规律产前检查子痫前期患者早期临床发病特点分析

Study on early clinical characteristics of mild and severe preeclampsia with regular prenatal care

目的分析接受规律产前检查的轻重度子痫前期(PE)发病的影响因素和早期临床特征,以及不同产前检查模式的影响,探讨延缓PE发展、降低重度PE发生的临床监控和干预时机。方法收集2008年1月至2011年12月在北京大学第三医院接受规律产前检查发生和诊治的238例PE病历临床资料,采用历史前瞻性队列分析方法对发生轻度PE(M-PE)与重度PE(S-PE)的风险因素和临床发病特征进行对比分析。并对比分析接受强化产前检查与常规产前检查病例间临床预警信息及PE发生孕期时段和诊断时限。结果 (1)轻与重度PE间发病风险因素及临床首发症状差异无统计学意义(P>0.05)。(2)单胎妊娠单纯性轻与重度PE早期临床特征分析:①诊断前预警信息:S-PE组在诊断前存在高血压前期、低蛋白血症、血小板(PLT)下降趋势比例高于M-PE组(P<0.05);S-PE组血清白蛋白<29 g/L、PLT下降大于40%比例显著高于M-PE组(P<0.05)。②S-PE组预警信息出现至临床症状出现时间短于M-PE组,预警信息出现至做出PE诊断标准时间也短于M-PE组(P<0.05)。(3)产前检查模式分析显示:强化产检组PE重度发病率低于常规产检组(P<0.05)。强化产检组发现临床症状早于常规产检组,但PE发生时间迟于常规产检组(P<0.05)。(4)多因素回归分析显示孕早期超重(OR 2.480,P=0.035),高血压前期(OR 3.304,P=0.046),低蛋白血症(OR 3.951,P=0.035)、PLT下降趋势(OR 2.582,P=0.047)、强化产检(OR 0.321,P=0.041)是子痫前期发病轻重的独立影响因素。结论发病前临床预警信息在轻与重度PE存在明显异质性。强化产检可显著降低S-PE发病率,提早发现临床症状,延缓S-PE发病时间。孕早期超重、高血压前期、胎儿生长受限、强化产检是影响子痫前期轻与重的独立因素。

Objective Study on the early clinical features of mild pre-eclampsia （M-PE） and severe pre-eclampsia （ S- PE ） cases with regular prenatal care to investigate the clinical means and intervention timing to reduce the occurrence and development of S-PE. Methods Clinical observational data of pre-eclampsia cases with regular prenatal care in Peking University Third Hospital belween January 2008 and December 2011 was collected. A cohort analysis study was conducted. The high risk factors and clinical characteristics were analyzed in mild and severe cases. These cases were subgrouped into routine prenatal care and reinforce prenatal care groups. Results 1. There was no significance difference of high risk factors and initial symptoms between M-PE and S-PE groups （P 〉 0. 05）. 2. Clinical characteristics were analyzed in M-PE and S-PE of singleton pregnancy with isolated PE cases. 1 ） Warning clinical signs before meet the PE diagnostic criteria：Compared with M-PE group,the rate of prehypertension,hypoproteinemia,PLT declined were higher in S- PE group （P 〈0. 05）. Also,The rate of cases experienced albumin 〈29 g/L,PLT declined 〉40% were higher in S-PE group than M-PE group （ P 〈 0. 05 ）. 2 ） The interval time from warning signs to initial symptoms appearance in S-PE group was shorter than M-PE group （ P 〈 0. 05 ）. The time interval from warning signs to meet the PE diagnostic criteria in S-PE group was shorter than M-PE group （P 〈 0. 05 ）. 3. The proportion of S-PE was much lower in reinforce prenatal care group than in routine prenatal care group （ P 〈 0. 05 ）. Compared with routine prenatal care group, though the initial symptoms appeared earlier in reinforce prenatal care group, but the onset of PE was later （P 〈 0. 05）. 4. Multivariate regression analysis showed that overweight in early pregnancy （OR 2. 480,P = 0. 035 ）, prehypertension （ OR 3. 304,P = 0. 046 ）, hypoproteinemia （ OR 3.951, P = 0. 035 ）, PLT decreased （ OR 2. 582 ,P =0. 047） ,reinforce prenatal care（ OR 0. 321 ,P = 0. 041 ） were independent risk factors affecting the severity of pre-eclampsia. Conclusion This study shows there was significant heterogeneity in warning clinical sign before disease onset between M-PE and S-PE groups. It is possible to monitor and manage the clinical symptoms earlier, and reduce the occurrence and development of PE, especially S-PE. Overweight in early pregnancy, prehypertension, hypoproteinemia, PLT decreased, and prenatal care were independent factors affecting the severity of pre-eclampsia.