体外受精－胚胎移植术后子痫前期患者临床特点分析

doi:10.3877/cma.j.issn.2095-3259.2020.02.010

目的

探讨体外受精与胚胎移植(in vitro fertilization-embryo transfer, IVF-ET)术后单胎妊娠与子痫前期的关系及临床特点。

方法

回顾性分析2012年6月至2018年12月郑州大学第一附属医院产科收治的通过IVF-ET受孕的单胎子痫前期患者58例(IVF-ET组)，同期自然受孕的单胎子痫前期患者100例(自然受孕组)的临床资料。比较两组孕妇的临床特点和妊娠结局。

结果

IVF-ET组患者的平均住院日(8.74±4.98) d较自然受孕组(7.26±3.07) d长，t＝－2.314，P<0.05；发病时间(28.6±5.63)周和诊断孕周(32.0±6.07)周均早于自然受孕组(28.6±5.63)周和(33.9±4.28)周，t＝4.02和2.04，P<0.05；IVF-ET组尿蛋白(＋＋＋)的发生率34.5%、胸腹水发生率48.3%、胎儿宫内生长受限发生率41.4%均高于自然受孕组20%，29%和26%，P<0.05。

结论

IVF-ET术后单胎子痫前期患者以严重尿蛋白和胸腹水为主要临床症状，胎儿不良结局主要为胎儿宫内生长受限。

关键词: 生殖技术，辅助, 子痫前期, 妊娠结局

Objective

To investigate the association and clinical characteristics between singleton pregnancy after in vitro fertilization-embryo transfer (IVF-ET) and preeclampsia.

Methods

From June 2012 to December 2018, 58 patients (IVF-ET group) with single pregnancy and 100 patients (natural pregnancy group) with single pregnancy were analyzed retrospectively. The clnical features and pregnancy outcomes were compared between the two groups.

Results

The average length of stay in hospital in IVF-ET group was (8.74±4.98) days, longer than that in natural pregnancy group (7.26±3.07), t=-2.314, P<0.05. The onset time of IVF-ET group was (28.6±5.63) weeks and the diagnosis week (32.0±6.07) weeks earlier than that of natural pregnancy group (28.6±5.63) weeks and (33.9±4.28) weeks, t=4.02 and 2.04, P<0.05. The incidence of urinary protein (+ + + ) in IVF-ET group was 34.5%, the incidence of hydrothorax and ascites was 48.3%, and the incidence of fetal intrauterine growth restriction was 41.4%, which was higher than that 20%, 29% and 26% in natural pregnancy group, respectively (P<0.05).

Conclusions

The main clinical symptons of preeclampsia patients with singleton pregnancy after IVF-ET were severe urinary protein, hydrothorax and ascites, and the main fetal adverse outcome was fetal growth restriction.

Key words: Reproductive technique, assisted, Preeclampsia, Pregnancy outcome

表1 两组患者一般情况比较(±s)

组别	例数	年龄(岁)	孕次(次)	产次(次)	住院日(d)
IVF-ET组	58	32.98±6.00	1.24±1.07	0.35±1.95	8.74±4.98
自然受孕组	100	32.73±6.49	1.49±1.83	0.43±1.36	7.26±3.07
t值	?	0.242	0.329	1.87	－2.314
P值	?	0.809	0.847	0.063	0.022

表1 两组患者一般情况比较(±s)

组别	例数	年龄(岁)	孕次(次)	产次(次)	住院日(d)
IVF-ET组	58	32.98±6.00	1.24±1.07	0.35±1.95	8.74±4.98
自然受孕组	100	32.73±6.49	1.49±1.83	0.43±1.36	7.26±3.07
t值	?	0.242	0.329	1.87	－2.314
P值	?	0.809	0.847	0.063	0.022

