慢性肾脏病患者妊娠结局的Meta分析

Pregnancy outcomes in patients with chronic kidney disease:a Meta analysis

目的系统评价慢性肾脏病合并妊娠的患者对妊娠结局的影响。方法计算机检索MEDLINE、EMBASE、万方数据库、中国知网、中国生物医学等数据库中自建库以来至2023年7月31日公开发表的慢性肾脏病合并妊娠对妊娠结局影响的相关文献,由2名研究人员独立筛选文献、提取资料、纳入文献质量评价,采用Review Manager 5.3和STATA 17.0软件进行Meta分析。结果最终纳入15个病例对照研究及队列研究2785115例受试者的妊娠结果。Meta分析结果显示妊娠不良结局:(1)CKD会增加妊娠不良结局发生的风险,导致子痫前期(OR=3.65,95%CI:1.88~7.12)、妊娠期高血压(OR=6.29,95%CI:2.58~15.32)、早产(OR=4.62,95%CI:2.78~7.67)、小于胎龄儿(OR=1.54,95%CI:1.24~1.91)、低出生体重儿(OR=2.44,95%CI:1.78~3.35)发生的风险增加。(2)CKD3~5期患者相比较于CKD1~2期患者更容易发生重症子痫前期(OR=2.31,95%CI:1.35~3.94)、早产(OR=5.06,95%CI:3.28~7.79)、小于胎龄儿(OR=3.85,95%CI:1.91~7.76)、低出生体重儿(OR=2.90,95%CI:1.37~6.13)、胎儿死亡(OR=3.41,95%CI:1.33~8.73)等不良妊娠结局。(3)大量蛋白尿的妊娠患者相较于少量蛋白尿的患者更容易发生重度子痫前期(OR=2.76,95%CI:1.89~4.04)、妊娠期高血压(OR=2.38,95%CI:1.62~3.50)、早产(OR=3.84,95%CI:2.69~5.47)、低出生体重儿(OR=2.38,95%CI:1.62~3.50)、胎儿死亡(OR=2.36,95%CI:1.37~4.05)等妊娠不良结局。结论慢性肾脏病可以增加妊娠患者发生子痫前期、妊娠期高血压、早产、小于胎龄儿、低出生体重儿等妊娠不良结局的风险,且CKD3~5期/24 h蛋白尿≥1 g的妊娠患者相较于CKD1~2期/24 h蛋白尿<1 g的妊娠患者更容易导致妊娠不良结局的发生。

Objective To systematically evaluate the impact of chronic kidney disease(CKD)on pregnancy outcomes in pregnant patients.Methods Computer searching was conducted within the databases of MEDLINE,EMBASE,WANFANG DATA,China National Knowledge Infrastructure(CNKI)and China Biomedical Literature Database(CBM)from the establishment to July 2023 to identify the relevant literature items on the impact of CKD on pregnancy outcomes in pregnant patients.Two researchers independently screened the literature,extracted data and evaluated the quality of the included studies.Meta-analysis was performed with Review Manager 5.3 and STATA 17.0 software.Results A total of 15 case-control and cohort studies,including 2,785,115 subjects,were included for final analysis.The results of Meta-analysis demonstrated the following adverse pregnancy outcomes:CKD elevated the risk of adverse pregnancy outcomes,including preeclampsia(OR=2.68,95%CI:1.47-4.89),gestational hypertension(OR=6.29,95%CI:2.58-15.32),preterm birth(OR=4.62,95%CI:2.78-7.67),small for gestational age(OR=1.54,95%CI:1.24-1.91)and low birth weight(OR=2.44,95%CI:1.78-3.35).CKD stage 3-5 patients were more prone to severe preeclampsia(OR=2.31,95%CI:1.35-3.94),preterm birth(OR=5.06,95%CI:3.28-7.79),small for gestational age(OR=3.85,95%CI:1.91-7.76),low birth weight(OR=2.90,95%CI:1.37-6.13)and fetal mortality(OR=3.41,95%CI:1.33-8.73)as compared with CKD stage 1-2 counterparts.Pregnant patients with massive proteinuria were more prone to severe preeclampsia(OR=2.76,95%CI:1.89-4.04),gestational hypertension(OR=2.38,95%CI:1.62-3.50),preterm birth(OR=3.84,95%CI:2.69-5.47),low birth weight(OR=2.38,95%CI:1.62-3.50)and fetal mortality(OR=2.45,95%CI:1.44-4.17)as compared with those with mild proteinuria.Conclusion CKD elevates the risk of adverse pregnancy outcomes,including preeclampsia,gestational hypertension,preterm birth,small for gestational age and low birth weight.Pregnant patients with CKD stage 3-5 or massive proteinuria(≥1 g)are more prone to adverse pregnancy outcomes as compared with those with CKD stage 1-2 or mild proteinuria(<1 g).