早发型重度子痫前期血清白蛋白水平对母胎结局的影响

Analysis between serum albumin levels and perinatal outcomes in patients with early onset severe preeclampsia

目的:探讨血清白蛋白水平与早发型重度子痫前期(sPE)母儿预后的关系。方法:收集单胎早发型sPE患者152例。根据入院时血清白蛋白水平,分为低血清白蛋白组(<30g/L)83例和正常血清白蛋白组(≥30g/L)69例。比较两组患者的一般情况,孕产妇并发症:子痫、脑血管意外、HELLP综合征、胎盘早剥、肾功能不全、心功能不全、视网膜剥离、产后出血、腹水的发生率,围产儿一般情况及并发症:新生儿出生体重、出生孕周、Apgar评分,胎儿生长受限(FGR)、胎儿新生儿死亡、新生儿窒息、新生儿呼吸窘迫综合征(NRDS)、新生儿缺血缺氧性脑病(HIE)、新生儿颅内出血、新生儿败血症、新生儿坏死性小肠结肠炎的发生率。结果:低血清白蛋白组的胎盘早剥(12.0%vs 2.9%)、腹水(63.9%vs 34.8%)、FGR(16.9%vs 5.8%)及新生儿窒息(72.9%vs 44.4%)发生率明显高于正常血清白蛋白组,新生儿出生体重、Apgar评分低于正常血清白蛋白组,差异均有统计学意义(P<0.05)。多因素二元回归分析提示,胎盘早剥与血清白蛋白水平相关(OR=0.812,P<0.05)。结论:早发型sPE合并低血清白蛋白虽不增加胎儿新生儿死亡率,但胎盘早剥、腹水、FGR及新生儿窒息发生率明显升高。低血清白蛋白水平虽不能作为早发型sPE患者终止妊娠的指标,但可作为常规检测指标,合并低血清白蛋白时应警惕胎盘早剥的发生,做好新生儿复苏的准备。

Objective:To investigate the association between serum albumin levels and perinatal outcomes in patients with early onset severe preeclampsia.Method:A retrospective analysis was carried out in a total of 152 patients with singleton pregnancy under early onset severe preeclampsia.According to the serum albumin levels at admission,83 patients were divided into low serum albumin group(<30g/L)and 69 patients were divided into normal serum albumin group(≥30g/L).The general data of the two groups were recorded.The incidences of main maternal complications were recorded:eclampsia,cerebrovascular accident,hemolysis elevated liver enzymes and low platelet count(HELLP)syndrome,placental abruption,renal insufficiency,cardiac insufficiency,retinal detachment,postpartum hemorrhage,ascites;the general fetal data as neonatal birth weights,gestation ages,Apgar scores and the incidences of main fetal complications were also recorded:FGR,fetal and neonatal death,asphyxia,neonatal respiratory distress syndrome(NRDS),hypoxic ischemic encephalopathy(HIE),intracranial hemorrhage,sepsis,necrotizing enterocolitis.Results:Patients of early onset severe preeclampsia with low serum albumin levels(<30g/L)had higher incidences of placental abruption(12.0%vs 2.9%),ascites(63.9%vs 34.8%),FGR(16.9%vs 5.8%)and neonatal asphyxia(72.9%vs 44.4%,)and also had lower neonatal weights and Apgar scores,the differences were statistically significant(P<0.05).Multivariate binary regression analysis suggested that placental abruption was associated with serum albumin levels(OR=0.812,P<0.05).Conclusion:Although the fetal and neonatal mortality doesn't increase in patients of early onset severe preeclampsia with low serum albumin levels,the incidences of placental abruption,ascites,FGR and neonatal asphyxia are higher than in those with normal serum albumin levels.We think that low serum albumin levels can not be used as an indicator of pregnancy termination in patients with early onset severe preeclampsia,but it can be used as a routine test.The low serum albumin levels could be a predictor for placental abruption and we must prepare for neonatal resuscitation when patients combined with low serum albumin levels.