Outcome and risk factors of early onset severe preeclampsia

Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.

早发与晚发型重度子痫前期对围产儿结局影响

目的探讨早发型重度子痫前期与晚发型重度子痫前期对围产儿的影响。方法选择2008年10月。2009年10月在甘肃省妇幼保健院治疗的早发型重度子痫前期孕妇32例，随访其围产儿的，临床结局和预后，与同期随机选取的45例晚发型重度子痫前期孕妇的围产儿结局进行比较。结果早发型重度子痫前期组的剖宫产率、羊水污染率、新生儿窒息率、围产儿死亡率与晚发型重度子痫前期组比较，差异均有统计学意（X^2分别为8。342、6．301、9．692、12．485，均P〈0．05）；早发型重度子痫前期组的分娩孕周和出生体重与晚发型重度子痫前期组比较，差异亦均有统计学意义（t分别为－3．559、－7．077，均P〈0．05）。结论对于重度子痫前期孕妇，发病孕周越小，胎儿窘迫、新生儿窒息、围产儿死亡、早产的发生率越高。因此在保证母亲安全的前提下，尽量延长孕周，可显著改善围产儿不良结局，提高新生儿的生存率。

胰岛素生长因子-1与早发型重度子痫前期

目的 探讨胰岛素样生长因子-1与早发型重度子痫前期的关系.方法 采用放免法测定研究组（早发型重度子痫前期）和对照组母血、脐血胰岛素样生长因子-1水平,免疫组化法测定胎盘中胰岛素样生长因子-1表达水平.结果 研究组母血胰岛素样生长因子-1（160.32±21.03 vs 230.21±31.09μg/L）、脐血胰岛素样生长因子-1水平（41.21±20.51 vs 80.57±19.39μg/L）、胎盘中胰岛素样生长因子-1表达水平（平均灰度71.13±30.59 vs 110.54±28.91）水平明显低于对照组（P〈0.01）,且母血胰岛素样生长因子-1水平与脐血、胎盘及新生儿出生体重成正相关（相关系数r值分别为0.36,0.44,0.61,P〈0.05）.结论 早发型重度子痫前期的发生与胰岛素样生长因子-1的水平降低有关.

半夏白术天麻汤联合小剂量低分子肝素钙对早发型重度子痫前期患者凝血功能及母婴结局的影响

【目的】探讨半夏白术天麻汤联合小剂量低分子肝素钙对早发型重度子痫前期(EOSP)患者凝血功能及母婴结局的影响。【方法】按患者自愿原则将106例EOSP患者分为肝素组51例和试验组55例。2组患者均给予常规综合治疗(包括解痉、降压、促进胎肺成熟和支持治疗等),在此基础上,对照组给予小剂量低分子肝素钙治疗,试验组给予半夏白术天麻汤联合小剂量低分子肝素钙治疗,疗程为1周,并随访至分娩后3个月。观察2组患者治疗前后凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)等凝血功能指标的变化情况,并比较2组患者的终止妊娠时间、产后2 h出血量、分娩方式、并发症发生率及围生儿结局等母婴结局情况。【结果】(1)治疗后,2组患者的PT、APTT、TT均较治疗前延长(P<0.05),但组间比较,试验组的PT、APTT、TT均明显短于对照组,差异均有统计学意义(P<0.01)。(2)经随访,试验组患者的终止妊娠时间长于对照组,差异有统计学意义(P<0.01),而2组患者的产后2 h出血量、分娩方式以及围生儿结局和并发症发生率比较,差异均无统计学意义(P>0.05)。【结论】半夏白术天麻汤联合小剂量低分子肝素钙治疗,可调节EOSP患者凝血功能,改善母婴结局。

Incidence and Clinical Risk Factors for Preeclampsia and Its Subtypes:A Population-Based Study in Beijing,China

