妊娠晚期血尿酸与不良妊娠结局的相关性研究

The correlation between serum uric acid levels in the third trimester of pregnancy and adverse pregnancy outcomes

目的探讨妊娠晚期血清尿酸水平与不良妊娠结局之间的关系。方法采集2014年1月至2019年1月住院分娩的7995例孕妇队列资料,比较高尿酸血症(HUA)孕妇与非HUA孕妇不良妊娠结局情况。使用平滑曲线拟合尿酸水平与早产、低出生体重、小于胎龄儿分娩的关系,logistic回归分析不良妊娠结局的危险因素以及各因素的交互作用。结果妊娠晚期10%的孕妇尿酸水平高于420μmol/L。在HUA孕妇队列中,中位新生儿出生体重为2590(1790,3410)g,早产发生概率为49.81%,小于胎龄儿分娩的发生率为20.41%,与非HUA孕妇组[3300(2850,3640)g、23.09%、6.55%]比较,差异有统计学意义(P值均<0.01)。拟合曲线显示,母体尿酸水平与新生儿出生体重呈负相关,与小于胎龄儿分娩的发生风险呈正相关;尿酸水平与婴儿早产的概率呈U型关系,在200~400μmo/L时早产的发生概率最低。新生儿低出生体重(尿酸每增加10μmo/L,调整后β=-5.22,95%CI-6.46~-3.99)及小于胎龄儿分娩(调整后OR=1.03,95%CI 1.02~1.04)的发生风险随尿酸水平增加明显升高。高尿酸、高血压、羊水过少和子痫前期是不良妊娠结局的重要危险因素。当HUA母体合并高血压和子痫前期时,早产、低出生体重分娩的风险增大。结论血尿酸水平可成为预测不良妊娠结局的标志物之一,为临床干预提供理论依据。

Objective To investigate the associations between serum uric acid levels during the third trimester of pregnancy and risks of adverse pregnancy outcomes.Methods In this retrospective study,a cohort of 7995 pregnant women who were hospitalized for childbirth from January 2014 to January 2019 were collected to compare pregnancy outcomes between subjects with or without hyperuricemia(HUA).A smooth curve analysis was used to evaluate the relationship between uric acid levels and preterm delivery,low birth weight and smaller than gestational age.Logistic regression analyses were performed to identify risk factors for adverse pregnancy outcomes,and the interaction of the factors.Results During the third trimester of pregnancy,the uric acid levels of about 10%pregnant women were over 420μmol/L.In those with HUA,the median neonatal birth weight was 2590(1790,3410)g,the probability of premature birth was 49.81%,and the incidence of small than gestational age was 20.41%.These were significantly different from the women without HUA(the median neonatal birth weight:3300(2850,3640)g;the probability of premature birth 23.09%;the incidence of small than gestational age 6.55%,respectively)(All P<0.001).Maternal uric acid levels were negatively correlated with neonatal birth weight,and positively correlated with the risk of smaller than gestational age.It has a U-shaped association with the probability of premature birth,and the lowest probability of premature birth was at 200-400μmol/L of the uric acid.Risks of low birth weight(adjustedβ=-5.22,95%CI-6.46—-3.99)and smaller than gestational age(adjusted OR=1.03,95%CI 1.02-1.04)were increased in the function of uric acid levels.High uric acid,hypertension,oligoamnios and preeclampsia were important risk factors for the adverse pregnancy outcomes.The risk of preterm delivery and low birth weight enhanced when hyperuricemia combined with hypertension and preeclampsia.Conclusions Serum uric acid level can be used as one of reliable markers for predicting adverse pregnancy outcomes,which might provide theoretical basis for clinical intervention in practice.