子痫前期复发影响因素临床研究

Clinical study on the factors affecting the recurrence of preeclampsia

目的 探讨子痫前期复发相关影响因素。方法 回顾分析2009年1月至2014年3月在北京大学第三医院产科住院并结束妊娠的有过子痫前期病史的82例临床病例资料,按照此次妊娠有无子痫前期复发分为复发子痫前期组（RPE组）和未复发子痫前期组（NRPE组）,并对两组资料进行对比分析。结果 2009年1月至2014年3月子痫前期总体发病率为6.6%（1182/17939）,82例有子痫前期病史者,再次妊娠子痫前期复发率为45.1%（37/82）。分析子痫前期复发影响因素：母体基础状况：有子痫前期病史的82例中,43.9%（36/82）合并内科疾病,其中以合并慢性高血压者最多,为34.1%（28/82）。RPE组合并内科疾病者（67.6%,25/37）、合并慢性高血压者（54.1%,20/37）均明显高于NRPE组[24.4%（11/45）、17.8%（8/45）],P〈0.001、P=0.001。前次妊娠子痫前期发病情况：RPE组前次妊娠最高收缩压[180.0（160.0~200.0）mmHg]和最高舒张压[110.0（100.0~129.0）mmHg]均明显高于NRPE组[166.0（150.0~180.0）mmHg、100.0（98.5~120.0）mmHg],P=0.009、0.004。RPE组前次最高收缩压为140~159mmHg者所占比例（13.5%,5/37）低于NRPE组（35.0%,14/40）（P=0.029）,前次最高收缩压≥160mmHg者所占比例（86.4%,32/37）、前次最高舒张压≥110mmHg者所占比例（59.5%,22/37）、前次为重度高血压者所占比例（73.0%,27/37）均明显高于NRPE组[62.5%（25/40）、32.5%（13/40）、42.5%（17/40）],P=0.016、0.018、0.007。产前检查情况：RPE组中规律产前检查者所占比例（64.9%,24/37）、三级医院规律产前检查者所占比例（40.5%,15/37）均明显低于NRPE组[86.7%（39/45）、86.7%（39/45）],P=0.020、P〈0.001,注册时为高血压前期者所占比例（81.8%,9/11）明显高于NRPE组（29.7%,11/37）,P=0.006。多因素回归分析显示,合并慢性高血压（调整OR=7.00,95%CI 2.27,21.52）、不规律产前检查（调整OR=4.19,95%CI 1.14,15.42）是子痫前期复发的独立危险因素。结论 合并慢性高血压、不规律产前检查是子痫前期复发的独立影响因素;母体基础疾病是影响子痫前期发病和复发重要因素。

Objective To investigate the factors associated with recurrence of preeclampsia.Methods A retrospective study of 82 cases of preeclampsia history in Obstetric Department of Peking University Third Hospital from January 2009 to March 2014 was performed. Cases were divided into two groups： cases with preeclampsia history and recurrent pre- eclampsia in the subsequent pregnancy was RPE group ,while cases with preeclampsia history without recurrence in the subsequent pregnancy was NRPE group. The clinical data was analyzed in the two group. Results In the population studied, the incidence of preeclampsia was 6.6% （1182/17939）;in those who have a history of preeclampsia, preeclamp- sia recurrence rate was 45.1% （37/82）. Preeclampsia recurrence factors： the maternal foundation： in 82 patients with a history of preeclampsia , 43.9% （36/82） were combined with medical disease, in which 34.1% （28/82） were combined with chronic hypertension;in RPE group medical diseases combined accounted for 67.6% （35/37）,chronic hypertension accounted for 54.1% （20/37） , both of which were significantly higher than NRPE group （P〈0.001 ,P=0.O01）. Previous preeclampsia pregnancy： the highest systolic blood pressure （P=0.009） and maximum diastolic blood pressure （P = 0.004） of previous preeclampsia in RPE group were significantly higher than NRPE group; the proportion of previous severe hypertension in RPE group was significantly higher than in NRPE group （P=0.007）. Prenatal care：the proportion of regular antenatal care in RPE group was significantly lower than that in NRPE group （P= 0.020）; the proportion of regular antenatal care in tertiary hospital was significantly lower than NRPE group （P〈0.001）.Muhivariate logistic regression analysis showed that patients with chron- ic hypertension （adjusted OR=7.00, 95% CI 2.27, 21.52） and irregular prenatal care （adjusted 0R=4.19, 95% CI 1.14, 15.42） were independent risk factors of preeclampsia recurrence. Conclusion Chronic hypertension and irregular prenatal care are independent risk factors of preeclampsia recurrence. Maternal underlying disease is an important factor in preeclampsia morbidity and relapse.