汉族女性妊娠期高血压疾病的流行病学及发病机制研究

Epidemiology and Pathogenesis of Hypertensive Disorder Complicating Pregnancy in Han Nationality

目的探讨汉族女性妊娠期高血压疾病的流行病学及发病机制研究。方法选取笔者医院10年内妊娠期高血压疾病患者689例,作为病例组,选取689例正常妊娠的女性作为对照组,采用多中心、大规模、随机队列研究方法分析汉族女性妊娠期高血压疾病患者(病例组)和对照组的资料,并通过电话随访对家属进行固定问卷式问题,对对象的年龄、孕前体重指数、孕次、产次、流产次数、孕中期平均动脉压、子痫前期史、糖尿病或肾脏疾病史、多胎妊娠等相关因素进行分析,并进行Logistic回归分析;对两组研究对象的ACE基因和AT1R基因水平、Th1/Th2比值、胎盘生长因子(PLGF)、活性氧(ROS)水平和脂质过氧化物(LPO),分析汉族女性妊娠期高血压疾病的发病与免疫学、遗传学、氧化应激的关系。结果年龄>35岁的初产女性、过高或过低的孕前体重指数、孕中期平均动脉压高、流产次数高、具有子痫前期史、糖尿病或肾脏疾病史、多胎妊娠的女性是导致汉族女性妊娠期高血压疾病的主要单因素(P<0.05);多因素分析年龄>35岁的初产女性、过高或过低的孕前体重指数、孕中期平均动脉压高、具有子痫前期史、糖尿病或肾脏疾病史、多胎妊娠是导致汉族女性妊娠期高血压疾病的危险因素(P<0.05);病例组的ACE基因和AT1R基因、Th1/Th2比值、PLGF、ROS和LPO与对照组差异有统计学意义(P<0.05)。结论汉族女性妊娠期高血压疾病的发病与免疫学、遗传学、胎盘或滋养细胞缺血、氧化应激中的相关指标有关,而且>35岁的初产女性、过高或过低的孕前体重指数、孕中期平均动脉压高、具有子痫前期史、糖尿病或肾脏疾病史、多胎妊娠是导致汉族女性妊娠期高血压疾病的危险因素。

Objective To study the epidemiology and pathogenesis of hypertensive disorder complicating pregnancy in Han nationality women. Methods Totally 689 cases of patients with hypertensive disorders in pregnancy within 10 years in our hospitals were selected as case group, 689 cases of normal pregnant women were selected as control group. The data of patients with hypertensive disorder complicating pregnancy （case group） and control group were analyzed by multi center, large scale and random cohort study. Fixed questionnaires were conducted by telephone follow-up include the object of the age, BMI before pregnancy, gravidity, parity, abortion, maternal mean arterial pressure, history of preeclampsia, history of diabetes or kidney disease, multiple pregnancy related factors analysis and logistic regression analysis. Two groups of subjects of ACE gene and AT1R gene level and the ratio of Th1/Th2 and placenta growth factor （PLGF）, reactive oxygen species （ROS） level and lipid peroxide （LPO）, the relationship and the pathogenesis of immunology, genetics, oxidative stress analysis of Han women in pregnancy induced hypertension. Results Women older than 35 years of age, prepregnancy body mass index, high or low maternal mean arterial pressure, high frequency of abortion is high, with a history of preeclampsia, history of diabetes or kidney disease, multiple pregnancy women were the main cause of the single factor of pregnancy induced hypertension in Han women （P〈0.05）; Multivariate analysis for more than 35 years of age, primiparous women pre pregnancy body mass index, high or low maternal mean arterial pressure high, with a history of preeclampsia, history of diabetes or kidney disease, multiple pregnancy was a risk factor of pregnancy induced hypertension in Han women （P〈0.05）;The ACE gene and AT1R gene, Th1/Th2 ratio, PLGF, ROS and LPO in the case group were significantly different from those in the control group （P〈0.05）. Conclusion The incidence of hypertensive disorder complicating pregnancy in pregnant women was related to the indexes of immunology, genetics, placental or trophoblastic ischemia and oxidative stress. And more than 35 years of age primiparous women,too high or too low pre pregnancy body mass index, high mean arterial pressure in the second trimester of pregnancy, pre eclampsia, diabetes or kidney disease, multiple pregnancy were risk factors for hypertensive disorders in pregnant women.