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浙江大学学报（医学版）
浙江大学学报（医学版）  2015, Vol. 44 Issue (3): 258-263    DOI: 10.3785/j.issn.1008-9292.2015.05.04
专题报道     
再发子痫前期相关因素及母子转归的单中心临床研究
张坚贞1,2, 贺晶1
1. 浙江大学医学院附属妇产科医院产科, 浙江 杭州 310006;
2. 嘉兴市妇幼保健院产科, 浙江 嘉兴 314000
Risk factors of recurrent preeclampsia and its relation to maternal and offspring outcome
ZHANG Jian-zhen1,2, HE Jing1
1. Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
2. Department of Obstetrics, Women's Hospital of Jiaxing, Jiaxing 314000, China
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摘要：

目的:探讨再发子痫前期发病相关危险因素,观察再发子痫前期发病特征及远期母子预后。方法:选择 2009年 1 月至 2013 年 12月在浙江大学医学院附属妇产科医院住院分娩的有子痫前期史孕妇153人,其中可获得完整病史资料及随访资料者共115人,将其按是否再发子痫前期分为再发组和非再发组,分析病史、再发子痫前期病情和母子随访资料。结果:115例有子痫前期病史的孕妇再次妊娠时再发子痫前期82例(71.3%),发病年龄、妊娠间隔时间、是否正规产检、孕期体质量增加、体质量指数(BMI)、高脂血症、胎儿生长受限、母系家族史与子痫前期再发密切相关 (均P<0.05)。Logistic回归分析结果提示:妊娠间隔时间(OR=1.349,P=0.004)、BMI(OR=1.249,P=0.004)、胎儿生长受限(OR=9.642,P=0.009)是预测子痫前期复发的主要危险因素。与第一次妊娠时子痫前期比较,再发子痫前期孕妇发病孕周、妊娠终止孕周更早,血压更高,尿蛋白达++及以上例数增加,并发症发生例数增加 (均P<0.05);再发子痫前期子代早产(特别是小于34周的早产)发生例数增加,新生儿出生体质量更低(均P<0.05)。随访结果,孕妇产后发生远期高血压病例数再发组(47.5%)多于非再发组(23.3%,P<0.05);初次妊娠获得子代发生体质量过大例数再发组(31.25%)多于非再发组(6.70%,P<0.05)。结论:发病年龄、妊娠间隔时间、是否正规产检、孕期体质量增加、BMI、高脂血症、胎儿生长受限和母系家族史与子痫前期再发有密切相关,妊娠间隔时间、BMI和胎儿生长受限是预测子痫前期复发的主要危险因素,再发子痫前期具有更严重的临床结局,母子近期和远期并发症高,需重视预防。
关键词： 子痫;  妊娠并发症;  发病年龄;  胎儿生长迟缓;  妊娠结局;  人体质量指数;  高脂血症;  随访研究    
Abstract:

Objective: To investigate the risks of recurrent preeclampsia and observe the incidence and long-term prognosis of recurrent preeclampsia. Methods: One hundred and fifteen women with preeclampsia history admitted in Women's Hospital, Zhejiang University School of Medicine from January 2009 to December 2013 were enrolled in the study. The clinical data were retrospectively analyzed. Results: Among 115 women with preeclampsia, 82 cases (71.3%)had recurrent preeclampsia. The onset age, the pregnant interval time, regular prenatal check-up, weight gain during pregnancy, body mass index (BMI), hyperlipidemia, fetal growth restriction(FGR), maternal family history were closely associated with recurrent preeclampsia (P<0.05). Logistic regression analysis showed that the pregnant interval time, BMI, FGR were independent risk factors for preeclampsia recurrence. Compared with the preeclampsia in first pregnancy, the mather had earlier onset and termination of pregnancy, higher blood pressure, higher rate of urine protein≥2+ and higher rate of complications in recurrent preeclampsia. The offspring had higher rate of preterm birth, especially the time of birth for 34 weeks or earlier and lower birth weight (P<0.05). The incidence of chronic hypertension in recurrent preeclampsia group was higher than that in no recurrence group (47.5% vs 23.3%, P<0.05); the overweight rate of first pregnant offspring in recurrence group was higher than that in no recurrence group (31.25% vs 6.70%, P<0.05). Conclusion: The onset age, time interval, regular prenatal check-up, weight gain during pregnancy, BMI, hyperlipidemia, FGR, maternal family history are closely associated with recurrent preeclampsia, and the pregnant interval time, BMI, FGR are independent risk factors for preeclampsia recurrence. Recurrent preeclampsia has more serious clinical outcome and complications, and prevention need to be emphasized.
Key words: Eclampsia    Pregnancy complications    Age of onset    Fetal growth retardation    Pregnancy outcome    Body mass index    Hyperlipidemias    Follow-up studies
收稿日期: 2015-02-11 出版日期: 2015-05-25
:  R714.24  
基金资助:

卫生行业科研专项(201402006)
通讯作者: 贺晶(1959-),女,学士,教授,主任医师,硕士生导师,主要从事围产医学、胎儿医学研究;E-mail:hej@zju.edu.cn;http://orcid.org/0000-0002-9579-9593     E-mail: hej@zju.edu.cn
作者简介: 张坚贞(1979-),女,硕士研究生,主治医师,主要从事产科临床工作;E-mail:wan_02wan09@126.com;http://orcid.org/0000-0002-1663-5196
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引用本文:

张坚贞, 贺晶. 再发子痫前期相关因素及母子转归的单中心临床研究[J]. 浙江大学学报（医学版）, 2015, 44(3): 258-263.

ZHANG Jian-zhen, HE Jing. Risk factors of recurrent preeclampsia and its relation to maternal and offspring outcome. Journal of ZheJiang University(Medical Science), 2015, 44(3): 258-263.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2015.05.04    或    http://www.zjujournals.com/med/CN/Y2015/V44/I3/258

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