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妊娠期蛋白尿患者蛋白尿转归及妊娠结局的危险因素分析
Risk factors of the prognoses of gestational proteinuria and pregnancy outcome
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DOI:
作者:
谢光亮,徐先明,朱琳,张燕敏,张倩楠,于青
XIE Guangliang, XU Xianming, ZHU Lin, ZHANG Yanmin, ZHANG Qiannan, YU Qing
作者单位:
上海交通大学附属第一人民医院肾内科(谢光亮、于青、朱琳、张燕敏、张倩楠),妇产科(徐先明)
Department of Nephrology, First People’s Hospital Affiliated to Shanghai Jiaotong University , Shanghai 200080, China
关键词:
妊娠;蛋白尿;肾脏损害;妊娠结局
Pregnancy; Proteinuria;Kidney injury; Pregnancy outcome
摘要:
目的 分析影响妊娠期蛋白尿患者蛋白尿转归及妊娠结局的相关因素,为改善蛋白尿的转归、降低不良妊娠结局的发生提供依据。 方法 回顾性分析上海交通大学附属第一人民医院南院产科2012年1月至2014年6月8241例住院孕妇的临床资料,其中病史资料完整的妊娠期蛋白尿患者83例,记录其临床资料、分娩信息及随访记录,采用多因素logistic回归方法分析蛋白尿转归不良的危险因素及不良妊娠结局的危险因素。 结果 83例妊娠期蛋白尿患者平均年龄为(28.5±5.2)岁。对年龄、妊娠次数、血压、血红蛋白、血浆白蛋白、肝肾功能、水肿、产检、慢性肾脏病、蛋白尿出现时间、蛋白尿严重程度等因素进行分析,logistic结果提示,妊娠前慢性肾脏病史(OR=8.921,P=0.027)、蛋白尿出现时间(OR=6.393,P=0.001)、以及蛋白尿严重程度(OR=2.737,P=0.024)是妊娠蛋白尿转归不良的危险因素;妊娠期收缩压(OR=3.834,P=0.011)、舒张压(OR=2.132,P=0.002)、蛋白尿严重程度(OR=2.899,P=0.015)是不良妊娠结局的危险因素。 结论 慢性肾脏病、蛋白尿出现时间、蛋白尿严重程度是妊娠蛋白尿转归不良的危险因素,蛋白尿严重程度是妊娠蛋白尿转归不良和不良妊娠结局的共同危险因素。
Objective To analyze the factors that impacting the prognoses of gestational proteinuria and pregnancy outcome, aiming to improve the prognoses of proteinuria and reduce the incidence rate of adverse pregnancy outcomes. Methods The clinical data of 8241 pregnant women who were admitted to obstetrical department of Shanghai First People’s Hospital Affiliated to Shanghai Jiaotong University from January 2012 to June 2014 were retrospectively analyzed. Antenatal care data, parturition records and follow-up data were identified in 83 patients with gestational proteinuria. Logistic regression was used to analyze the risk factors of poor prognoses of proteinuria and adverse pregnancy outcome. Results 83 patients with an average age of (28.5±5.2) met the inclusion criteria. The factors including age, gravidity, blood pressure, edema, hemoglobin, plasma albumin, hepatorenal function, antenatal care, chronic kidney disease, the occurrence time of proteinuria and the severity of proteinuria were analyzed by logistic regression. According to the logistic regression results, chronic kidney disease(OR=8.921,P=0.027), the occurrence time of proteinuria(OR=6.393,P=0.001) and the severity of proteinuria(OR=2.737,P=0.024) were the risk factors of poor prognoses of gestational proteinuria, and systolic pressure (OR=3.834,P=0.011), diastolic pressure(OR=2.132,P=0.002),the severity of proteinuria(OR=2.899,P=0.015) were the risk factors of adverse pregnancy outcome. Conclusion Chronic kidney disease, the occurrence time of proteinuria and the severity of proteinuria are the risk factors of poor prognoses of gestational proteinuria, the severity of proteinuria is both the risk factor of poor prognoses of gestational proteinuria and adverse pregnancy outcome.
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