 kg/m2작위계치예측중도자간전기발병적민감도위84%,특이도위81%;이0.41 kg/m2위계치,기민감도위79%,특이도위91%.(3)체중:연구조잉부재잉만기(＞28주)발병전매주체중평균증가위(0.93±0.70)kg,대조조위(0.63±0.20)kg,량조비교,차이유통계학의의(P<0.01).연구조체중과도증가(체중매주증장＞0.50 kg)자25례(60%,25/42),대조조53례(63%,53/84),량조비교,차이무통계학의의(P>0.05),단량조잉부체중증가적폭도비교,차이유통계학의의(P<0.01).(4)고혈압전기표현:연구조유8례잉부(17%,8/47)재발병전유고혈압전기표현,대조조부유5례(5%,5/94),량조비교,차이유통계학의의(P<0.01).(5)수종:연구조유25례잉부(25/47,53%)재발병전출현수종,대조조정개잉기유17례잉부(17/94,18%)출현수종,량조비교,차이유통계학의의(P<0.01).(6)저단백혈증:연구조중유8례잉부재잉만기발병전존재저단백혈증,평균혈장백단백수평위(32.6±1.6)g/L,대조조잉부평균위(38.4±2.1)g/L,지유1례발생저단백혈증,량조비교,차이유통계학의의(P<0.01). (7)단백뇨:연구조중유10례잉부(21%)발병전유단항단백뇨출현;대조조지유4례잉부(4%)단백뇨출현,량조비교,차이유통계학의의(P<0.01). (8)다인소회귀분석현시,수종[OR=6.16,95%가신구간(CI)위2.29～16.57]、단항뇨단백(OR=9.68,95%CI위1.86～50.30)、고혈압전기표현(OR=6.21,95%CI위1.56～24.77)급잉만기매주체중증가>0.85 kg(OR=11.60,95%CI위3.54～37.97)대중도자간전기발병유현저영향.결론 수종、과도체중증가、고혈압전기표현화저단백혈증시중도자간전기발생적예경신식,구비저사예경신식자응납입중점산전검사범위.
    Objective To identify the early warning signs of severe preeclampsia (SPE). Methods A case-control (1: 2) observational study was conducted. Forty-seven pregnant women with SPE, who attended the prenatal clinics of Peking University Third Hospital regularly from Jan. 2002 to Dec. 2007, were selected as the study group, including 12 early onset and 35 late onset ones. The control group consisted of 94 healthy singleton pregnant women at the same period. Clinical data were collected and analyzed. Results (1) The basal body mass index (BMI) showed no difference between the study and control group [(23.27±4.31)kg/m2 vs (21.52±3.09)kg/m2, P>0.05]. (2) The net increase of BMI in the study group before the onset of SPE was higher than that in the control [(5.60±2.17)kg/m2 vs (4.85±1.52)kg/m2, P<0.05] and the increase of BMI per week was also higher [(0.74±0.41)kg/(m2*w)-1 vs (0.23±0.18)kg/(m2*w)-1, P<0.01]. The sensitivity and specificity of BMI increase per week in predicting SPE was 84% and 81% at a cut-off value of 0.39 kg/(m2*w)-1, respectively, and 79% and 91% at 0.41 kg/(m2*w)-1 correspondingly. (3) During the third trimester and before the onset of SPE, the weight gain per week in the study group was higher than that of the control [(0.93±0.70)kg vs (0.63±0.20)kg, P<0.01]. Significant difference was also found in the net weight gain between the two groups (P<0.01), but not in the percentage of women with excessive weight gain (>0.50 kg/w) [60%(25/42) in the study group vs 63%(53/84) in the control group, P>0.05]. (4) Higher percentage of women experienced pre-hypertension in the study group than in the controls [17%(8/47) vs 5%(5/94), P<0.01]. (5) In the study group, 53%(25/47) of the women had edema before SPE onset, but the figure dropped to 18% (17/94) in the controls(P<0.01). (6) Eight women in the study group and one in the control group suffered from hypoproteinemia before SPE onset with the average level of plasma albumin of (32.6±1.6)g/L and(38.4±2.1)g/L(P<0.01), respectively. (7) Proteinuria was reported in 10 cases (21%)in the study group and 4(4%) in the controls (P<0.01). (8) Logistic regression analysis showed that the risk factors for SPE included edema (OR=6.16,95%CI:2.29-16.57),pre-hypertension (OR=6.21,95%CI:1.56-24.77),proteinuria (OR=9.68,95%CI:1.86-50.30), and weight gain >0.85 kg/w during the third trimester (OR=11.60,95%CI:3.54-37.97). Conclusions Edema, excessive weight gain,pre-hypertension and hypoproteinemia are early warning signs of SPE. Pregnant women with the above signs required close monitoring during prenatal care.
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