子痫前期患者肾功能的评价及其临床意义

Evaluation of renal function and its clinical significance in pregnant women with preeclampsia

目的探讨评价子痫前期孕妇肾功能的临床意义。方法单胎妊娠孕妇833例分为合并重度子痫前期组(A组,208例)、轻度子痫前期组(B组,215例)、妊娠期高血压组(C组,305例)和正常妊娠组(D组,105例)。检测孕妇24-h尿蛋白、血肌酐(SCr)、血尿素氮(BUN)、血清尿酸(UA)和肾小球滤过率(GFR)。依据GFR水平,子痫前期孕妇分为伴肾功能损害(P1)组(GFR<90ml·min-1·1.73m-2)和无肾功能损害(P2)组(GFR≥90ml·min-1·1.73m-2),比较两组围产儿预后不良的发生率。结果与B、C和D组比较,A组24-h的血SCr、BUN和UA升高,GFR降低(P<0.05);与C、D组比较,B组24-h尿蛋白、血SCr、BUN和UA值升高,GFR值降低(P<0.05)。P1组围产儿预后不良率高于P2组(P<0.05)。结论血清UA及GFR测定可作为子痫前期严重程度及围产儿不良结局的预测指标。

Objective To investigate the clinical significance of evaluating renal function in pregnant women with preeclampsia.Methods A total of 833 single pregnancy women was assigned into four groups of A（with severe preeclampsia,208cases）,B（with mild preeclampsia,215cases）,C（with gestational hypertension,305cases）and D（normal pregnancy,105cases）.The 24-h urinary protein,serum creatinine（SCr）,blood urea nitrogen（BUN）,uric acid（UA）and glomerular filtration rate（GFR）were tested and compared.On the basis of GFR,the patients with preeclampsia were divided into two groups of P1（with renal injury,GFR90ml·min^-1·1.73m^-2）and P2（without renal injury,GFR≥90 ml· min^-1·1.73 m^-2）.The incidence of adverse perinatal outcome was compared between groups of P1 and P2.Results The levels of 24-h urinary protein,SCr and BUN were higher,but GFR was lower,in group A than those in groups of B,C and D（P〈0.05）.The levels of 24-h urinary protein,SCr,BUN and UA were higher,but GFR was lower,in group B than those in groups of C and D（P〈0.05）.The incidence of adverse perinatal outcome was higher in group P1 than that in group P2（P〈0.05）.Conclusion Serum UA and GFR can be taken as the predictors for evaluating the severity of preeclampsia and adverse perinatal outcomes in pregnant women with preeclampsia.