中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
10期
672-681
,共10页
先兆子痫%高血压,妊娠性%危险因素%Meta分析
先兆子癇%高血壓,妊娠性%危險因素%Meta分析
선조자간%고혈압,임신성%위험인소%Meta분석
Pre-eclampsia%Hypertension,pregnancy-induced%Risk factors%Meta analysis
目的 评价子痫前期的危险因素. 方法 检索Pubmed、Web of Science和Ovid等外文数据库及中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库,收集1990年1月1月至2012年12月31日关于子痫前期危险因素研究的病例对照研究或队列研究文献,按纳入和剔除标准进行筛选.采用随机效应模型或固定效应模型,应用Stata 12.0软件进行meta分析,分析各危险因素的OR值及其95％CI. 结果 共纳入文献20篇,病例组53 393例,对照组1 197 773例.本研究共涉及以下危险大素:既往子痫前期病史(OR=10.27,95％CI:7.67～13.75)、合并慢性肾脏疾病(OR-4.69,95％CI:1.94～11.33)、多胎(OR=2.98,95％CI:2.43～3.66)、妊娠前体重指数≥25(OR=2.47,95％CI:1.97～3.09)、合并血糖异常(OR=2.84,95％CI:2.28～3.55)、初产(OR=2.47,95％CI:2.12～2.82)、既往高血压病史(OR=3.47,95％CI:2.39～5.04)、妊娠期体力工作(OR=1.62,95％CI:1.30～2.02)、高血压家族史(OR=2.14,95％CI:1.84～2.50)、基础舒张压≥70 mmHg(OR=2.17,95％CI:1.44～3.27)、初中以下文化程度(OR=1.69,95％CI:1.34～2.15)、基础收缩压≥120 mmHg(OR-2.31,95％CI:1.86～2.86)、妊娠期尿路感染(OR=1.96,95％CI:1.54～2.48)、分娩年龄≤20岁或≥35岁(OR-1.43,95％CI:1.29～1.57)以及妊娠期不良情绪(OR=1.35,95％CI:1.24～1.47).此外,研究还表明,妊娠前或妊娠期吸烟可能降低子痫前期的发病率(OR=0.66,95％CI:0.56～0.79). 结论 既往子痫前期病史、合并慢性肾脏疾病、既往高血压病史、多胎、妊娠前体重指数≥25、合并血糖异常、初产、妊娠期体力工作及有高血压家族史者发生子痫前期的风险较高.妊娠期或妊娠前吸烟的孕妇子痫前期发病风险较低,但吸烟造成的不良围产结局更值得关注.
目的 評價子癇前期的危險因素. 方法 檢索Pubmed、Web of Science和Ovid等外文數據庫及中國生物醫學文獻數據庫、中國學術文獻總庫、萬方和維普中文數據庫,收集1990年1月1月至2012年12月31日關于子癇前期危險因素研究的病例對照研究或隊列研究文獻,按納入和剔除標準進行篩選.採用隨機效應模型或固定效應模型,應用Stata 12.0軟件進行meta分析,分析各危險因素的OR值及其95％CI. 結果 共納入文獻20篇,病例組53 393例,對照組1 197 773例.本研究共涉及以下危險大素:既往子癇前期病史(OR=10.27,95％CI:7.67～13.75)、閤併慢性腎髒疾病(OR-4.69,95％CI:1.94～11.33)、多胎(OR=2.98,95％CI:2.43～3.66)、妊娠前體重指數≥25(OR=2.47,95％CI:1.97～3.09)、閤併血糖異常(OR=2.84,95％CI:2.28～3.55)、初產(OR=2.47,95％CI:2.12～2.82)、既往高血壓病史(OR=3.47,95％CI:2.39～5.04)、妊娠期體力工作(OR=1.62,95％CI:1.30～2.02)、高血壓傢族史(OR=2.14,95％CI:1.84～2.50)、基礎舒張壓≥70 mmHg(OR=2.17,95％CI:1.44～3.27)、初中以下文化程度(OR=1.69,95％CI:1.34～2.15)、基礎收縮壓≥120 mmHg(OR-2.31,95％CI:1.86～2.86)、妊娠期尿路感染(OR=1.96,95％CI:1.54～2.48)、分娩年齡≤20歲或≥35歲(OR-1.43,95％CI:1.29～1.57)以及妊娠期不良情緒(OR=1.35,95％CI:1.24～1.47).此外,研究還錶明,妊娠前或妊娠期吸煙可能降低子癇前期的髮病率(OR=0.66,95％CI:0.56～0.79). 結論 既往子癇前期病史、閤併慢性腎髒疾病、既往高血壓病史、多胎、妊娠前體重指數≥25、閤併血糖異常、初產、妊娠期體力工作及有高血壓傢族史者髮生子癇前期的風險較高.妊娠期或妊娠前吸煙的孕婦子癇前期髮病風險較低,但吸煙造成的不良圍產結跼更值得關註.
