危险因素聚集对慢性高血压并发子痫前期不良结局的影响

Effect of risk factors aggregation on adverse outcome of chronic hypertension complicated with preeclampsia

目的探讨多个危险因素聚集与慢性高血压并发子痫前期及其不良结局的影响.方法选取2018年1-12月安徽省妇幼保健院和安徽医科大学第二附属医院住院分娩的产妇16401例,其中慢性高血压疾病合并妊娠的产妇124例,将慢性高血压并发子痫前期的产妇68例为研究组,未并发子痫前期的产妇53例为对照组,分析多种高危因素聚集对母婴不良结局的影响.结果(1)慢性高血压妊娠的比率为7.6‰(124/16401),其中56.20%的慢性高血压患者并发子痫前期(68/121);(2)单因素非条件Logistic分析显示:未定期产检、血压控制不满意(特别是血压≥180/110 mmHg)、伴高尿酸、高红细胞压积及低血小板与慢性高血压患者是否并发子痫前期相关,OR(95%CI)分别为0.338(0.156~0.734)、2.875(1.116~7.406)、2.367(1.078~5.195)、11.229(3.652~34.531)、4.574(2.008~10.418)、0.459(0.216~0.978);(3)多因素Logistic分析:高尿酸及高红细胞压积均是子痫前期发病的独立危险因素;进一步对高尿酸及高红细胞压积两个独立危险因素进行聚集性分析,结果显示:两个独立危险因素同时存在时,并发子痫前期的可能性明显增加(P<0.001);(4)随着危险因素的聚集,母婴不良明显增加(母体器官损伤、早产及胎儿生长受限等)(P<0.05).结论高尿酸、高红细胞压积是慢性高血压并发子痫前期的两个独立危险因素;两危险因素聚集可增加慢性高血压并发子痫前期发生率,且存在剂量反应关系;随着危险因素聚集,同时也增加母婴不良结局的风险.

Objective The study aimed to investigate the effect of risk factors aggregation and chronic hypertension complicated with preeclampsia and its adverse outcomes.Methods There were childbirth puerpera 16401 cases in the Anhui province maternal and child health care and the second affiliated hospital,Anhui medical university hospital between January 2018 and December 2018.Among them,there were 124 cases chronic hypertension disease merging of maternal pregnancy.68 cases of chronic hypertension complicated by preeclampsia women were selected as experimental group and 53 cases which not complicated by preeclampsia maternal as control group.We analysis the influence of poor gathered a variety of risk factors of maternal and infant outcomes.Results(1)the rate of pregnancy with chronic hypertension was 7.6‰(124/16401),among which 56.20%of the patients with chronic hypertension complicated with preeclampsia(68/121);(2)univariate unconditioned logistic analysis shows that:no regular prenatal examination,unsatisfactory blood pressure control(especially blood pressure≥180/110 mmHg),high uric acid,high red cell accreta and low platelet were correlated with preeclampsia in patients with chronic hypertension,OR(95%CI)were 0.338(0.156~0.734),2.875(1.116~7.406),2.367(1.078~5.195),11.229(3.652~34.531),4.574(2.008~10.418),0.459(0.216~0.978),respectively;(3)multivariate logistic analysis:high uric acid and high red cell accretion were independent risk factors for preeclampsia.Further aggregation analysis of two independent risk factors of high uric acid and high red cell accretion showed that when two independent risk factors existed simultaneously,the possibility of preeclampsia was significantly increased(P<0.001);(4)with the aggregation of risk factors,maternal and infant malfunctions increased significantly(maternal organ damage,premature delivery,fetal growth restriction,etc.)(P<0.05)Conclusions high uric acid and high red cell accretion are two independent risk factors for chronic hypertension complicated with preeclampsia.The aggregation of two risk factors could increase the incidence of chronic hypertension complicated with preeclampsia.There is a dose⁃response relationship.When risk factors accumulate,they also increase the risk of adverse outcomes for mothers and infants.