妊娠合并肺动脉高压病因构成及妊娠结局

Study of Current Pathogenesis and the Pregnancy Outcomes of Pregnancy with Pulmonary Arterial Hypertension

目的探讨妊娠合并肺动脉高压(pulmonary arterial hypertension, PAH)患者的原发病构成及妊娠结局。方法收集2015年1月至2018年12月浙江大学医学院附属医院第一医院产科收治的妊娠合并PAH患者38例,根据肺动脉压力情况分为轻度组14例,中度组13例,重度组11例。并分析其病因及妊娠结局。结果本研究中妊娠合并肺动脉高压的主要病因包括:先天性心脏病占23例(60.5%),风湿性心瓣膜病10例(26.3%)。先天性心脏病及风湿性心脏病患者肺动脉高压的轻、中、重度构成比上无显著差异(χ~2=2.009,P=0.366)。妊娠结局包括医源性流产12例,早产19例,足月产7例。顺利分娩的患者中,重度PAH组分娩孕周及apgar评分均低于轻中度PAH组(P=0.011,P=0.001),差异有统计学意义。结论先天性心脏病和风湿性心瓣膜病可能是妊娠合并肺动脉高压最常见的病因,肺动脉压力越高,分娩孕周越小,医源性早产率随之增加;新生儿评分越低,新生儿窒息率随之增加。对病因的早期识别诊断便于孕期综合管理,以取得良好母婴结局。

Objective To explore current pathogenesis of pregnancy with pulmonary arterial hypertension(PAH)and the pregnancy outcomes.Method The clinical data of 38 pregnant women with PAH were collected in the first affiliated Hospital of Zhejiang University between Jan 2015 to Dec 2018.The patients were divided into three groups according to the degree of pulmonary artery hypertension:mild group 14 cases,moderate group 13 cases,severe group 11 cases.The pathogenesis and the pregnancy outcome were analysis.Results In this study,the common primary diseases of PAH were congenital heart disease(23,60.5%)and rheumatic heart disease(10,26.3%).Congenital heart disease and rheumatic heart disease showed no significant difference at the constituent ratio of the three grade of pulmonary hypertension(χ~2=2.009,P=0.366).Pregnancy outcomes included 12 cases of iatrogenic abortion,19 cases of premature delivery,and 7 cases of full-term birth.Between patients who had a successful delivery,the delivery gestational weeks and the apgar scores of the severe group were significantly below than those of mild and moderate group(P=0.011,P=0.001).Conclusion Congenital heart disease and rheumatic heart disease may be the most common cause for pregnancy women with PAH.The higher the pulmonary artery pressure,the higher the iatrogenic premature rate and the lower the neonatal score.Early identification and diagnosis of the pathogenesis can facilitate comprehensive management of the pregnant women with pulmonary hypertension to achieve a good maternal and child ending.