101例慢性肾脏病患者妊娠的结局及影响因素
|
摘要
目的:观察慢性肾脏病(CKD)患者妊娠后胎儿和母亲的结局,并分析相关的影响因素。方法:回顾性分析国家肾脏疾病临床医学研究中心2010年1月至2018年8月间101例CKD妊娠患者,在同期非CKD妊娠女性中随机选取350例为对照组,根据估算的肾小球滤过率(eGFR)值将CKD患者分为肾功能正常组(CKD 1期,n=84)和肾功能异常组(CKD 2～4期,n=17)。分析并比较肾功能正常组与对照组间,及肾功能异常组与肾功能正常组间胎儿及母亲结局发生率及其影响因素。结果:(1)肾功能正常组早产、剖宫产的发生率高于对照组,肾功能异常组早产、早早产、小于胎龄儿(SGA)、新生儿重症监护病房(NICU)、剖宫产发生率高于肾功能正常组。(2)CKD 2～4期是早早产、NICU、剖宫产的独立危险因素,尿蛋白≥1 g/24h、高血压是早产的独立危险因素,年龄是剖宫产的独立危险因素。(3)肾功能异常组患者产后血清肌酐(SCr)增高、eGFR下降,肾功能正常组患者妊娠前和产后的SCr、eGFR无明显差异。两组CKD患者产后中位尿蛋白水平较妊娠前均显著增加。结论:与非CKD女性相比,CKD患者妊娠胎儿及母亲出现不良结局的风险上升,且随着肾功能的进展,不良妊娠结局的发生率增加。
Objective:To analyse the risk factors of adverse pregnancy outcomes in women with chronic kidney disease(CKD). Methodology:The analysis was retrospective,101 pre-pregnancy CKD female patients who achieved singleton pregnancy were collected in our unit from January 2010 to August 2018. 350 pregnancies without CKD were collected as the control group. CKD patients were divided into normal renal function group(CKD stage 1,n=84) and renal dysfunction group(CKD stage 2～4,n=17) according to estimated golmerular filtration rate(eGFR).Fetal and maternal outcomes were analyzed between the CKD 1 stage and the control group,CKD 2～4 stage and CKD 1 stage. Results:(1)The incidence of preterm,cesarean section are higher in normal renal function group than in the control group. Renal dysfunction group had higher incidence of preterm,early preterm,small for gestational age infant(SGA),neonatal intensive care unit(NICU),cesarean section than in the normal renal function group.(2)CKD 2～4 stage is an independent risk factor for early premature labour,NICU,and cesarean section. Baseline proteinuria≥1 g/24 h and baseline hypertension are independent risk factors for preterm,and age is an independent risk factor for cesarean section.(3)In renal dysfunction group,serum creatinine increased and eGFR decreased postpartum. There was no significant difference in serum creatinine and eGFR between pre-pregnancy and postpartum in patients with normal renal function. Postpartum median proteinuria in both CKD groups was significantly higher than that before pregnancy. Conclusion:Compared with women without CKD,CKD patients have an increased risk of fetal and maternal adverse outcomes,and the incidence of adverse pregnancy outcomes increases with progression of renal function.
Objective:To analyse the risk factors of adverse pregnancy outcomes in women with chronic kidney disease(CKD). Methodology:The analysis was retrospective,101 pre-pregnancy CKD female patients who achieved singleton pregnancy were collected in our unit from January 2010 to August 2018. 350 pregnancies without CKD were collected as the control group. CKD patients were divided into normal renal function group(CKD stage 1,n=84) and renal dysfunction group(CKD stage 2～4,n=17) according to estimated golmerular filtration rate(eGFR).Fetal and maternal outcomes were analyzed between the CKD 1 stage and the control group,CKD 2～4 stage and CKD 1 stage. Results:(1)The incidence of preterm,cesarean section are higher in normal renal function group than in the control group. Renal dysfunction group had higher incidence of preterm,early preterm,small for gestational age infant(SGA),neonatal intensive care unit(NICU),cesarean section than in the normal renal function group.(2)CKD 2～4 stage is an independent risk factor for early premature labour,NICU,and cesarean section. Baseline proteinuria≥1 g/24 h and baseline hypertension are independent risk factors for preterm,and age is an independent risk factor for cesarean section.(3)In renal dysfunction group,serum creatinine increased and eGFR decreased postpartum. There was no significant difference in serum creatinine and eGFR between pre-pregnancy and postpartum in patients with normal renal function. Postpartum median proteinuria in both CKD groups was significantly higher than that before pregnancy. Conclusion:Compared with women without CKD,CKD patients have an increased risk of fetal and maternal adverse outcomes,and the incidence of adverse pregnancy outcomes increases with progression of renal function.
