摘要
目的分析子痫前期(PE)患者并发低蛋白血症的影响因素,观察其妊娠结局。方法回顾性收集并分析广州医科大学附属第六医院(清远市人民医院)2018年7月至2020年12月收治的237例PE孕妇临床资料,以是否并发低蛋白血症为依据分两组,并发低蛋白血症为观察组,未并发低蛋白血症为对照组,对两组一般情况、临床数据及母婴不良结局进行统计分析,采用logistic回归分析危险因素,并用受试者工作特征曲线(ROC)评估预测效能。结果两组一般资料比较,差异均无统计学意义(均P>0.05);多因素分析显示,D-二聚体(OR=1.25,P=0.004)、24 h尿蛋白(OR=1.29,P<0.001)及胆汁酸(TBA)(OR=1.08,P=0.010)是PE并发低蛋白血症的独立危险因素,由这3个指标构建的回归模型预测效能(ROC曲线下面积=0.855,P<0.001)大于单一指标的预测效能;母婴不良结局方面,观察组胎盘早剥(9.4%,P=0.019)、肝肾功能损害(34.4%,P<0.001)、胸腹水(28.1%,P=0.001)、胎儿宫内生长受限(FGR)(50.0%,P=0.001)、眼底病变(6.2%,P=0.018)、HELLP综合征(9.4%,P=0.019)、新生儿轻度窒息(15.6%,P=0.022)、重度窒息(6.2%,P=0.049)、代谢性酸中毒(12.5%,P=0.001)、宫内感染(12.5%,P=0.004)及新生儿住院天数超20 d(37.5%,P<0.001)等发生率均高于对照组,而在产后出血、子痫、呼吸窘迫综合征及胎儿丢失或新生儿死亡等方面,差异均无统计学意义(均P>0.05)。结论D-二聚体、24 h尿蛋白及胆汁酸是PE并发低蛋白血症的独立危险因素。PE并发低蛋白血症患者母婴不良结局发生风险高。
Objective To analyze the influential factors of hypoalbuminemia in patients with preeclampsia and observe the pregnancy outcomes.Methods The clinical data of 237 pregnant women with preeclampsia who received treatment in The Sixth Affiliated Hospital of Guangzhou Medical University(Qingyuan People's Hospital)from July 2018 to December 2020 were retrospectively collected and analyzed.These patients were divided into hypoproteinemia(observation group)and no hypoproteinemia(control group)groups according to whether they had hypoproteinemia.The general situation,clinical data,and adverse maternal and infant outcomes were statistically analyzed.Risk factors of hypoalbuminemia were analyzed using a logistic regression model.The predictive efficacy was evaluated using the receiver operating characteristic curve.Results There were no significant differences in general data between the two groups(all P>0.05).Multivariate analysis showed that D-dimer(OR=1.25,P=0.004),24-hour urinary protein(OR=1.29,P<0.001),and total bile acid(OR=1.08,P=0.010)were the independent risk factors for hypoproteinemia in preeclampsia.The predictive efficacy of these three indicators(area under the receiver operating characteristic curve=0.855,P<0.001)was greater than that of a single indicator.The incidences of adverse maternal and infant outcomes including placental abruption(9.4%,P=0.019),liver and kidney dysfunction(34.4%,P<0.001),pleural and ascitic fluid(28.1%,P=0.001),fetal intrauterine growth restriction(50.0%,P=0.001),fundus lesions(6.2%,P=0.018),HELLP syndrome(9.4%,P=0.019),mild neonatal asphyxia(15.6%,P=0.022),severe asphyxia(6.2%,P=0.049),metabolic acidosis(12.5%,P=0.001),intrauterine infection(12.5%,P=0.004),and neonatal hospitalization for more than 20 days(37.5%,P<0.001)were greater in the observation group compared with the control group.There were no significant differences in postpartum hemorrhage,eclampsia,respiratory distress syndrome,fetal loss,and neonatal death between the two groups(all P>0.05).Conclusion D-dimer,24-hour urinary protein,and total bile acid are independent risk factors for hypoproteinemia in preeclampsia.Patients with preeclampsia complicated by hypoproteinemia have a high risk of adverse maternal and infant outcomes.
作者
彭翠
佘芹
贺惠琴
成志
曾木兰
黄旭君
Peng Cui;She Qin;He Huiqin;Cheng Zhi;Zeng Mulan;Huang Xujun(Department of Obstetrics,The Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan 511518,Guangdong Province,China)
出处
《中国基层医药》
CAS
2023年第4期546-551,共6页
Chinese Journal of Primary Medicine and Pharmacy
