24h尿蛋白定量与重度子痫前期母婴并发症关系研究

Study on the Relationship between 24-hour Urinary Protein Quantification and Maternal and Neonatal Complications in Severe Preeclampsia

目的探讨24h尿蛋白定量与重度子痫前期的母婴并发症关系。方法选取2011年1月1日~12月31日中国大陆地区共37家医院,其中18家三甲医院及19家二级医院所有诊断为重度子痫前期且发病孕周在28周以上的单胎孕妇共2305例。根据入院后最高24h尿蛋白定量结果分为3组:Ⅰ组尿蛋白定量为0~2g,共590例,Ⅱ组尿蛋白定量2~5g,共843例,Ⅲ组为5g以上,共872例。分析不同组别的母儿并发症的发生率。结果研究对象中低蛋白血症的发生率为14.8%,胸/腹腔积液/肺水肿/心力衰竭的发生率为1.6%,肾功能损害的发生率为0.6%,胎盘早剥的发生率为2.7%,HELLP综合征发生率为3.0%。各组间低蛋白血症的发生率差异有统计学意义,Ⅰ组的发生率明显低于Ⅱ组及Ⅲ组(P<0.017)。胎儿生长受限的发生率为3.3%,胎儿窘迫的发生率为9.5%,新生儿窒息的发生率为1.1%。三组新生儿体重、胎儿生长受限及新生儿窒息的发生率差异有统计学意义(P均<0.05),Ⅰ组新生儿体重明显高于Ⅱ组及Ⅲ组(P<0.017)。Ⅱ组FGR的发生率明显高于Ⅲ组(P<0.017)。Ⅰ组的新生儿窒息发生率明显低于Ⅲ组(P<0.017)。三组间心力衰竭/肺水肿、胎盘早剥、HELLP综合征及剖宫产率差异无统计学意义。结论不同程度的24h尿蛋白可能增加了重度子痫前期孕妇低蛋白血症的风险,但不增加心力衰竭/肺水肿、胎盘早剥及HELLP综合征的风险。24h尿蛋白定量与重度子痫前期新生儿体重、胎儿生长受限及新生儿窒息的发生率相关。

Objective To investigate the relationship between 24 - hour urinary protein quantification and maternal and neonatal complications in severe preeclampsia. Methods Totally 2305 cases of pregnant women which were diagnosed as severe preeclampsia J more than 28 weeks of single pregnancy in 37 hospitals in China's Mainland were selected from January 1 to December 31, 2011. According to the results of the highest 24 hours urine protein quantitative after admission, the subjects were divided into 3 groups. The group I in- eluded 590 cases whose 24h urinary protein were 0 -2g. There were 843 cases in group 1/ whose 24h urinary protein were 2 -5g, 872 cases were in group HI whose 24h urinary protein were more than 5g. The complications of the maternal and neonatal outcome were ana- lyzed among the three groups. Results The incidence of hypoalbuminemia was 14.8% , the rate of chest/ascites/pulmonary edema/ heart failure was 1.6% , the incidence of renal dysfuction was 0.6% and the incidence of placental abruption and HELLP syndrome was 2.7% and 3.0%. There was significant difference in the incidence of hypoalbuminemia among the three groups of which the incidence of group I was significantly lower than that of group lI and group 111 （ P 〈 0. 017）. The rate of fetal growth restriction, fetal distress and neo- natal asphyxia was 3.3% , 9.5% , and 1.1%. The incidence of neonatal body weight, fetal growth restriction and neonatal asphyxia a- mong the three groups were significantly different （P 〈 0.05 ）. The body weight of neonatal group was significantly higher than that of group lI and group HI （P 〈 0. 017）. The incidence of FGR in group II was significantly higher than that in group Ⅲ （P 〈 0. 017）. The rate of neonatal asphyxia in group I was significantly lower than that in group Ⅲ（P 〈 0. 017）. There are no significant difference in the incidence of heart failure/pulmonary edema,placental abruption, HELLP syndrome and cesarean section among the three groups. Conclu- sion 24 - hour urinary protein may increase the risk of hypoalbuminemia in pregnant women with severe preeclampsia, but do not in- crease the risk of heart failure/pulmonary edema, placental abruption and HELLP syndrome. 24 - hour urinary protein was associated with severe lareeclampsia neonatal body weight, fetal growth restriction, and neonatal asphyxia.