引文
1 Piccoli GB,Conijn A,Attini R,et al.Pregnancy in chronic kidney disease:need for a common language.J Nephrol,2011,24(3):282-299.
2 Davidson NL,Wolski P,Callaway LK,et al.Chronic kidney disease in pregnancy:Maternal and fetal outcomes and progression of kidney disease.Obstet Med,2015,8(2):92-98.
3 Bharti J,Vatsa R,Singhal S,et al.Pregnancy with chronic kidney disease:maternal and fetal outcome.Eur J Obstet Gynecol Reprod Biol,2016,204:83-87.
4 Fischer MJ,Lehnerz SD,Hebert JR,et al.Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy.Am J Kidney Dis,2004,43(3):415-423.
5 Bramham K1,Briley AL,Seed PT,et al.Pregnancy outcome in women with chronic kidney disease:a prospective cohort study.Reprod Sci,2011,18(7):623-630.
6 Piccoli GB,Attini R,Vasario E,et al.Pregnancy and chronic kidney disease:a challenge in all CKD stages.Clin J Am Soc Nephrol,2010,5(5):844-855.
7 Krane NK,Hamrahian M.Pregnancy:kidney diseases and hypertension.Am J Kidney Dis,2007,49(2):336-345.
8 Cabiddu G,Castellino S,Gernone G,et al.A best practice position statement on pregnancy in chronic kidney disease:the Italian Study Group on Kidney and Pregnancy.J Nephrol,2016,29(3):277-303.
9 Piccoli GB,Attini R,Cabiddu G,et al.Maternal-foetal outcomes in pregnant women with glomerulonephritides.Are all g￣l￣o￣m￣e￣r￣u￣l￣o￣n￣e￣p￣h￣r￣i￣t￣i￣d￣e￣s alike in pregnancy?J Autoimmun,2017,79:91-98.
10 Kendrick J,Sharma S,Holmen J,et al.Kidney disease and maternal and fetal outcomes in pregnancy.Am J Kidney Dis,2015,66(1):55-59.
11 Alsuwaida A,Mousa D,Al-Harbi A,et al.Impact of early chronic kidney disease on maternal and fetal outcomes of pregnancy.J Matern Fetal Neonatal Med,2011,24(12):1432-1436.
12 南京总医院,国家肾脏疾病临床医学研究中心.慢性肾脏病患者妊娠管理指南.中华医学杂志,2017,97(46):3604-3611.
13 Li Y,Wang W,Wang Y,et al.Fetal Risks and Maternal Renal Complications in Pregnancy with Preexisting Chronic G￣l￣o￣m￣e￣r￣u￣l￣o￣n￣e￣p￣h￣r￣i￣t￣i￣s.Med Sci Monit,2018,24:1008-1016.
14 Piccoli GB1,Fassio F,Attini R,et al.Pregnancy in CKD:whom should we follow and why?Nephrol Dial Transplant,2012,27 Suppl 3:iii111- iii118.
15 Piccoli GB,Cabiddu G,Attini R,et al.Risk of Adverse Pregnancy Outcomes in Women with CKD.J Am Soc Nephrol,2015,26(8):2011-2022.
16 Piccoli GB,Cabiddu G,Attini R,et al.Hypertension in CKD Pregnancy:a Question of Cause and Effect (Cause or Effect?This Is the Question).Curr Hypertens Rep,2016,18(5):35.
