HELLP综合征产妇并发死产的相关因素分析

Analysis of related factors of stillbirth in pregnant women with HELLP syndrome

目的探讨HELLP综合征产妇并发死产的相关因素。方法选取2015年1月至2021年3月江西省妇幼保健院收治的84例HELLP综合征产妇作为研究对象,将新生儿死亡的19例产妇作为观察组,将新生儿存活的65例产妇作为对照组。采用logistic回归模型分析研究对象21项临床资料指标与其并发死产的相关性。结果单因素分析显示,两组患者年龄、月经初潮年龄、孕次,血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、前白蛋白(PA),血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),本次妊娠早产、胎儿窘迫、羊水过少等发生率比较,差异无统计学意义(P>0.05);观察组产次、收缩压(SBP)、舒张压(DBP),血清总胆红素(TBil)高于对照组,全血血红蛋白(Hb)、血小板计数(PLT)以及血浆纤维蛋白原(Fbg)低于对照组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,SBP、DBP、血清TBil是HELLP综合征产妇并发死产的独立危险因素(P<0.05),全血Hb、PLT以及血浆Fbg则是其独立保护因素(P<0.05)。结论HELLP综合征产妇并发死产的相关因素较多,临床可以针对性地进行干预,以改善妊娠预后。

Objective To investigate the related factors of stillbirth in pregnant women with HELLP syndrome.Methods A total of 84 cases of HELLP syndrome admitted into Jiangxi Maternal and Child Health Hospital from January 2015 to March 2021 were selected as the research objects,and 19 cases of neonatal death were defined as the observation group,while 65 cases of neonatal survival were defined as the control group.The logistic regression model was used to analyze the correlation between 21 clinical data indexes and stillbirth.Results The singe-factor analysis showed that the differences were not statistically significant in the age,menarche age,gravidity,serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(GGT)and prealbumin(PA),plasma prothrombin time(PT)and activated partial thromboplastin time(APTT),the incidence rates of premature delivery,fetal distress and oligohydramnios between the 2 groups(P>0.05).The parity,systolic blood pressure(SBP),diastolic blood pressure(DBP),serum total bilirubin(TBil)of the observation group were higher than those of the control group,while the whole blood hemoglobin(Hb),platelet(PLT)and plasma fibrinogen(Fbg)were lower than those of the control group,the differences were statistically significant(P<0.05).The multivariate logistic analysis showed that the SBP,DBP and serum TBil were independent risk factors of stillbirth in pregnant women with HELLP syndrome(P<0.05),while the whole blood Hb,PLT and plasma Fbg were independent protective factors(P<0.05).Conclusion There are many related factors of stillbirth in women with HELLP syndrome,and some clinical intervention measures can be targeted to improve the prognosis of pregnancy.