CAJ | 학술논문

目的分析重度子痫前期临床水肿发生类型及其与病情相关性,探讨重度子痫前期临床表现的异质性和不平行性.方法对2002年2月至2009年2月北京大学第三医院的228例重度子痫前期患者,按水肿表现形式分为无水肿(A型)、单纯组织间隙水肿(B型)、单纯腔隙水肿(C型)、混合水肿即组织间隙与腔隙水肿并存(D型).分析比较水肿类型在不同产前检查模式的临床表现、实验室检查指标、发病孕周、并发症和产科及围产结局,并且分析不同水肿类型与血白蛋白和尿蛋白峰值的关系.结果 86％(197例)患者存在不同形式的水肿.规律产前检查与未规律产前检查者比较,水肿类型构成比(P＜0.01)、并发症发生率(P＜0.01)、血白蛋白水平(P＜0.01)差异均有统计学意义(均P＜0.01),尿蛋白峰值差异无统计学意义(P＞0.05);早发型与晚发型患者比较,水肿类型构成比(P＜0.01)、尿蛋白峰值(P＜0.01)差异均有统计学意义(均P＜0.01),血白蛋白水平、并发症发生率差异无统计学意义(P＞0.05);各型水肿患者间比较,血白蛋白水平、尿蛋白峰值、并发症发生率、发病孕周及治疗性早产发生率差异均有统计学意义(均P ＜0.05).胎盘早剥、心衰及HELLP综合征的发生率在不同水肿型间的差异均有统计学意义(均P＜0.05);单纯组织间隙水肿程度与血白蛋白水平及并发症发生率存在相关性(均P＜0.05),与尿蛋白峰值无相关性(P＞0.05).结论重度子痫前期在水肿临床表现形式多样,与发病类型和不同并发症发生存在相关性.加强规律产检和早期监查水肿可改善不良产科结局.
목적 분석중도자간전기림상수종발생류형급기여병정상관성,탐토중도자간전기림상표현적이질성화불평행성.방법 대2002년2월지2009년2월북경대학제삼의원적228례중도자간전기환자,안수종표현형식분위무수종(A형)、단순조직간극수종(B형)、단순강극수종(C형)、혼합수종즉조직간극여강극수종병존(D형).분석비교수종류형재불동산전검사모식적림상표현、실험실검사지표、발병잉주、병발증화산과급위산결국,병차분석불동수종류형여혈백단백화뇨단백봉치적관계.결과 86％(197례)환자존재불동형식적수종.규률산전검사여미규률산전검사자비교,수종류형구성비(P＜0.01)、병발증발생솔(P＜0.01)、혈백단백수평(P＜0.01)차이균유통계학의의(균P＜0.01),뇨단백봉치차이무통계학의의(P＞0.05);조발형여만발형환자비교,수종류형구성비(P＜0.01)、뇨단백봉치(P＜0.01)차이균유통계학의의(균P＜0.01),혈백단백수평、병발증발생솔차이무통계학의의(P＞0.05);각형수종환자간비교,혈백단백수평、뇨단백봉치、병발증발생솔、발병잉주급치료성조산발생솔차이균유통계학의의(균P ＜0.05).태반조박、심쇠급HELLP종합정적발생솔재불동수종형간적차이균유통계학의의(균P＜0.05);단순조직간극수종정도여혈백단백수평급병발증발생솔존재상관성(균P＜0.05),여뇨단백봉치무상관성(P＞0.05).결론 중도자간전기재수종림상표현형식다양,여발병류형화불동병발증발생존재상관성.가강규률산검화조기감사수종가개선불량산과결국.
Objective The aim of this study was to analysis the clinical edema forms and explore the heterogeneity of edema in severe preeclampsia(PE).Method From February 2002 to February 2009,Peking University Third Hospital admitted with severe preeclampsia 228 cases who were enrolled in this study.The form is divided into no edema (A-type),pure interstitial edema (B-type),a simple cavity gap edema (C-type) and mixed interstitial edema that coexist with lacunar edema (D-type).Analysis and comparison of various types of edema in patients with different clinical manifestations of prenatal care models,laboratory parameters,the incidence of gestational age,complications and obstetric and perinatal outcomes,and analyze the relationship between different types of edema and albumins and the peak value of proteinuria.Results Edema was seen in 86％ (197/228) of all of cases.Compared the cases who have regular prenatal care with those who have irregular care,differences were statistically significant in edema type composition ratio (P ＜ 0.01) and the incidence of serious complications (P ＜ 0.01),and serum albumin levels (P ＜0.01),but not in the peak value of proteinuria (P ＞ 0.05) ; Compared early-onset PE and late-onset PE patients,differences were statistically significant in edema type composition ratio (P ＜ 0.01) and peak value of proteinuria (P ＜ 0.01),but not in serum albumin levels and the incidence of serious complications (P ＞ 0.05).Comparison between the various types of edema,differences were statistically significant in serum albumin levels and peak value of proteinuria and incidence of serious complications and the gestational week at PE onset and the incidence of treatment preterm labor (P ＜ 0.05).Occurrence of placental abruption,heart failure and HELLP syndrome had statistical significance in different types of edema (P ＜ 0.05).The varying degrees of interstitial edema were correlated with serum albumin levels (r =-0.19,P ＜ 0.05) and serious complication occurrence (r =-0.232,P ＜ 0.05),but no correlation displayed with the peak value of urinary protein (P ＞ 0.05).Conclusions The manifestations of edema were diverse in severe preeclampsia.The forms of edema were related to the PE onset of gestational age and serious complication involving in different organs.Strengthen prenatal care and early detection of edema may improve adverse obstetric outcomes.