子前期胎儿生长受限的危险因素分析

Analysis of risk factors of fetal growth restriction in pregnancy with preeclampsia

目的探讨子前期中胎儿生长受限的危险因素。方法1998年9月至2004年10月复旦大学附属妇产科医院分娩的247例子前期单胎患者,按新生儿出生体重分为小于胎龄儿(SGA)组(47例)和非SGA组(200例)。对两组中子前期监测指标和并发症进行分析,找出胎儿生长受限的危险因素。结果(1)SGA组和非SGA组出生体重分别为(1717.6±457.3)g和(3012.3±838.9)g,两组中发病孕龄、分娩孕龄、子前期严重程度、1minApgar评分差异有统计学意义(P<0.05),年龄、病程、5minApgar评分无明显差别(P>0.05)。(2)初步分析高血压、蛋白尿、眼底异常、低蛋白血症、脐血流改变、羊水过少是胎儿生长受限的影响因素(P<0.05),而贫血、肌酐、血小板异常、丙氨酸转氨酶升高、胎盘异常、合并高血压、妊娠期肝内胆汁淤积症(ICP)、糖尿病、肾脏疾病对胎儿生长发育无明显影响(P>0.05)。(3)进一步用逐步回归方法分析影响因素发现分娩孕龄(β=0.705,P<0.05)、蛋白尿(β=0.206,P<0.05)、羊水过少(β=0.127,P<0.05)是新生儿出生体重的独立影响因素。结论子前期中蛋白尿是胎儿生长受限的危险因素。

Objective To analyze the influences on small-for-gestational-age （ SGA ） infants of women with preeclampsia, and to investigate the risk factors associated with fetal growth restriction. Methods 247 pregnant women with preeelampsia having delivered in Obstetrics and Gynecology Hospital affiliated to Fudan University from Sep 1998 to Oct 2003 were divided into SGA group （ n = 47 ） and control [ appropriate for gestational age （ AGA ） , and large for gestational age （LGA） ] group（ n = 200 ）. The complications of preeclampsia and the risk factors for fetal growth restriction were analyzed. Results （1）The birthweight of group SGA and the control were （1717.6 ±457.3）g and （3012.3±838.9）g, the maternal age, gestational age（weeks） , the class of preeclampsia and Apgar score at 1 min were significantly different （ P 〈 0.05 ）. The age, days gained before delivery and Apgar score at 5 min were similar in the two groups （ P 〉 0.05 ）. （2） The differences in hypertension, proteinuria, abnormal eyeground, Hypoproteinemia, oligohydramnios and umbilical cord hemodynamics between the two groups were significant （ P 〈 0. 05 ） ; there was no statistical difference in anaemia, abnormal placental, creatinine, blood platelet, glutamic pyruvic transaminase, combined hypertension, intrahepatic cholestasis of pregnancy（ICP）, diabetes mellitus and renal disease. （3） Stepwise logistic regression analysis showed that gestational age （β = 0. 705, P 〈 0.05 ） , proteinuria （β = 0. 206, P 〈 0. 05 ） and oligohydramnios （β = 0. 127, P 〈 0. 05 ） were independent indicators of fetal growth restriction. Conclusions Proteinuria is an independent risk factor of preeclampsia.