重度子痫前期患者脏器损伤与不良妊娠结局相关性的多中心研究

The Correlation between Organ Function Impairment and Adverse Pregnancy Outcome in Patients with Severe Preeclampsia:a Multicenter Study

目的:分析重度子痫前期(SPE)患者不同脏器损伤与不良妊娠结局的相关性。方法:回顾性分析2015年1月至2018年12月来自全国4家医院的817例SPE患者的完整临床资料,其中发生单种脏器功能损伤患者为A组(553例),发生两种及以上脏器功能损伤患者为B组(264例),比较两组患者各种母胎不良结局发生率。采用多因素Logistic回归分析产生不良妊娠结局的相关因素并拟合预测模型,受试者工作曲线以评估相关因素对不良结局的预测性能。结果:在817例患者中,母体脏器损伤以蛋白尿为主(92.66%)。B组患者的低蛋白血症伴胸腹水发生率(28.41%vs 21.70%,P=0.035)、子痫发作率(12.12%vs 3.80%,P<0.001)、HELLP综合征发生率(4.92%vs 0.72%,P<0.001)、FGR/SGA发生率(28.79%vs 18.63%,P=0.001)、医源性早产率(68.56%vs 50.45%,P<0.001)及医源性引产率(5.30%vs 2.17%,P=0.017)明显高于A组,而其他母胎结局差异无统计学意义(P>0.05)。Logistic回归分析提示蛋白尿(OR 10.423,P<0.001)、肝功能损伤(OR 2.869,P<0.001)及血小板减少症(OR 3.052,P=0.002)与不良妊娠结局相关。ROC曲线显示上述3种脏器损伤对不良妊娠结局的诊断性能良好(AUC 0.754,95%CI 0.720~0.789,P<0.001)。结论:SPE患者蛋白尿的出现和加重仍然是母体脏器损伤、严重并发症出现及围产儿不良结局发生的早期信号和重要临床指标。SPE合并复合型脏器功能损伤患者产生不良妊娠结局的风险增加。蛋白尿、肝功能受损和血小板减少症对不良妊娠结局具有良好的预测价值,可作为临床诊治工作中重点监测指标。

Objective:To analyze the correlation between organ functional impairments and adverse pregnancy outcome in patients with severe preeclampsia(SPE).Methods:The complete clinical data of 817 SPE patients from four hospitals across China from January 2015 to December 2018 were retrospectively analyzed.Among these patients,553 with single organ dysfunction were involved in group A,and 264 with compound organ dys-functions were divided into group B.The incidence of adverse outcomes in two groups were compared.The multi-variate logistic regression was used to analyze the correlation factor of adverse pregnancy outcome and build a predictive model.The receiver operating characteristic curve(ROC)was constructed to assess the diagnostic per-formance of relevant organ dysfunctions for adverse outcome.Results:The main maternal symptom was proteinu-ria in 817 patients(92.66%).The incidence of hypoproteinemia with pleural and ascites(28.41%vs.21.70%,P=0.035),eclampsia(12.12%vs.3.80%,P<0.001),HELLP syndrome(4.92%vs.0.72%,P<0.001),FGR/SGA(28.79%vs.18.63%,P=0.001),iatrogenic premature delivery(68.56%vs.50.45%,P<0.001)and iatrogenic induction(5.30%vs.2.17%,P=0.017)in the B group were significantly higher than that of the A group(P<0.05).There was no significant difference concerning other maternal and fetal outcomes.Furthermore,multivariate logistic regression analysis showed that proteinuria(OR 10.423,P<0.001),impaired liver function(OR 2.869,P<0.001),and thrombocytopenia(OR 3.052,P=0.002)were significantly associated with adverse pregnancy out-come.The receiver operating characteristic(ROC)curve showed that the diagnostic performance of proteinuria,impaired liver function and thrombocytopenia for adverse outcome was good(AUC 0.754,95%CI 0.720-0.789,P<0.001).Conclusions:The appearance and exacerbation of proteinuria in SPE patients are still early signals and important clinical indicators of maternal organ damage,severe complications and adverse perinatal outcomes.SPE patients complicated with compound organ dysfunctions have an increased risk of adverse pregnancy out-comes.Proteinuria,liver dysfunction and thrombocytopenia have a good predictive value for adverse pregnancy outcome and could be used as key monitoring indicators in clinical work.