妊娠期高血压疾病患者尿蛋白成分与妊娠结局的关系
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摘要
目的:探讨妊娠期高血压疾病患者尿蛋白成分与妊娠结局的关系。方法:回顾性分析2015年5月-2016年12月本院门诊产检的孕产妇的临床资料,选取出现妊娠期高血压疾病和蛋白尿的产妇120例为研究组,按照第一次监测出高血压的时间分为A组(<12周)、B组(12~28周)和C组(>28周),各40例;同期选取正常孕妇40例为对照组。比较四组入院准备分娩时尿液中蛋白成分;比较四组孕妇分娩结局和围生儿不良结局。结果:四组尿蛋白成分比较差异有统计学意义(X~2=45.144,P=0.000);四组剖宫产、ICP、胎盘早剥、羊水过多和产后出血比较,差异均有统计学意义(P<0.05);四组死胎、早产、低出生体重儿及胎儿宫内窘迫比较,差异均有统计学意义(P<0.05);剖宫产比例越高,出现ICP、胎盘早剥、羊水过多和产后出血比例越大,围生儿不良结局比例越高。结论:妊娠期高血压疾病出现时间越早的产妇,尿蛋白中大分子蛋白质含量越高,产妇和新生儿结局越差,提早对妊娠期高血压产妇的干预和监控,必要时可结束妊娠来减少围生期不良结局的出现。
Objective:To investigate the relationship between urinary protein components and pregnancy outcome in patients with hypertensive disorder complicating pregnancy.Method:The clinical data of pregnant women in our hospital from May 2015 to December 2016 were retrospectively analyzed,120 pregnant women with hypertension and proteinuria were selected as study group,according to the first monitoring of the time of hypertension,they were divided into A group(<12 weeks),B group(12-28 weeks) and C group(>28 weeks),40 cases in each group,and 40 cases of normal pregnant women in the same period were selected as control group.The urinary protein components in four groups at admission for delivery were compared,the outcomes of delivery and perinatal adverse outcomes in four groups were compared.Result:The urine protein components in four groups were compared,the difference was statistically significant( X~2=45.144,P=0.000).The cesarean section,ICP,placentalabruption,amniotic fluid and postpartum hemorrhagein of four groups were compared,the differences were statistically significant(P<0.05).The fetal death,premature delivery,low birth weight infants and intrauterine fetal distress in four groups were compared,the differences were statistically significant(P<0.05).The higher proportion of cesarean section,ICP,placental abruption,amniotic fluid excess and postpartum hemorrhage,the higher the proportion of perinatal adverse outcome.Conclusion:The higher the time of onset of hypertensive disorder complicating pregnancy,the higher the content of large molecular protein in urine protein,the worse the maternal and neonatal outcomes,the intervention and monitoring of maternal hypertension should be early,if necessary,the pregnancy can be terminated to reduce the occurrence of perinatal adverse outcomes.
Objective:To investigate the relationship between urinary protein components and pregnancy outcome in patients with hypertensive disorder complicating pregnancy.Method:The clinical data of pregnant women in our hospital from May 2015 to December 2016 were retrospectively analyzed,120 pregnant women with hypertension and proteinuria were selected as study group,according to the first monitoring of the time of hypertension,they were divided into A group(<12 weeks),B group(12-28 weeks) and C group(>28 weeks),40 cases in each group,and 40 cases of normal pregnant women in the same period were selected as control group.The urinary protein components in four groups at admission for delivery were compared,the outcomes of delivery and perinatal adverse outcomes in four groups were compared.Result:The urine protein components in four groups were compared,the difference was statistically significant( X~2=45.144,P=0.000).The cesarean section,ICP,placentalabruption,amniotic fluid and postpartum hemorrhagein of four groups were compared,the differences were statistically significant(P<0.05).The fetal death,premature delivery,low birth weight infants and intrauterine fetal distress in four groups were compared,the differences were statistically significant(P<0.05).The higher proportion of cesarean section,ICP,placental abruption,amniotic fluid excess and postpartum hemorrhage,the higher the proportion of perinatal adverse outcome.Conclusion:The higher the time of onset of hypertensive disorder complicating pregnancy,the higher the content of large molecular protein in urine protein,the worse the maternal and neonatal outcomes,the intervention and monitoring of maternal hypertension should be early,if necessary,the pregnancy can be terminated to reduce the occurrence of perinatal adverse outcomes.
引文
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[3]马颖,刘妍,张慧珠,等.广州市妊娠高血压综合征危险因素的病例对照研究[J].中国社会医学杂志,2013,30(4):253-255.
[4]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:293.
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[6]陈惠萍,张炯,唐政,等.妊娠与肾脏病变[J].肾脏病与透析肾移植杂志,2009,18(2):188-193,199.
[7]高志群.妊娠蛋白尿预后多因素相关分析[J].海南医学,2010,21(20):38-39,37.
[8]Naesens M,Lerut E,Emonds M P,et al.Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure:An Observational Cohort Study[J].J Am Soc Nephrol,2016,27(1):281-292.
