早发型子痫前期伴不同程度蛋白尿的围生结局

Perinatal outcomes in early-onset preeclampsia with proteinuria

目的探讨早发型子痫前期伴不同程度蛋白尿的围生结局。方法选择2004年1月至2008年12月期待治疗超过24h的早发型子痫前期130例为研究对象，根据24h尿蛋白定量分为3组：轻度蛋白尿组（〈5g／24h）71例；重度蛋白尿组（5．0～99g／h）32例；大量蛋白尿组（〉10g／24h）27例。分析孕妇入院时病情及母胎结局。结果大量蛋白尿组入院孕周早、血清白蛋白低，与轻度蛋白尿组比较，差异均有统计学意义（均P〈0．05）；大量蛋白尿组新生儿出生体重低、孕龄小、围生儿死亡率高。与轻度蛋白尿组比较，差异均有统计学意义（均P〈0．05）；大量蛋白尿组期待治疗时间短，与轻度蛋白尿组和重度蛋白尿组比较，差异均有统计学意义（均P〈0．05）；大量蛋白尿组因蛋白尿进行性增加终止妊娠的比例高于轻度蛋白尿组和重度蛋白尿组，差异均有统计学意义（均P〈0．05）。结论大量蛋白尿对早发型子痫前期孕妇血清白蛋白水平有一定影响，伴大量蛋白尿的早发型子痫前期发病早，新生儿出生孕龄小是影响围生儿结局的重要因素。

Objective To investigate the perinatal outcomes in early-onset preeclampsia with proteinuria. Methods One hundred and thirty lying-in women with early-onset preeclampsia were delivered in our hospital during January 2004 to December 2008. Patients were classified as mild proteinuria （〈5g/24h） in 71 cases, severe proteinuria （5.0-9.9g/24h） in 27 cases and massive proteinuria （≥ 10g/24h） in 27 cases. The maternal demography, disease severity, maternal and fetal outcomes were analyzed and compared among 3 groups. Results The gestational age at admission of massive proteinuria group was significantly earlier than that of mild proteinuria group （P 〈0.05）. The levels of serum albumin of massive proteinuria group were significantly lower than those of mild proteinuria group （P 〈0.05）. The time interval from admission to delivery in massive proteinuria group was significantly shorter than those of other groups （P〈0.05）. The birth weight of massive proteinuria group was significantly lower than that of mild proteinuria group （P 〈0.05）. The rate of termination of pregnancy in massive proteinuria group was significantly higher than those of other groups（P 〈0.05）; The gestational age at delivery in massive proteinuria group was significantly earlier than that of the other groups （P 〈0.05）.The rate of perinatal mortality of massive proteinuria group were significantly higher than that of mild proteinuria group （P 〈0.05）, Conclusion Massive proteinuria does occur earlier in gestasion and is associated with poorer perinatal outcomes and increased perinatal mortality.