不典型子痫前期危险因素及围产结局的研究

发布时间：2018-04-30 10:33

本文选题：不典型子痫前期 + 典型子痫前期　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的分析不典型子痫前期（Atypical Preeclampsia，APE）危险因素及围产结局。方法整理和分析2010年1月~2013年12月于福建省妇幼保健院住院分娩的365例孕产妇，根据是否同时检出高血压和蛋白尿分不典型子痫前期组73例、典型子痫前期组146例和对照组146例。其中不典型子痫前期组再分为单纯高血压组50例和单纯蛋白尿组23例。采用病例对照研究方法，分析三组孕产妇临床资料。结果 1、不典型子痫前期组的临床特征：不典型子痫前期组中产前出现症状者64例（87.67%），产后出现症状者9例（12.32%）。单纯蛋白尿者23例（31.51%），单纯高血压者50例（68.49%），可复性后部脑病综合征（Posterior ReversibleEncephalopathy Syndrome，PRES）2例（2.74%），毛细血管渗漏综合征（CapillaryLeak Syndrome，CLS）1例（1.37%）。以FGR、LDH升高、PLT减少、肝功能损害、腹水、全身水肿、头晕头痛、视物模糊为首发表现者分别为5例（6.85%），31例（42.46%），8例（10.96%），19例（26.02%），1例（1.37%），1例（1.37%），9例（12.32%）、1例（1.37%）。 2、三组孕妇一般情况比较：三组孕妇年龄比较，差异均无统计学意义（均P0.05）。不典型组和典型组分娩孕周与对照组比较，均显著减少，差异均有统计学意义（均P0.05）；不典型组分娩孕周与典型组比较，差异无统计学意义（P0.05）。不典型组和典型组与对照组孕期收缩压、舒张压、平均动脉压比较，均显著升高，差异均有统计学意义（均P0.05）；不典型组与典型组各血压值比较，差异均无统计学意义（均P0.05）。不典型子痫前期组孕前体质量指数（BodyMass index，BMI）、入院时BMI、孕期增加体质量、孕期BMI增加值与对照组比较，均显著增加，差异均有统计学意义（均P0.05）。不典型组孕前BMI与典型子痫前期组比较显著减少，差异有统计学意义（P0.05）。典型子痫前期组孕前BMI、入院时BMI、孕期增加体质量、孕期BMI增加值与对照组比较，均显著增加，差异均有统计学意义（均P0.05）。与对照组比较，不典型组和典型组孕次均增多、产次均减少，差异均有统计学意义（均P0.05）。不典型组孕次与典型组比较，显著增多，差异有统计学意义（P0.05）。不典型组产次与典型组比较，差异无统计学意义（P0.05）。 3、三组孕妇血红蛋白、肝肾功能、血脂结果比较：与对照组比较，不典型组孕期甘油三酯（Triglyceride，TG）、丙氨酸氨基转移酶（Alanine Aminotrans-ferase，ALT）、尿酸（Uric Acid，UA）、肌酐（Creatinine，Cr）、乳酸脱氢酶（LactateDehydrogenase，LDH）、肌酸激酶（Creatine Kinase，CK）、肌酸激酶同工酶-MB（Creatine Kinase MB，CKMB）均显著升高，高密度脂蛋白（High DensityLipoprotein，HDL）、载脂蛋白B（Apolipoprotein-B，ApoB）、总蛋白（Total Protein，TP）、白蛋白（Albumin，ALB）、前白蛋白（Pre albumin，PA）、血红蛋白（Hemoglobin，HGB）、比较均显著降低，差异均有统计学意义（均P0.05）。典型组与对照组TG、总胆固醇（Total Cholesterol，TC）、载脂蛋白A1（Apolipoprotein-A1，ApoA1）、ALT、UA、Cr、LDH、CK、CKMB比较，均显著升高，，HDL、ApoB、TP、ALB、PA、HGB比较，均显著降低，差异均有统计学意义（均P0.05）。不典型组与典型组各指标比较，差异均无统计学意义（均P0.05）。 4、不典型子痫前期组发病危险因素：不典型组与对照组比较，单因素Logistic回归分析结果显示，孕期BMI增加值≥6kg/m2、年龄≥35岁、生活居住地位于农村、初中以下文化程度、无职业、孕次≥2次、初产、有异常妊娠史、不规律产检、多胎妊娠、胎儿性别为女与不典型子痫前期发生相关，差异均有统计学意义（均P0.05）；多因素Logistic回归分析结果显示：孕期BMI增加值≥6kg/m2（OR=4.287，95%CI：1.54~11.94）初产（OR=3.247，95%CI：1.22~9.44）、孕次≥2次（OR=3.63，95%CI：1.58~10.86）、生活居住地为农村（OR=4.74，95%CI：1.73~13.00）是不典型子痫前期的独立危险因素。不典型组与典型组比较，单因素Logistic回归分析显示：孕次≥2次、初产与不典型子痫前期发病相关（均P0.05）；多因素Logistic回归分析结果显示：孕次≥2次是不典型子痫前期独立危险因素（OR=1.908，95%CI：0.91~4.01）。 5、三组孕妇终末器官损害、分娩方式比较：不典型组HELLP综合征（Hemolysis Elevated Liver enzymes and Low Platelets syndrome，HELLP syn-drome）、血小板减少症、产后出血、肝功能损害发生率均高于对照组，差异均有统计学意义（均P0.05）；典型组HELLP综合征、产后出血、贫血、羊水量异常及产褥感染发生率均高于对照组，差异均有统计学意义（均P0.05）；不典型组血小板减少、肝功能损害、贫血发生率与典型组比较均显著升高，差异均有统计学意义（均P0.05）。不典型组羊水量异常发生率，与典型组比较，显著减少，差异有统计学意义（P0.05）。三组剖宫产发生率两两较，差异均有统计学意义（均P0.05）。不典型组和典型组，视网膜病变发生率比较差异无统计学意义（P0.05）。 6、三组胎儿及新生儿结局比较：不典型组胎儿窘迫、FGR、新生儿畸形、转NICU（Neonatal Intensive Care Unit, NICU）、早产发生率与对照组比较均显著升高，差异均有统计学意义（均P0.05）；不典型组转NICU发生率比典型组高，差异有统计学意义（P0.05）；典型组死胎、胎儿窘迫、FGR、新生儿畸形、早产发生率与对照组比较均显著升高，差异均有统计学意义（均P0.05）。结论 1、孕期BMI增加值≥6kg/m2、孕次≥2次、初产、生活居住地位于农村是不典型子痫前期的独立危险因素。对具备这些危险因素者，及时采取针对性的预防措施，可有效降低不典型子痫前期的发生率。 2、不典型子痫前期母儿预后不良。应该提高对不典型子痫前期的认识，对存在危险因素的孕妇，及时采取针对性的预防措施，改善母儿结局。
[Abstract]:objective
