IgA肾病孕妇的临床资料分析

Clinical study on pregnant women with IgA nephropathy in a hospital in recent 10 years

目的分析浙江中医药大学附属温州中医院近10年IgA肾病孕妇的妊娠结局及其危险因素。方法选取我院2006年6月至2016年8月收治的IgA肾病孕妇86例的临床资料,分析其妊娠结局的影响因素。结果 86例患者共妊娠90次,妊娠20~40周,平均(36.2±5.6)周。58例为足月产,9例为早产,23例于妊娠28周前终止妊娠,分别占64.44%、10.00%和25.56%。67例胎儿中62例活胎,体重1 038.9~5 896.3 g,平均体重为(3 012.5±253.9)g;低体重儿14例,极低体重儿6例,分别占22.58%和9.67%。妊娠成功组年龄、平均动脉压、血肌酐、妊娠前24 h尿蛋白量显著低于失败组(t值分别为2.332、2.257、2.259、2.225,均P<0.05),血红蛋白显著高于失败组(t=2.302,P<0.05),Lee氏分级显著低于失败组(χ~2=5.661,P<0.05)。两组病程、血清白蛋白、总胆固醇无显著性差异(t值分别为1.025、0.562、0.785,均P>0.05),且肾小球球性硬化、肾小球节段性硬化发生率均无显著性差异(χ~2值分别为1.535、0.981,均P>0.05)。Logistic回归分析结果显示,年龄、妊娠前肾性高血压、Lee氏分级、血红蛋白和妊娠前24h尿蛋白量是IgA肾病孕妇妊娠结局的独立影响因素(OR值分别为3.038、3.927、3.358、2.038,均P<0.05),年龄越大,Lee氏分级越高,妊娠前24h尿蛋白量高,低血红蛋白,伴有妊娠前肾性高血压的IgA肾病孕妇更易出现不良妊娠结局,胎儿预后亦差。结论 IgA肾病可能导致妊娠结局不良,其中妊娠前肾病的临床表现与妊娠结局存在紧密关系,应积极控制妊娠前上述症状,从而改善妊娠结局。

Objective To analyze the pregnancy outcomes and risk factors of pregnant women with IgA nephropathy（IgAN） in Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine in recent 10 years. Methods Eighty-six patients with IgAN admitted in the hospital from June to August in 2016 were selected. Their clinical data was analyzed and influencing factors of pregnancy outcomes were analyzed. Results Number of pregnancies of 86 patients was 90 and gestation time was 20 to40 weeks with an average of 36. 2 ± 5. 6 weeks. Among them,58 cases were term delivery,9 cases were preterm birth,and 23 cases terminated pregnancy before 28 gestational week,accounting for 64. 44%,10. 00% and 25. 56%,respectively. In 67 fetuses,62 were live births,weighing 1 038. 9-5 896. 3g,and average body weight was 3 012. 5 ± 253. 9 g. There were 14 cases of low birth weight and 6cases of very low birth weight,accounting for 22. 58% and 9. 67%,respectively. Age,mean arterial pressure,serum creatinine and 24 h urine protein quantity before pregnancy of women with successful pregnancy were significantly lower than those of women with failed pregnancy（t value was 2. 332,2. 257,2. 259 and 2. 225,respectively,all P〈0. 05）,but hemoglobin was significantly higher（t =2. 302,P〈0. 05）. Lee＇s classification in successful group was significantly lower than in failed group（χ~2= 5. 661,P〈0. 05）. There was no significant difference in duration of disease,serum albumin and total cholesterol between two groups（t value was 1. 025,0. 562 and0. 785,respectively,all P〈0. 05）. Incidence of glomerular sclerosis and segmental glomerular sclerosis in two groups was not significantly different（χ~2value was 1. 535 and 0. 981,respectively,both P〈0. 05）. Logistic regression analysis results showed that age,renal hypertension before pregnancy,Lee＇s classification,hemoglobin and 24 h urine protein quantity before pregnancy were independent factors affecting pregnancy outcomes of pregnant women with IgAN（OR value was 3. 038,3. 927,3. 358 and 2. 038,respectively,all P〈0. 05）.Pregnant women with IgAN of elder age, higher Lee ＇s classification, higher 24 h urine protein quantity before pregnancy, lower hemoglobin,and suffering from renal hypertension before pregnancy were prone to adverse pregnancy outcomes and poor fetus prognosis.Conclusion IgAN may lead to poor pregnancy outcomes,and clinical manifestations of pre-pregnancy kidney disease are closely related to pregnancy outcomes. Such symptoms before pregnancy should be actively controlled to improve pregnancy outcomes.