子痫前期患者胎盘早剥发病危险因素分析

Multivariate analysis of risk factors with placental abruption in preeclampsia

目的 探讨子痫前期患者胎盘早剥发病的危险因素.方法 对1994年1月至2008年12月的15年间,在北京大学第三医院住院并分娩的219例患者的临床资料进行回顾性分析,根据病情分为3组：子痫前期早剥组,52例,为重度子痫前期发生胎盘早剥的患者;子痫前期组,130例,为重度子痫前期未发生胎盘早剥的患者;原因不明早剥组,37例,为非子痫前期发生胎盘早剥的患者.选择同期无并发症的正常分娩产妇178例为对照组（按1∶2病例对照研究方法选择）.采用单因素及多因素回归分析方法,分析子痫前期患者胎盘早剥的发病危险因素.结果 （1）与对照组比较,单因素分析结果显示,孕次、产次、子痫前期病史、中晚期妊娠丢失史、自身免疫性疾病史、慢性高血压病史、此次孕期无规律产前检查、胎儿生长受限（FGR）及脐动脉收缩期最大血流速度（S）与舒张末期血流速度（D）的比值（S/D）异常是子痫前期患者胎盘早剥发病的危险因素;多因素回归分析显示,孕期无规律产前检查（OR=45.348,95%CI为17.096～120.288,P=0.000）、FGR（OR=27.087,95%CI为5.585～131.363,P=0.000）及中晚期妊娠丢失史（OR=16.068,95% CI为1.698～152.029,P=0.015）是子痫前期患者胎盘早剥发病的独立危险因素.（2）与子痫前期组比较,子痫前期病史（OR=3.715,95% CI为1.096～12.596,P=0.035）及孕期无规律产前检查（OR=2.509,95%CI为1.173～5.370,P=0.018）是子痫前期患者胎盘早剥发病的独立危险因素.结论 孕期无规律产前检查、子痫前期病史、中晚期妊娠丢失史及FGR是影响子痫前期患者胎盘早剥发病的危险因素.

Objective To investigate the risk factors with placental abruption in patients with preeclampsia.Methods Retrospective analysis on medical documents of 219 patients treated in Peking University Third Hospital from Jan.1994 to Dec.2008.Patients were divided into 3 groups, including 52 cases with severe preeclampsia terminated following placental abruption, 130 cases only with severe preeclampsia and 37 cases with unexplained placental abruption without preeclampsia.One hundred and multivariate regression analysis were used to identify the risk factors for placental abruption in patients with preeclampsia.Results （1） When compared with those in control group, univariate analysis showed that gravidity, parity, history of preeclampsia, second and third trimester pregnancy loss, history of autoimmune disease, chronic hypertension disease, lack of regular antenatal care, fetal growth restriction （FGR） and raises of umbilical artery Doppler resistance were risk factors associated with placental abruption.Logistic regression analysis showed that lack of a regular antenatal care （ OR = 45.348, 95% CI： 17.096 - 120.288,P = 0.000 ）, FGR （ OR = 27.087, 95% CI： 5.585 - 131.363, P = 0.000 ） and second/third trimester pregnancy loss（ OR = 16.068, 95% CI： 1.698 - 152.029, P = 0.015 ） were independent risk factors with placental abruption.（2） When compared with those in preeclampsia patients without placental abruption,the history of preeclampsia （ OR = 3.715,95% CI： 1.096 - 12.596, P = 0.035 ） and lack of a regular antenatal care（ OR = 2.509,95% CI：1.173 -5.370,P =0.018） were risk factors for placental abruption in preeclampsia.Conclusion Lack of regular antenatal care, FGR, history of preeclampsia and second/third trimester pregnancy loss were risk factors associated with placental abruption in patients with preeclampsia.