[9]朱君玲,王艳秋.妊娠合并急性肾损伤的发生率和危险因素分析[J].中国全科医学,2011,14(2):119-121,124.
[10]许秋芳,张国平,吴冬生,等.尿微量白蛋白和血清胱抑素C检测在妊娠高血压妇女早期肾损伤诊断中的应用[J].苏州大学学报(医学版),2012,32(3):397-399.
[11]李学燕.妊娠高血压伴瘢痕子宫产妇妊娠结局分析[J].医疗装备,2016,29(1):149-150.
[12]谢爱群.护理干预对妊娠高血压分娩结局的影响[J].国际护理学杂志,2012,31(5):803-805.
[13]吴梅芳.拉贝洛尔治疗妊娠高血压的临床疗效及对分娩结局影响[J].海峡药学,2013,25(3):62-63.
[14]王大伟.蛋白尿与肾功能损伤对妊娠高血压综合征患者预后的影响[J].中国实用医刊,2016,43(9):34-35.
[15]王润梅,杨秋红,张芳,等.子痫前期患者远期预后及其后代发病风险的评估[J].山东大学学报(医学版),2017,55(12):31-35.
[16]李冠琳,杨慧霞.子痫前期的发病机制及亚型分类[J].中华围产医学杂志,2017,16(12):899-903.
[17]张文玉,苑薇,李金萍,等.先兆子痫及蛋白尿对孕产妇和围生儿结局的影响研究[J].中国妇幼保健,2016,31(22):4647-4650.
[18]申叶,杨孜,陈扬,等.轻中度妊娠期高血压孕妇的孕期血压控制和维持水平对母儿结局的影响[J].中华妇产科杂志,2017,52(9):586-593.
[19]罗玉珍.妊娠高血压综合征孕妇肾脏叶间动脉、胎儿大脑中动脉血流阻力检测联合胎心监护预测胎儿窘迫的价值[J].中国计划生育学杂志,2015,23(3):198-200.
[20]殷为,钟梅.妊娠期高血压疾病的病因、预测及诊疗进展[J].实用医学杂志,2016,32(11):1887-1890.
[2]Hale SA,Sobel B,Benvenuto A,et al.Coagulation and Fibrinolytic System Protein Profiles in Women with Normal Pregnancies and Pregnancies Complicated by Hypertension[J].Pregnancy Hypertension,2012,2(2):152-157.
[3]马颖,刘妍,张慧珠,等.广州市妊娠高血压综合征危险因素的病例对照研究[J].中国社会医学杂志,2013,30(4):253-255.
[4]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:293.
[5]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志,2015,50(10):721-728.
[6]陈惠萍,张炯,唐政,等.妊娠与肾脏病变[J].肾脏病与透析肾移植杂志,2009,18(2):188-193,199.
[7]高志群.妊娠蛋白尿预后多因素相关分析[J].海南医学,2010,21(20):38-39,37.
[8]Naesens M,Lerut E,Emonds M P,et al.Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure:An Observational Cohort Study[J].J Am Soc Nephrol,2016,27(1):281-292.
[9]朱君玲,王艳秋.妊娠合并急性肾损伤的发生率和危险因素分析[J].中国全科医学,2011,14(2):119-121,124.
[10]许秋芳,张国平,吴冬生,等.尿微量白蛋白和血清胱抑素C检测在妊娠高血压妇女早期肾损伤诊断中的应用[J].苏州大学学报(医学版),2012,32(3):397-399.
[11]李学燕.妊娠高血压伴瘢痕子宫产妇妊娠结局分析[J].医疗装备,2016,29(1):149-150.
[12]谢爱群.护理干预对妊娠高血压分娩结局的影响[J].国际护理学杂志,2012,31(5):803-805.
[13]吴梅芳.拉贝洛尔治疗妊娠高血压的临床疗效及对分娩结局影响[J].海峡药学,2013,25(3):62-63.
[14]王大伟.蛋白尿与肾功能损伤对妊娠高血压综合征患者预后的影响[J].中国实用医刊,2016,43(9):34-35.
[15]王润梅,杨秋红,张芳,等.子痫前期患者远期预后及其后代发病风险的评估[J].山东大学学报(医学版),2017,55(12):31-35.
[16]李冠琳,杨慧霞.子痫前期的发病机制及亚型分类[J].中华围产医学杂志,2017,16(12):899-903.
[17]张文玉,苑薇,李金萍,等.先兆子痫及蛋白尿对孕产妇和围生儿结局的影响研究[J].中国妇幼保健,2016,31(22):4647-4650.
[18]申叶,杨孜,陈扬,等.轻中度妊娠期高血压孕妇的孕期血压控制和维持水平对母儿结局的影响[J].中华妇产科杂志,2017,52(9):586-593.
[19]罗玉珍.妊娠高血压综合征孕妇肾脏叶间动脉、胎儿大脑中动脉血流阻力检测联合胎心监护预测胎儿窘迫的价值[J].中国计划生育学杂志,2015,23(3):198-200.
[20]殷为,钟梅.妊娠期高血压疾病的病因、预测及诊疗进展[J].实用医学杂志,2016,32(11):1887-1890.