子痫前期并发胎儿生长受限的危险因素及围产儿结局分析

Maternal risk factors of preeclampsia with fetal growth restriction and its perinatal outcome

目的探讨子痫前期患者并发胎儿生长受限(FGR)的相关危险因素及其围产儿结局。方法选取2016年1月至2020年12月于北京市通州区妇幼保健院规律产检的276例子痫前期患者作为研究对象,根据其分娩新生儿的体重分为FGR组(n=126)和非FGR组(n=150)。对两组患者的基线资料、临床指标、实验室检查结果及围产儿结局进行比较,探索子痫前期并发FGR的相关危险因素。结果FGR组患者收缩压≥160mmHg、胎儿脐动脉收缩末期峰值/舒张末期峰值(S/D)升高、乳酸脱氢酶、尿酸、24h尿蛋白定量、凝血酶原时间活动度、凝血酶时间显著高于非FGR组,白蛋白、凝血酶原时间、国际标准化比率显著低于非FGR组;FGR组新生儿住院率(62.7%)高于非FGR组(13.3%),且肺透明膜病、宫内感染、贫血、心肌酶谱异常、代谢性酸中毒、低血糖症、呼吸暂停、高胆红素血症的发生率明显高于非FGR组。Logistic回归分析结果表明,子痫前期并发FGR与患者24h尿蛋白定量增加、S/D升高、收缩压≥160mmHg之间关系密切。结论子痫前期并发FGR患者的新生儿住院率高,合并症多;24h尿蛋白定量增加、S/D升高、收缩压≥160mmHg可能是子痫前期并发FGR的相关危险因素。

Objective To investigate the maternal related risk factors and perinatal outcomes of preeclampsia with fetal growth restriction(FRG).Methods 276 cases of preeclampsia patients who received regular obstetric check-up in Tongzhou District Maternal and Child Health Hospital of Beijing from January 2016 to December 2020 were selected as research subjects.According to the weight of their newborns,they were divided into FGR group(n=126)and non-FGR group(n=150).The baseline data,clinical indicators,laboratory results and perinatal outcomes of patients in the two groups were compared to explore the risk factors related to preeclampsia complicated with FGR.Results Systolic blood pressure≥160 mmHg,fetal umbilical artery end systolic peak/end diastolic peak(S/D),lactate dehydrogenase,uric acid,24 h urine protein,prothrombin time activity and thrombin time in FGR group were significantly higher than those in non-FGR group,while albumin,prothrombin time and international standardized ratio were significantly lower than those in non-FGR group.The hospitalization rate of neonates in FGR group(62.7%)was higher than that in non-FGR group(13.3%),and the incidences of hyaline membrane disease,intrauterine infection,anemia,abnormal myocardial enzyme profile,metabolic acidosis,hypoglycemia,apnea,hyperbilirubinemia were significantly higher than those in non-FGR group.Logistic regression analysis showed that the patients with preeclampsia complicated with FGR had a close relationship with the increase of 24 h urinary protein,S/D and systolic blood pressure≥160 mmHg.Conclusions The hospitalization rate of newborns with FGR in preeclampsia is high,and there are many complications.Increased 24 h urine protein,S/D and systolic blood pressure≥160 mmHg may be related risk factors of FGR in preeclampsia.