Objective to analyze the risk factors and perinatal outcomes of Atypical Preeclampsia (APE).
Method
365 pregnant and parturient women who were hospitalized in Fujian Provincial Maternity and Child Care Center in December ~2013 January 2010 were analyzed. According to whether 73 cases of hypertension and proteinuria were detected at the same time, 146 cases of typical preeclampsia group and 146 cases were in control group. The atypical preeclampsia group was divided into 50 cases of simple hypertension group and simple protein. 23 cases in the urine group. The clinical data of three groups of pregnant women were analyzed by case control study.
Result
1, the clinical characteristics of the atypical preeclampsia group: 64 cases (87.67%) before the preeclampsia group, 9 (12.32%) postpartum symptoms, 23 cases of simple proteinuria (31.51%), 50 patients with simple hypertension (68.49%), and 2 patients (Posterior ReversibleEncephalopathy Syndrome, PRES), 2 cases (2.74%), hair CapillaryLeak Syndrome (CLS) was 1 cases (1.37%). With FGR, LDH elevation, PLT decrease, liver function damage, ascites, whole body edema, dizziness headache, and blurred headache, 5 cases (6.85%), 31 cases (42.46%), 19 cases (26.02%), 1 cases (1.37%), 1 cases (1.37%).
2, three groups of pregnant women general comparison: the three groups of pregnant women age comparison, the difference was not statistically significant (all P0.05). The typical group and typical group of pregnancy weeks compared with the control group, both significantly decreased, the difference was statistically significant (all P0.05), the difference between the typical group and the typical group, the difference was not statistically significant (P0.05). The systolic pressure, diastolic pressure and mean arterial pressure in the typical group and the control group were all significantly higher, and the difference was statistically significant (all P0.05). The difference was not statistically significant (all P0.05) in the atypical group and the typical group (both BodyMass index, BMI), BMI at admission and the increase of pregnancy. Compared with the control group, the body mass and the BMI increase during pregnancy were all significantly increased (all P0.05). The pre eclampsia BMI in the atypical group was significantly lower than the typical preeclampsia group (P0.05). The pre eclampsia group was BMI before pregnancy, BMI at admission, increased body mass during pregnancy, and the BMI increase during pregnancy compared with the control group. The difference was statistically significant (all P0.05). Compared with the control group, both the atypical group and the typical group increased, the production times were decreased, the difference was statistically significant (P0.05). The difference was statistically significant (P0.05) in the untypical group and the typical group. The difference between the atypical group and the typical group was different from that of the typical group. Study meaning (P0.05).
