24小时尿蛋白定量和血清白蛋白与未足月重度子痫前期母儿结局的关系分析

Clinical Analysis of Quantitative Test of 24 h Urinary Protein,Albumin and Maternal-Fetal Outcomes with Preterm Severe Preeclampsia

目的:探讨24小时尿蛋白定量和血清白蛋白水平与未足月重度子痫前期(SPE)母儿结局的关系。方法:选择2009年7月至2013年12月于本院产科住院治疗并分娩的孕周<37周的99例重度子痫前期的孕妇及其分娩的新生儿作为研究对象。回顾性分析孕妇24小时尿蛋白定量、血清白蛋白结果及主要母儿并发症和新生儿预后。结果:124小时尿蛋白定量≥5 g/24 h组胎儿生长受限(FGR)和脑瘫的发生率明显高于<5 g/24 h组,新生儿体重(1765.0±567.4 g)也明显轻于后者(2000.7±607.4 g)(P<0.05);两组比较HELLP综合征、子痫、胎盘早剥、肾功能损害、心功能损害、视网膜脱落、胎儿窘迫、胎死宫内(IUFD)引产的发生率,及新生儿死亡、机械通气使用率、肺泡表面活性物质(PS)使用率、窒息、新生儿呼吸窘迫综合征(NRDS)、颅内出血、败血症、新生儿缺血缺氧性脑病(HIE)的发生率差异均无统计学意义(P>0.05)。2血清白蛋白<25 g/L组活产儿机械通气的使用率、窒息率和NRDS发生率均明显高于血清白蛋白≥25 g/L组,且前者新生儿的体重(1803.2±559.3 g)明显轻于后者(2115.2±639.5 g)(P<0.05);两组其余指标比较差异均无统计学意义(P>0.05)。3早发型重度子痫前期与晚发型重度子痫前期组比较,前者血清白蛋白<25 g/L、新生儿体重<1500 g的发生率均明显高于后者(P<0.01),两组患者24小时尿蛋白定量≥5 g/24 h的发生率比较,差异无统计学意义(P>0.05)。结论:24小时尿蛋白定量与血清白蛋白水平在某种程度上可以反映未足月重度子痫前期新生儿的预后,可作为其评价指标,且血清白蛋白结果更优于24小时尿蛋白定量。

Objective： To investigate the relationship between maternal-fetal outcomes in patients with severe preeclampsia（ SPE） and quantitative test of 24 h urinary protein and the albumin. M ethods： Retrospective investigations and analysis were carried out in 99 pregnant women who underwent SPE in our hospital from July 2009 to December 2013 and the newborn babies who were less than 37 weeks gestation. The quantitative test of 24 h urinary protein,the albumin,the major maternal-fetal complications and the maternal-fetal outcomes were analyzed retrospectively. Results： 1Patients with a large amount of proteinuria group（ 24 h urinary protein ≥5 g /24 h） had a higher rates of FGR and cerebral palsy than the less amount of proteinuria group（ 24 h urinary protein 5 g /24h）,and had lower newborn weight（ 1765. 0 ± 567. 4 g） than the less amount of proteinuria group（ 2000. 7 ± 607. 4g）（ P 0. 05）. There was no significant difference on the maternal-fetal complications and the maternal-fetal outcomes between the two groups,which including HELLP syndrome,eclampsia,FGR,intrauterine fetal death,neonatal death,NICU medical supports,NRDS,asphyxia,mechanical ventilation,PS,sepsis,intracranial hemorrhage and cerebral palsy（ P 0. 05）. 2Patients with hypoproteinemia（ albumin 25 g / L） had a higher rates of mechanical ventilation、NRDS and asphyxia than those of albumin patients with albumin ≥25 g / L,had a lower babyweight（ 1803. 2 ± 559. 3 g） than that of albumin patients with albumin ≥25 g / L（ 2115. 2 ± 639. 5 g）（ P 0. 05）.There was no significant difference on the other indexes among the two groups（ P 0. 05）. 3Compared with the late severe preeclampsia,the early set severe preeclampsia had a higher rates of low serum albumin（ 25 g / L）and a lower baby weight（ P 0. 01）,but the massive quantitative test of 24 h urinary protein rates had no significant difference between the two groups（ P 0. 05）. Conclusions： Quantitative test of 24 h urinary protein and the albumin level can reflect the neonatal outcomes of preterm patients with severe preeclampsia（ SPE） to some extent,which can be the evaluating marker for the prognosis of fetal outcomes in patients with SPE. As a predictor marker,albumin is better than quantitative test of 24 h urinary protein.