小剂量阿司匹林对子宫动脉血流频谱异常孕妇发生子痫前期的影响因素分析

Influencing factors analysis of low-dose aspirin on pre-eclampsia in gravidae with abnormal uterine artery blood flow spectrum

目的探讨小剂量阿司匹林对子宫动脉血流频谱异常孕妇发生子痫前期(PE)的影响因素。方法选择2013年2月至2014年12月,延安大学附属医院收治的90例子宫动脉血流频谱异常孕妇为研究对象。根据90例孕妇于孕龄为13孕周至预产期前1周是否使用小剂量阿司匹林,将其分为实验组(n=45)和对照组(n=45)。回顾性分析2组孕妇的临床资料,并对子宫动脉血流频谱异常孕妇发生PE的影响因素进行多因素非条件logistic回归分析。(1)对2组孕妇的一般临床资料,包括年龄构成比、年龄、人体质量指数(BMI)、分娩孕龄、高血压史所占比例、糖尿病史所占比例、分娩方式构成比、早孕期舒张压、早孕期收缩压、早孕期24h尿蛋白定量、新生儿性别构成比及新生儿出生体重进行统计学比较。(2)比较分析2组孕妇中、晚孕期舒张压、收缩压、24h尿蛋白定量,以及PE发生率。(3)对子宫动脉血流频谱异常孕妇发生PE者与未发生PE者的相关临床资料,进行单因素分析。根据已有研究结果,并结合临床经验,以及子宫动脉血流频谱异常孕妇发生PE的单因素分析结果中差异有统计学意义的因素,进一步对子宫动脉血流频谱异常孕妇发生PE的影响因素进行多因素非条件logistic回归分析。本研究遵循的程序符合延安大学附属医院人体试验委员会制定的伦理学标准,得到该委员会批准。分组征得受试者同意,并与之签署临床研究知情同意书。结果 (1)2组孕妇年龄构成比、年龄、BMI、分娩孕龄、高血压史所占比例、糖尿病史所占比例、分娩方式构成比、早孕期舒张压、早孕期收缩压、早孕期24h尿蛋白定量、新生儿性别构成比及新生儿出生体重比较,差异均无统计学意义(P>0.05)。(2)实验组孕妇中、晚孕期舒张压、收缩压和24h尿蛋白定量,均较对照组孕妇低,并且差异均有统计学意义(中孕期:t=2.144,P=0.012;t=5.632,P=0.009;t=10.310,P<0.001;晚孕期:t=14.680,P<0.001;t=20.431,P<0.001;t=106.212,P<0.001)。(3)实验组孕妇PE发生率为6.7%(3/45),低于对照组孕妇的44.4%(20/45),并且差异有统计学意义(χ~2=5.780,P=0.003)。(4)子宫动脉血流频谱异常孕妇发生PE影响因素的单因素分析结果显示,发生PE者与未发生PE者的年龄构成比、高血压史所占比例、新生儿性别构成比比较,差异均有统计学意义(χ~2=6.317,P=0.012;χ~2=7.220,P=0.007;χ~2=5.332,P=0.021)。子宫动脉血流频谱异常孕妇发生PE影响因素的多因素非条件logistic回归分析结果显示,使用小剂量阿司匹林(OR=0.015,95%CI:0.002~0.248,P=0.005)和新生儿性别为女性(OR=0.131,95%CI:0.014~0.649,P=0.016)为子宫动脉血流频谱异常孕妇发生PE的独立保护因素,而孕妇年龄<20岁(OR=6.767,95%CI:3.418~7.084,P=0.024)及孕妇年龄>40岁(OR=3.360,95%CI:1.849~5.051,P=0.044)为子宫动脉血流频谱异常孕妇发生PE的独立危险因素。结论小剂量阿司匹林可以较为有效预防子宫动脉血流频谱异常孕妇发生PE,建议对年龄<20岁及>40岁的子宫动脉血流频谱异常孕妇,使用小剂量阿司匹林预防PE的发生。

