早發(fā)型子癇前期發(fā)病的危險因素及對分娩結(jié)局的影響

楊佳 吳朝勇

[關(guān)鍵詞] 早發(fā)型子癇前期;危險因素;妊娠結(jié)局;安全分娩

[中圖分類號] R714.244? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）25-0081-04

Influence analysis on risk factors and safe delivery outcome of early onset preeclampsia

YANG Jia? ?WU Chaoyong

Department of Obstetrics and Gynecology， Keqiao District Maternal and Child Health Hospital in Shaoxing in Zhejiang Province， Shaoxing? ?312030， China

[Abstract] Objective To explore the correlated risk factors and safe delivery outcome of early onset preeclampsia （EOP）. Methods A total? of 129 cases of EOP in obstetrics and gynecology department of our hospital from June 2019 to December 2020 were chosen as EOP group，and 258 cases of normal pregnancy women without EOP were randomly sampled as control group. The factors such as age， weight gain during pregnancy， history of spontaneous abortion， family history of hypertension， history of preeclampsia， without taking folic acid， hypertensive disorder complicating pregnancy （HDCP）， gestational diabetes mellitus （GDM）， anemia， infection during pregnancy， oligohydramnios， mean arterial pressure （MAP）， increased D-dimer， abnormal transaminase， vtamin E deficiency， peak end systolic/peak end diastolic ratio of uterine artery（S/D） were respectively screened by single factor and multiple factors Logistic regression method， and the difference of pregnancy outcome was compared between the two groups with χ2 test. Results The risk factors of EOP mainly included in age of pregnancy women （OR=2.477）， weight gain during pregnancy （OR=4.023）， HDCP （OR=4.568）， MAP （OR=5.171）， D-dimer increased （OR=4.328）， lack of Vitamin E （OR=3.728） and S/D ratio increased （OR=4.191）. The incidence rates of eclampsia， placental abruption， fetal distress， neonatal asphyxia and cesarean section in the EOP group were all higher than the control group （P<0.05）. Conclusion There are many risk factors affecting the incidence of EOP， and exist interaction among them. Furthermore， the incidence of EOP will seriously affect the pregnancy outcome. To aim directly at these high risk factors， we should early discover， early diagnose， early intervene and treat it， to improve pregnancy outcome of mother and baby.

[Key words] Early onset preeclampsia （EOP）; Risk factors; Pregnancy outcome; Safe delivery

早發(fā)型子癇前期（Early onset preeclampsia，EOP）是孕34周前發(fā)生高血壓、水腫、蛋白尿等癥狀，EOP具有發(fā)病早、病情進(jìn)展較快、并發(fā)癥多且重、妊娠結(jié)局差等特點[1]，已成為婦產(chǎn)科醫(yī)生面臨的難題之一。EOP的發(fā)生和發(fā)展可能與基因多態(tài)性和基因表達(dá)異常、氧化應(yīng)激、滋養(yǎng)層細(xì)胞功能發(fā)生異常、胎盤形態(tài)學(xué)異常、血管內(nèi)皮細(xì)胞炎性反應(yīng)、胎盤毒性物質(zhì)釋放增加等密切相關(guān)[2]，但具體病因機(jī)制仍尚未明確。由于EOP發(fā)病的孕齡一般相對較早，此階段胎兒的各項器官功能尚未發(fā)育成熟，若能在妊娠中早期就發(fā)現(xiàn)孕婦有關(guān)EOP的高危因素，有針對性的預(yù)防和干預(yù)治療，嚴(yán)密監(jiān)測母嬰安全的前提下盡量延長孕齡，可一定程度上改善母嬰妊娠結(jié)局[3]。為此，本研究對129例EOP病例和258名正常孕產(chǎn)婦進(jìn)行回顧性調(diào)查，篩選影響EOP發(fā)病的相關(guān)高危因素，并分析EOP對母嬰妊娠結(jié)局的影響，現(xiàn)報道如下。