목적 평개자간전기적위험인소. 방법 검색Pubmed、Web of Science화Ovid등외문수거고급중국생물의학문헌수거고、중국학술문헌총고、만방화유보중문수거고,수집1990년1월1월지2012년12월31일관우자간전기위험인소연구적병례대조연구혹대렬연구문헌,안납입화척제표준진행사선.채용수궤효응모형혹고정효응모형,응용Stata 12.0연건진행meta분석,분석각위험인소적OR치급기95％CI. 결과 공납입문헌20편,병례조53 393례,대조조1 197 773례.본연구공섭급이하위험대소:기왕자간전기병사(OR=10.27,95％CI:7.67～13.75)、합병만성신장질병(OR-4.69,95％CI:1.94～11.33)、다태(OR=2.98,95％CI:2.43～3.66)、임신전체중지수≥25(OR=2.47,95％CI:1.97～3.09)、합병혈당이상(OR=2.84,95％CI:2.28～3.55)、초산(OR=2.47,95％CI:2.12～2.82)、기왕고혈압병사(OR=3.47,95％CI:2.39～5.04)、임신기체력공작(OR=1.62,95％CI:1.30～2.02)、고혈압가족사(OR=2.14,95％CI:1.84～2.50)、기출서장압≥70 mmHg(OR=2.17,95％CI:1.44～3.27)、초중이하문화정도(OR=1.69,95％CI:1.34～2.15)、기출수축압≥120 mmHg(OR-2.31,95％CI:1.86～2.86)、임신기뇨로감염(OR=1.96,95％CI:1.54～2.48)、분면년령≤20세혹≥35세(OR-1.43,95％CI:1.29～1.57)이급임신기불량정서(OR=1.35,95％CI:1.24～1.47).차외,연구환표명,임신전혹임신기흡연가능강저자간전기적발병솔(OR=0.66,95％CI:0.56～0.79). 결론 기왕자간전기병사、합병만성신장질병、기왕고혈압병사、다태、임신전체중지수≥25、합병혈당이상、초산、임신기체력공작급유고혈압가족사자발생자간전기적풍험교고.임신기혹임신전흡연적잉부자간전기발병풍험교저,단흡연조성적불량위산결국경치득관주.
Objective To identify and evaluate the important risk factors for preeclampsia.Methods Databases of PubMed,Web of Science,Ovid CBM,China Knowledge Resource Integrated Database,Wanfang and VIP Database were searched from January 1,1990 to December 31,2012 to collect the cohort and case control studies involving the risk factors for preeclampsia.According to the inclusion and exclusion criteria,data of the included studies were extracted.Meta-analysis was performed using Stata 12.0 software with DerSimonian Laird model to calculate OR and its 95％CI of each risk factor.Results A total of 20 studies involving 53 393 patients in the research group and 1 197 773 cases in the control group were included.Fifteen risk factors for preeclampsia were investigated,including:history of preeclampsia (OR=10.27,95％CI:7.67-13.75),complication with chronic kidney diseases(OR=4.69,95％CI:1.94-11.33),history of chronic hypertension (OR-3.47,95％CI:2.39 5.04),multiple pregnancy (OR-2.98,95％CI:2.43-3.66),pre pregnancy body mass index (BMI) ≥ 25(OR=2.47,95％CI:1.97 3.09),maternal hyperglycemia(gestational diabetes and pre existing diabetes)(OR=2.84,95％CI:2.28-3.55),primiparity (OR=2.47,95％CI:2.12-2.82),physical work during pregnancy (OR=1.62,95％CI:1.30-2.02) ; family history of hypertension (OR=2.14,95％CI:1.84-2.50),basic diastolic blood pressure ≥ 70 mmHg (OR=2.17,95％CI:1.44-3.27),low education levels less than junior school (OR=1.69,95％CI:1.34 2.15),basic systolic blood pressure ≥ 120 mmHg (OR=2.31,95％CI:1.86-2.86),urinary tract infection (OR=1.96,95％CI:1.54-2.48),maternal age ≥ 35 or ≤ 20 years (OR=1.43,95％CI:1.29 1.57) and mental ademosyne (OR=1.35,95％CI:1.24-1.47).In addition,smoking before or during pregnancy was found to decrease the incidence of preeclampsia (OR-0.66,95％CI:0.56 0.79).Conclusions The main risk factors for preeclampsia are:history ofpreeclampsia,complication with chronic kidney diseases,history of chronic hypertension,multiple pregnancy,pre-pregnancy BMI ≥ 25,maternal hyperglycemia,primiparity,work during pregnancy and family history of hypertension.Smoking may decrease the incidence of preeclampsia.Nevertheless,more emphasis should be laid the adverse perinatal outcomes of smoking.