3, three groups of pregnant women hemoglobin, liver and kidney function, blood lipid results: compared with the control group, Triglyceride, TG, Alanine Aminotrans-ferase, ALT, Uric Acid (UA), creatinine (Creatinine, Cr), and lactate dehydrogenase (LactateDehydrogenase, LDH), and creatine kinase K), the creatine kinase isozyme -MB (Creatine Kinase MB, CKMB) increased significantly, high density lipoprotein (High DensityLipoprotein, HDL), apolipoprotein B (Apolipoprotein-B, ApoB), albumin, precursor protein, hemoglobin, and all the differences were all significantly reduced. Both typical group and control group TG, total cholesterol (Total Cholesterol, TC), apolipoprotein A1 (Apolipoprotein-A1, ApoA1), ALT, UA, Cr, LDH, respectively, were all significantly lower, the difference was statistically significant (all). The differences of the typical group and the typical group were all compared. There was no statistical significance (all P0.05).
4, the risk factors of the atypical preeclampsia group: the untypical group and the control group, the result of single factor Logistic regression analysis showed that the increase value of BMI in pregnancy was more than 6kg/m2, the age was more than 35 years old, the living place was in the rural area, the education level below junior high school, no occupation, pregnant times more than 2 times, primary birth, abnormal pregnancy history, irregular pregnancy test, multiple pregnancy, fetus. The gender was associated with atypical preeclampsia, and the difference was statistically significant (P0.05). The results of multiple factor Logistic regression analysis showed that the increase of BMI in pregnancy was more than 6kg/m2 (OR=4.287,95%CI:1.54~11.94) primary production (OR=3.247,95%CI:1.22~9.44), pregnancy more than 2 times (OR=3.63,95%CI:1.58~10.86), and living place in rural area (OR=4.). 74,95%CI:1.73~13.00) was an independent risk factor for atypical preeclampsia. Compared with the typical group, the untypical group Logistic regression analysis showed that the first pregnancy was more than 2 times, and the primary birth was associated with the atypical preeclampsia (P0.05). The multiple factor Logistic regression analysis showed that the pregnancy rate was more than 2 times in the atypical preeclampsia. Factors (OR=1.908,95%CI:0.91~4.01).
5, three groups of pregnant women end organ damage, delivery methods: HELLP syndrome (Hemolysis Elevated Liver enzymes and Low Platelets syndrome, HELLP syn-drome), thrombocytopenia, postpartum hemorrhage, liver function damage rate is higher than the control group, difference is statistically significant (all P0.05); typical group syndrome, The incidence of postpartum hemorrhage, anemia, amniotic fluid volume and puerperal infection were all higher than that of the control group, the difference was statistically significant (all P0.05); the incidence of anemia in the atypical group was significantly higher than that in the typical group (all P0.05). The abnormal rate of amniotic fluid in the atypical group, and the typical group The difference was statistically significant (P0.05). The incidence of caesarean section in three groups was 22, and the difference was statistically significant (P0.05). There was no significant difference in the incidence of retinopathy in the atypical and typical groups (P0.05).
6, three groups of fetal and neonatal outcomes were compared: untypical group fetal distress, FGR, neonatal malformation, NICU (Neonatal Intensive Care Unit, NICU), the incidence of premature birth was significantly higher than the control group, the difference was statistically significant (all P0.05), the atypical group was higher than the typical group, the difference was statistically significant (P0.05); The incidence of fetal death, fetal distress, FGR, neonatal malformation and preterm birth in the typical group were significantly higher than those in the control group (P0.05).
conclusion
1, the increased value of BMI in pregnancy, more than 6kg/m2, more than 2 times of pregnancy, primary birth and living in rural areas are independent risk factors for atypical preeclampsia. For those with these risk factors, taking timely and targeted preventive measures can effectively reduce the incidence of atypical preeclampsia.
2, the prognosis of the mothers and children in the preeclampsia preeclampsia is poor. We should improve the understanding of the atypical preeclampsia and take the targeted preventive measures in time for pregnant women with risk factors to improve the maternal and child outcomes.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.244

【参考文献】