重度子痫前期临床警示因素与产前随访时限

Study on the possibility of precaution and timing of follow-up of severe preeclampsia

目的：探讨重度子痫前期发病前的临床警示因素和适宜的随访时限，旨在探索临床重度子痫前期发展中的可防范性和可监控性。方法：采用1：2病例对照研究方法，对2002年1月～2007年12月经北京大学第三医院规律产前检查的47例重度子痫前期（研究组，早发型12例，晚发型35例）与同期正常妊娠者94例（对照组）临床资料进行对比分析，通过统计学方法对临床发病前潜在症状、体征、生化指标及其病程演变进行分析。结果：①研究组53．2％在出现高血压、蛋白尿及子痫前期之前存在水肿，对照组为18．1％，两组比较差异具有统计学意义（P=0．000）；平均体重过度增加研究组为（1．30±0．67）kg／周，而对照组为（0．75±0．10）kg/周，差异有统计学意义（P=0．000）；研究组17．0％在妊娠晚期发病前存在低蛋白血症，均值为（32．62±1．60）g／L，与对照组（37．58±1．57）g,／L比较差异有统计学意义（P〈0．05）；显示首发临床表现在研究组25．5％为单项血压增高、21．3％为单项蛋白尿、32．0％为高血压加蛋白尿、21．2％以重度子痫前期发病；59．6％在出现首发症状后到发展为重度子痫前期的时间小于常规产检间隔时间。结论：研究结果显示水肿、体重过度增加、高血压前期变化和低蛋白血症是重度子痫前期临床发病前存在的警示信息，对预警信息应加强系统监测；多数重度子痫前期有临床可观察到的疾病发展过程，是临床干预时机；存在警示信息者按照常规产前检查间隔则不能发现病情，需要缩短产前检查间隔时间。

Objective： To identify the warning signs before severe preeclampsia onset and time recall for the clinical preventive measures of severe preeclampsia. Methods： A case control observational study was conducted. Study group contained 47 cases meeting the criteria of severe preeclampsia between Jan. 2002. and Dec. 2007. in the Third hospital of Peking University with regular antenatal care. The control group contained 94 normal pregnant women at the same stage. Clinical data were analyzed. Results： In study group, 53.2% developed edema as the first clinic sign before preeclampsia diagnosed. Only 18.1% developed edema in control group （P = 0. 000） . In the third trimester, comparing the degree of the over - gain of weight between study and control groups, significant difference was found （ 1.30 ± 0. 67 kg/w vs. 0.75 ±0. 10 kg/w, P =0. 000） . In study group, 17.0% had hypoproteinemia （32. 62 ± 1. 60） g/L in the third trimester before the onset of preeclampsia, significant differences found when compared with the control group （P 〈 0. 05 ） . The first clinic sign of severe preeclampsia was varied, 25. 5% as high blood pressure, 21.3% as proteinuria, and 32.0% mild preeclampsia- The rest 21.2% developed severe preeclampsia without precursory signs. 59.6% in the study group, the days between the emergence of first clinic sign to the onset of severe preeclampsia was less than the interval of routine prenatal visits. Conclusion： Edema, over - gain of weight, pre - hypertension and hypoproteinemia may be the warning clinic signs of the severe preeclampsia. As most cases developed gradually, we can take chance for intervention. For some patients with warning signs need more intensive prenatal care.