摘要
目的探讨妊娠合并慢性肾脏疾病患者的围产结局，以及不良围产结局的相关危险因素。方法回顾性分析北京大学人民医院1998年1月至2010年8月收治的48例妊娠合并慢性。肾脏疾病患者的临床资料，总结其妊娠结局，并分析不良围产结局的危险因素。结果48例妊娠合并慢性肾脏疾病患者中，38例患者孕前有明确的慢性肾脏疾病病史，10例为孕期诊断。7例（15％，7／48）患者孕前肾功能明显异常[血清肌酐（sCr）≥125μmol／L]，9例（19％，9／48）合并慢性高血压。33例患者孕期有规律的产前检查。孕期并发子痫前期者共21例（44％，21／48）。孕期肾功能正常者（sCr〈71μmol／L）19例（40％，19／48），轻度肾功能不全者（sCr71～132μmol／L）20例（42％，20／48），中～重度肾功能不全者（sCr≥132μmol／L）9例（19％，9／48）。尿蛋白正常～轻度升高者（24h尿蛋白〈2000mg）20例，中度升高者（24h尿蛋白2000～5000mg）19例，重度升高者（24h尿蛋白≥5000mg）9例。终止妊娠孕周为24～41周，新生儿出生体质量890～4150g。出现不良围产结局（包括晚期流产1例、早产15例、小于胎龄儿11例、新生儿呼吸窘迫综合征2例、围产儿死亡4例）共计20例（42％，20／48）。8例患者产后肾功能较孕前明显恶化，2例进展为肾功能衰竭尿毒症期。多因素分析显示，孕期并发子痫前期（OR=24．72，P=0．002）及尿蛋白分度（OR=4．24，P=0．032）是不良围产结局的独立危险因素。结论慢性肾脏疾病患者妊娠期间子痫前期及不良围产结局的发生率均显著增加。其中，孕期并发子痫前期及尿蛋白水平可能是不良围产结局的独立危险因素。
Objective To investigate the perinatal outcome for pregnancies complicated with chronic renal diseases, and the risk factors for the adverse outcome. Methods Retrospectively analyze the clinical data of 48 patients with chronic renal diseases complicating pregnancy admitted in Peking University People＇s Hospital between January 1998 and August 2010, record the pregnancy outcome and explore the risk factors for the poor outcome using multivariate regression analysis. Results Thirty-eight patients had known chronic renal disease before conception, and ten were diagnosed during pregnancy. Seven patients （15%, 7/48 ） presented with obvious renal impairment [ serum creatinine （sCr） ≥ 125 μmol/L] prepregnancy, and nine （19%, 9/48 ） were recorded with chronic hypertension. Thirty-three patients received regular prenatal care. Twenty-one cases （44%, 21/48 ） developed preeclampsia. During the gestation, normal renal function （defined as sCr 〈71 μmol/L） was seen in nineteen cases （40% , 19/48）, mild dysfunction （sCr ranged 71 -132μmol/L） in twenty （42%, 20/48） and moderate to severe dysfunction （ sCr ≥ 132 μmol/L ） in nine cases （ 19%, 9/48 ）. Twenty patients had negative or mild proteinuria （ 24 hour urine protein 〈 2000 mg） , 19 had moderate （24 hour urine protein ranged 2000 - 5000 mg） and nine had severe proteinuria （24 hour urine protein ≥5000 mg）. The gestational age at delivery ranged from 24 to 41 weeks and the neonatal birth weight ranged from 890 to 4150 g. A total of twenty patients （42%, 20/48 ） suffered adverse perinatal outcome, including one case with late spontaneous abortion, fifteen with preterm delivery, eleven with small for gestational age, two with neonatal respiratory distress syndrome and four with perinatal death. Declined maternal renal function was seen in eight patients,and two patients progressed toward the end-stage renal failure （the stage of uremia）. Multivariate regression analysis identified that preeclampsia （ OR = 24. 72, P = 0. 002 ） and the degree of proteinuria （ OR = 4. 24, P = 0. 032） were the independent risk factors for the adverse perinatal outcome. Conclusions Pregnancies complicated with chronic renal diseases have significantly high incidence of preeclampsia and adverse perinatal outcome. Preeclampsia and the degree of proteinuria are perhaps the independent risk factors for the adverse outcome.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2012年第3期161-165,共5页
Chinese Journal of Obstetrics and Gynecology
关键词
妊娠合并症
肾功能不全
慢性
先兆子痫
妊娠结局
危险因素
Pregnancy complications
Renal insufficiency, chronic
Pre-eclampsia
Pregnancy outcome
Risk factors