17 Piccoli GB,Cabiddu G,Attini R,et al.Pregnancy in Chronic Kidney Disease:questions and answers in a changing panorama.Best Pract Res Clin Obstet Gynaecol,2015,29(5):625-642.
18 Su X,Lv J,Liu Y,et al.Pregnancy and Kidney Outcomes in Patients With IgA Nephropathy:A Cohort Study.Am J Kidney Dis,2017,70(2):262-269.
2 Davidson NL,Wolski P,Callaway LK,et al.Chronic kidney disease in pregnancy:Maternal and fetal outcomes and progression of kidney disease.Obstet Med,2015,8(2):92-98.
3 Bharti J,Vatsa R,Singhal S,et al.Pregnancy with chronic kidney disease:maternal and fetal outcome.Eur J Obstet Gynecol Reprod Biol,2016,204:83-87.
4 Fischer MJ,Lehnerz SD,Hebert JR,et al.Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy.Am J Kidney Dis,2004,43(3):415-423.
5 Bramham K1,Briley AL,Seed PT,et al.Pregnancy outcome in women with chronic kidney disease:a prospective cohort study.Reprod Sci,2011,18(7):623-630.
6 Piccoli GB,Attini R,Vasario E,et al.Pregnancy and chronic kidney disease:a challenge in all CKD stages.Clin J Am Soc Nephrol,2010,5(5):844-855.
7 Krane NK,Hamrahian M.Pregnancy:kidney diseases and hypertension.Am J Kidney Dis,2007,49(2):336-345.
8 Cabiddu G,Castellino S,Gernone G,et al.A best practice position statement on pregnancy in chronic kidney disease:the Italian Study Group on Kidney and Pregnancy.J Nephrol,2016,29(3):277-303.
9 Piccoli GB,Attini R,Cabiddu G,et al.Maternal-foetal outcomes in pregnant women with glomerulonephritides.Are all g￣l￣o￣m￣e￣r￣u￣l￣o￣n￣e￣p￣h￣r￣i￣t￣i￣d￣e￣s alike in pregnancy?J Autoimmun,2017,79:91-98.
10 Kendrick J,Sharma S,Holmen J,et al.Kidney disease and maternal and fetal outcomes in pregnancy.Am J Kidney Dis,2015,66(1):55-59.
11 Alsuwaida A,Mousa D,Al-Harbi A,et al.Impact of early chronic kidney disease on maternal and fetal outcomes of pregnancy.J Matern Fetal Neonatal Med,2011,24(12):1432-1436.
12 南京总医院,国家肾脏疾病临床医学研究中心.慢性肾脏病患者妊娠管理指南.中华医学杂志,2017,97(46):3604-3611.
13 Li Y,Wang W,Wang Y,et al.Fetal Risks and Maternal Renal Complications in Pregnancy with Preexisting Chronic G￣l￣o￣m￣e￣r￣u￣l￣o￣n￣e￣p￣h￣r￣i￣t￣i￣s.Med Sci Monit,2018,24:1008-1016.
14 Piccoli GB1,Fassio F,Attini R,et al.Pregnancy in CKD:whom should we follow and why?Nephrol Dial Transplant,2012,27 Suppl 3:iii111- iii118.
15 Piccoli GB,Cabiddu G,Attini R,et al.Risk of Adverse Pregnancy Outcomes in Women with CKD.J Am Soc Nephrol,2015,26(8):2011-2022.
16 Piccoli GB,Cabiddu G,Attini R,et al.Hypertension in CKD Pregnancy:a Question of Cause and Effect (Cause or Effect?This Is the Question).Curr Hypertens Rep,2016,18(5):35.
17 Piccoli GB,Cabiddu G,Attini R,et al.Pregnancy in Chronic Kidney Disease:questions and answers in a changing panorama.Best Pract Res Clin Obstet Gynaecol,2015,29(5):625-642.
18 Su X,Lv J,Liu Y,et al.Pregnancy and Kidney Outcomes in Patients With IgA Nephropathy:A Cohort Study.Am J Kidney Dis,2017,70(2):262-269.