摘要
目的探讨高龄与非高龄并发子痫前期的孕妇之间围生儿不良妊娠结局发病率的差异。方法采用计算机和手工检索主题词的方法,检索PubMed、Web of Science、中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库中2017年11月26日前国内外发表的关于高龄与非高龄并发子痫前期孕妇的妊娠结局相关研究。采用Cochrane评价手册推荐的非随机对照研究系统评价工具对纳入文献进行质量评价。Meta分析采用Revman5.3软件,根据文献的异质性采用固定效应模型或随机效应模型分析。结果最后总共纳入10篇文献,共3 205例高龄妊娠合并子痫前期,16 752例非高龄妊娠合并子痫前期。结果显示高龄妊娠合并子痫前期组发生率高于对照组的妊娠结局有:胎盘早剥(9项研究,OR=2.01,95%CI:1.42～2.86)、产后出血(9项研究,OR=1.50,95%CI:1.06～2.13)、早产(7项研究,OR=1.60,95%CI:1.45～1.76)、子痫(4项研究,OR=2.64,95%CI:1.55～4.49)、重度子痫前期(4项研究,OR=2.16,95%CI:1.63～2.85)、新生儿窒息(10项研究,OR=1.68,95%CI:1.48～1.90)、胎儿生长受限(7项研究,OR=2.06,95%CI:1.43～2.98)、围产儿死亡(10项研究,OR=2.85,95%CI:1.84～4.40);下列妊娠结局的发生率,两组间无统计学差异:妊娠高血压心脏病(OR=1.35,95%CI:0.46～3.95)、HELLP综合征(OR=1.14,95%CI:0.57～2.30)、胎儿窘迫(OR=1.25,95%CI:0.88～1.76)。结论对比非高龄妊娠合并子痫前期的孕妇,胎盘早剥、早产、产后出血、子痫、重度子痫前期、新生儿窒息、胎儿生长受限及围产儿死亡等不良妊娠结局的发生率在高龄妊娠合并子痫前期中有所升高。临床上应当高度重视合并有子痫前期的高龄孕妇,需密切监测母儿情况并加以适当干预,警惕多种母儿不良结局的发生,对改善母儿不良结局有一定的意义。
Objective To investigate the difference in morbidity of perinatal and maternal outcomes between aged and non-aged pregnancy complicated by preeclampsia. Methods A systematic search was conducted of PubM ed, Web of Science, SinoM ed, CNKI, Wanfang Medical Databases and CQVIP（-to November 26^（th） 2017） for studies relating to pregnancy outcomes in aged pregnancy complicated by preeclampsia. The Cochrane Handbook was used to evaluate the methodological quality and RevM an 5. 3 software was used for meta-analysis. The fixed effect or random effect model was adopted according to the result of heterogeneity. Results We included a total of 10 articles,of which 3 205 were aged pregnant with preeclampsia,16 752 were non-aged with preeclampsia.The results showed that the risk of aged pregnancy complicated with preeclampsia group was higher than the control group： placental abruption（ 9 studies, OR = 2. 01, 95% CI： 1. 42 ～ 2. 86）; postpartum hemorrhage（ 9 studies,OR = 1. 50,95% CI： 1. 06 ～ 2. 13）; premature（ 7 studies,OR = 1. 60,95% CI：1. 45 ～ 1. 76）; eclampsia（ 4 studies,OR = 2. 64,95% CI： 1. 55 ～ 4. 49）; severe preeclampsia（ 4 studies,OR = 2. 16,95% CI： 1. 63 ～ 2. 85）,neonatal asphyxia（ 10 studies,OR = 1. 68,95% CI： 1. 48 ～ 1. 90）;fetal growth restriction（ 7 studies,OR = 2. 06,95% CI： 1. 43 ～ 2. 98）; perinatal mortality（ 10 studies,OR= 2. 85, 95% CI： 1. 84 ～ 4. 40）. The incidence of pregnancy outcome results were not statistically significant： hypertensive heart disease of pregnancy（ OR = 1. 35, 95% CI： 0. 46 ～ 3. 95）; HELLP syndrome（ OR = 1. 14,95% CI： 0. 57 ～ 2. 30）; fetal distress（ OR = 1. 25,95% CI： 0. 88 ～ 1. 76）; fetal distress（ OR = 1. 25,95% CI： 0. 88 ～ 1. 76）. Conclusions Compared with the non-aged pregnancy complicated with preeclampsia,the incidence of the adverse pregnancy outcomes（ placental abruption,postpartum hemorrhage, eclampsia, severe preeclampsia, neonatal asphyxia, fetal growth restriction and perinatal death） increased in aged pregnancy complicated with preeclampsia. Therefore,we should attach great importance to the elderly pregnancy women with preeclampsia and closely monitor the situation of mothers and fetus and take appropriate interventions. In addition, we are supposed to alert to the occurrence of multiple maternal and fetal adverse outcomes,which is of great significance for improving the adverse outcomes of mothers and children.
作者
温宇文
裘毓雯
周琳
区爱莲
严昕玥
徐若霆
臧乃亮
黄莉萍
黄启涛
钟梅
WEN Yu-wen;QIU Yu-wen;ZHOU Lin;OU Ai-lian;YAN Xin-yue;XU Ruo-ting;ZANG Nai-liang;HUANG Li-ping;HUANG Qi-tao;ZHONG Mei.(First clinical medical college of Southern Medical University, Guangzhou 510000, China.)
出处
《妇产与遗传（电子版）》
2018年第1期15-22,共8页
Obstetrics-Gynecology and Genetics (Electronic Edition)
基金
国家自然科学基金(81671466)
广东省自然科学基金-博士启动计划(2015A030310025)
广州市珠江科技新星人才项目(201710010016
南方医院医院"杰青培育计划"(2016J008)
南方医院院长基金(2014B003
2015Z013
2016B019)
南方医科大学大学生创新训练计划项目资助(201612121007
201712121152)
关键词
高龄妊娠
先兆子痫
妊娠结局
荟萃分析
Aged preeclampsia
Preeclampsia
Pregnancy outcomes
Meta-analysis