Objective To analyze influencing factors of low-dose aspirin on pre-eclampsia （PE） in gravidae with abnormal uterine artery blood flow spectrum .Methods From February 2013 to December 2014 ,a total of 90 gravidae with abnormal uterine artery blood flow spectrum were enrolled into this study .They were divided into 2 groups ,study group （n=45） and control group （n=45） according to whether taking low-dose aspirin or not . Clinic data between two groups were retrospectively analyzed and multivariate unconditional logistic regression analysis was conducted to explore the influencing factors of low-dose aspirin on PE in gravidae with abnormal uterine artery blood flow spectrum .① The clinical data ,including constituent ratio of age ,age ,body mass index （BM I ） , gestational age at delivery , proportion of hypertension and diabetes mellitus history , constituent ratio of modes of delivery ,diastolic pressure ,systolic pressure blood pressure and 24 h urinary protein quantitation during first trimester of gravidae between two groups , ass well as constituent ratio of neonatal gender and birth weight of infants between two groups ,were compared .② The diastolic pressure ,systolic pressure and 24 h urinary protein quantitation during second and third trimester between two groups were detected and compared .③ Univariate analysis was conducted on the clinical data between gravidae with PE and gravidae without PE .Based on the results of existing studies ,clinical experience and univariate analysis results ,multivariate unconditional logistic regression analysis were conducted about low-dose aspirin on PE in gravidae with abnormal uterine artery blood flow spectrum . The procedures followed in this study were in line with the ethical standards set by Ethical Review Board of Investigation in Human Beings of Yan′an University Affiliated Hospital and were approved by the committee .The study obtained the informed consent of each subject ,and signed a clinical research informed consent with each subject .Results ① There were no significant differences between two groups in the aspects of constituent ratio of age ,age , BMI ,gestational age at delivery ,proportion of hypertension and diabetes mellitus history ,constituent ratio of modes of delivery ,diastolic pressure ,systolic pressure and 24 h urinary protein quantitation during first trimester ,as well as constituent ratio of neonatal gender and birth weight of infants （P〉0 .05） .② The diastolic pressure ,systolic pressure and 24 h urinary protein quantitation during second and third trimester in study group were all lower than those of control group （second trimester ：t=2.144 ,P=0 .012 ;t=5 .632 ,P=0 .009;t=10 .310 ,P〈0 .001 ;third trimester ：t=14 .680 ,P〈0.001 ;t=20 .431 ,P〈0.001 ;t=106 .21 ,P〈0 .001） .③ The incidence of PE in study group was 6.7% （3/45） ,which was lower than that of 44 .4% （20/45） in control group （χ2 = 5 .780 , P=0.003） .④ The univariate analysis showed the following results ,there were significant differences between gravidae with PE and gravidae without PE in the aspects of constituent ratio of age , proportion of hypertension history and constituent ratio of neonatal gender （χ2 =6 .317 , P=0 .012;χ2 =7.220 ,P= 0.007 ;χ2 = 5.332 , P= 0.021） .Furthermore ,multivariate unconditional logistic regression analysis showed that ,low-dose aspirin （OR=0 .015 ,95% CI：0 .002-0 .248 , P=0 .005） and female gender （OR=0 .131 ,95% CI：0 .014-0 .649 ,P=0.016） were the independent protective factors ,and age under 20-year-old （OR= 6 .767 ,95% CI：3.418-7 .084 , P= 0 .024） and age over 40-year-old （OR=3 .360 ,95% CI：1 .849-5 .051 ,P=0 .044） were the independent risk factors of PE in gravidae with abnormal uterine artery blood flow spectrum .Conclusions Low-dose aspirin can be used as one of the options for gravidae with abnormal uterine artery blood flow to prevent PE in clinic , especially for the age under 20-year-old and over 40-year-old .