Objective:This study aimed to evaluate the incidence and associated clinical risk factors for preeclampsia(PE)and its subtypes in a large multicentre retrospective study of Beijing,China.Methods:This study was conducted as a secondary analysis from the Gestational diabetes mellitus Prevalence Survey(GPS),a multicentre retrospective cohort study,which included 15 hospitals in Beijing,China.This analysis included 15,003 pregnant women who delivered in Beijing from June 20th to November 30th,2013.The incidence of PE was calculated.Risk factors for PE,including maternal age,pre-gestational body mass index(BMI),parity,chronic hypertension,pre-existing diabetes,and gestational diabetes mellitus,were assessed.PE was defined as early-or late-onset PE based on clinical manifestations during the week of delivery,and mild or severe PE based on the severity of the disease.Logistic regression analysis was used to quantify the association with the risk factors,and data were displayed as odds risks(OR)and 95%confidence interval(CI).Results:The overall incidence of PE was 2.65%(397/15,003).The prevalence of early-onset and late-onset PE was 0.36%(54/15,003)and 2.29%(343/15,003),respectively.The prevalence of mild and severe PE was 0.91%(137/15,003)and 1.73%(260/15,003),respectively.Risk factors including high BMI considered overweight(adjusted odds risk(aOR):1.48;95%CI:1.06-2.05;P=0.02)and obesity(aOR:2.15;95%CI:1.50-3.08;P<0.001),nulliparity(aOR:1.73;95%CI:1.32-2.25;P<0.001),multiple gestation(aOR:4.58;95%CI:2.86-7.32;P<0.001),and chronic hypertension(aOR:34.95;95%CI:26.60-45.93;P<0.001),were associated with increased risk for PE.Only chronic hypertension(aOR:13.75;95%CI:4.78-39.58;P<0.001)was a significant risk factors for early-onset PE,whereas high BMI considered both overweight(aOR:1.54;95%CI:1.09-2.18;P=0.01)and obesity(aOR:2.23;95%CI:1.53-3.27;P<0.001),nulliparity(aOR:2.00;95%CI:1.49-2.68;P<0.001),multiple gestation(aOR:4.11;95%CI:2.40-7.05;P<0.001),and chronic hypertension(aOR:35.57;95%CI:26.66-47.47;P<0.001)were more relevant risk factors for late-onset PE.Risk factors including obesity(aOR:2.20;95%CI:1.28-3.76;P<0.01 and aOR:1.80;95%CI:1.16-2.80;P=0.01),nulliparity(aOR:2.28;95%CI:1.44-3.60;P<0.001 and aOR:1.48;95%CI:1.09-2.02;P=0.01),multiple gestation(aOR:5.50;95%CI:2.87-10.67;P<0.001 and aOR:3.51;95%CI:1.93-6.41;P<0.001),and chronic hypertension(aOR:33.98;95%CI:22.20-52.01;P<0.001 and aOR:35.03;95%CI:25.40-48.31;P<0.001)were associated with mild and severe PE.Moreover,we found that women with an increasing number of these risk factors had a higher risk of developing PE than pregnant women without any identified risk factors.Conclusion:The incidence of PE in this study is consistent with previous reported studies.Our findings indicate chronic hypertension and multiple gestation are the most important risk factors for PE in Chinese pregnant women.The risk for developing PE is associated with both the type and abundance of risk factors.These factors are valuable when monitoring patients at risk for PE,as this can help ensure an earlier diagnosis and prediction in women who are more likely to develop PE.

早发型重度子痫前期患者胎盘组织Wnt信号通路抑制因子SFRP4基因甲基化水平及其差异表达

目的 探究早发型重度子痫前期(EOSPE)患者胎盘组织Wnt信号通路抑制因子SFRP4基因甲基化水平及其差异表达。方法 回顾性分析海口市第四人民医院2017年1月至2022年1月收治的具有完整资料的EOSPE病例80例,EOPE病例70例,经1∶1倾向性匹配评分后最终纳入研究EOSPE和EOPE病例各41例。定量PCR和免疫组化检测41例EOSPE孕妇和41例EOPE孕妇胎盘中SFRP4的mRNA和蛋白的表达情况,并采用甲基化特异性PCR(MSPCR)检测SFRP4甲基化情况。并同时使用RT-qPCR和免疫组化检测Wnt信号通路下游Wnt1和Wnt2的mRNA和蛋白表达。构建过表达SFRP4慢病毒转染滋养细胞HTR-8细胞,CCK-8、划痕实验和Transwell小室侵袭实验检测过表达SFRP4的HTR-8细胞的增殖、迁移和侵袭能力。结果 EOSPE组胎盘中的SFRP4的mRNA和蛋白表达均显著高于EOPE组,而EOSPE组胎盘组织的SFRF4甲基化率显著低于EOPE组(17.14%vs 63.33%,P=0.000),SFRF4蛋白表达水平与其启动子区域的甲基化程度呈负相关(r=-0.822,P=0.000)。EOSPE组胎盘组织的Wnt1和Wnt2的mRNA和蛋白表达均显著低于EOPE组。过表达SFRP4的HTR-8细胞增殖和侵袭能力显著下降。结论 SFRP4在EOSPE中甲基化水平降低,且SFRP4表达增加,抑制Wnt信号通路促进EOSPE的发病。

早发型重度子痫前期发病对母儿结局影响的研究

目的研究不同孕周早发型重度子痫前期(EOSP)的临床治疗及对母儿结局的影响。方法回顾性分析2012年收治的EOSP临床资料88例,据发病孕周分为远离足月组(孕28~31+6周)34例和近足月组(孕32~34周)54例,比较两组的期待治疗时间、并发症及围产儿结局。结果远离足月组并发症发生率(91.2%)高于近足月组(44.4%);胎儿窘迫、胎儿生长受限、新生儿窒息和围产儿病死率高于近足月组;发病孕周早是EOSP发生并发症的危险因素(OR=1.57),终止妊娠孕周数小是EOSP不良围产结局的危险因素(OR=1.23)。结论 EOSP病情复杂,发病时间越早孕妇并发症越多、围产儿预后越差。应早发现、早诊断、积极治疗,以获得良好的母儿结局。