对妊娠高血压综合征分类的新评价(附286例临床分析)

The re-evaluation of pregnancy-induced hypertension syndrome classification——Clinical analysis of 286 cases.

目的 从妊高征的临床表现、实验室检查及预后方面对国内现有妊高征分类方法进行评价。方法 对 2 86例妊高征孕妇临床资料进行分析 ,以蛋白尿、水肿、自觉症状、血细胞比容、血小板计数、肝肾功能作为评价指标 ,按轻、中、重度组 (包括先兆子痫及子痫 ) ,进行组间方差分析 ,将新生儿体重、Apgar评分与以上指标作逐步回归相关分析。 结果 轻度与中度组间的各项指标均无显著性差异 ,而二者与重度组间则差异极显著 (P <0 .0 1)。重度组孕产妇其并发症也明显重于轻、中度组。逐步回归分析显示 :影响新生儿状况的最主要因素是尿蛋白、肝酶及血尿酸值。结论 国内现有妊高征分类方法存在不合理性 ,建议取消中度分类 ,同时应加入产时及产后妊高征的分类 ,水肿不应作为妊高征的分类指标。

Objective To study the practicability and rationality of classification in pregnancy-induced hypertension syndrome(PIH) in terms of clinical manifestation, laboratory test and prognosis.Methods 286 cases of PIH were eligible for the retrospective study.The valuation items included proteinuria, edema, subjective symptoms and laboratory data (including Ht, PLT, liver and kidney functions).Analysis of variance was perfomed among the mild, moderate and severe groups of PIH.Stepwise regression analysis was carried out between neonatal weight or Apgar scores and the above items.Results There was no significant difference between the moderate group and mild group in clinical characteristic, but a significant difference existed between the severe group and the mild, moderate groups(P< 0.01).The morbility of complications in severe groups was significantly higher than in the mild and moderate groups.Stepwise regression analysis showed that the main factors affecting newborn condition were proteinuria, liver enzyme and blood uric acid level.Conclusion The classification of PIH remains disrationality now.It is recommended to exclude the moderate classification, Labor and postpartum PIH should be classified, and edema does not serve as the classified index of PIH.