表2 两组患者子痫前期发病特点和并发症的比较

组别	例数	发病孕周[周，(±s)]	诊断孕周[周，(±s)]	终止妊娠孕周[周，(±s)]	最高收缩压[mm Hg，(±s)]	最高舒张压[mm Hg，(±s)]
IVF-ET组	58	28.6±5.63	32.0±6.07	34.3±4.18	159.47±9.99	99.40±9.85
自然受孕组	100	32.3±5.62	33.9±4.28	34.6±4.22	162.2±16.91	102.03±14.99
t值	?	4.02	2.04	0.428	1.315	1.33
P值	?	0.00	0.044	0.669	0.19	0.186
组别	例数	胸腹水[例(%)]	尿蛋白[例(%)]			血小板减少[例(%)]	HELLP[例(%)]
组别	例数	胸腹水[例(%)]	(＋)	(＋＋)	(＋＋＋)及以上	血小板减少[例(%)]	HELLP[例(%)]
IVF-ET组	58	28(48.3)	9(15.5)	14(24.1)	20(34.5)	10(17.2)	1(1.7)
自然受孕组	100	29(29.0)	40(40.0)	14(14.0)	20(20.0)	14(14.0)	3(3.0)
χ²值	?	－2.424	－1.985			－0.545	－0.491
P值	?	0.015	0.047			0.585	0.624
组别	例数	肺动脉高压[例(%)]	贫血[例(%)]	肝损伤[例(%)]	早产[例(%)]	本次住院结局[例(%)]
组别	例数	肺动脉高压[例(%)]	贫血[例(%)]	肝损伤[例(%)]	早产[例(%)]	剖宫产	引产	未分娩
IVF-ET组	58	4(6.9)	40(69)	4(6.9)	25(53.2)	47(81)	1(1.7)	10(17.2)
自然受孕组	100	2(2.0)	58(58)	3(3.0)	40(50.0)	80(80)	7(7.0)	13(13.0)
χ²值	?	－1.547	－1.365	－1.144	－0.346	－0.008
P值	?	0.122	0.172	0.253	0.729	0.994

表2 两组患者子痫前期发病特点和并发症的比较

组别	例数	发病孕周[周，(±s)]	诊断孕周[周，(±s)]	终止妊娠孕周[周，(±s)]	最高收缩压[mm Hg，(±s)]	最高舒张压[mm Hg，(±s)]
IVF-ET组	58	28.6±5.63	32.0±6.07	34.3±4.18	159.47±9.99	99.40±9.85
自然受孕组	100	32.3±5.62	33.9±4.28	34.6±4.22	162.2±16.91	102.03±14.99
t值	?	4.02	2.04	0.428	1.315	1.33
P值	?	0.00	0.044	0.669	0.19	0.186
组别	例数	胸腹水[例(%)]	尿蛋白[例(%)]			血小板减少[例(%)]	HELLP[例(%)]
组别	例数	胸腹水[例(%)]	(＋)	(＋＋)	(＋＋＋)及以上	血小板减少[例(%)]	HELLP[例(%)]
IVF-ET组	58	28(48.3)	9(15.5)	14(24.1)	20(34.5)	10(17.2)	1(1.7)
自然受孕组	100	29(29.0)	40(40.0)	14(14.0)	20(20.0)	14(14.0)	3(3.0)
χ²值	?	－2.424	－1.985			－0.545	－0.491
P值	?	0.015	0.047			0.585	0.624
组别	例数	肺动脉高压[例(%)]	贫血[例(%)]	肝损伤[例(%)]	早产[例(%)]	本次住院结局[例(%)]
组别	例数	肺动脉高压[例(%)]	贫血[例(%)]	肝损伤[例(%)]	早产[例(%)]	剖宫产	引产	未分娩
IVF-ET组	58	4(6.9)	40(69)	4(6.9)	25(53.2)	47(81)	1(1.7)	10(17.2)
自然受孕组	100	2(2.0)	58(58)	3(3.0)	40(50.0)	80(80)	7(7.0)	13(13.0)
χ²值	?	－1.547	－1.365	－1.144	－0.346	－0.008
P值	?	0.122	0.172	0.253	0.729	0.994

表3 IVF-ET组和自然受孕组胎儿宫内情况与新生儿结局[例(%)]

组别	例数	胎儿窘迫	羊水少	生长受限	新生儿窒息	死胎
IVF-ET组	58	15(25.9)	17(29.3)	24(41.4)	8(17.0)	0(1)
自然受孕组	100	19(19.0)	25(25.0)	26(26.0)	6(7.5)	1(1)
χ²值	?	－1.008	－0.589	－1.997	－1.648	－0.762
P值	?	0.313	0.556	0.046	0.099	0.446

表3 IVF-ET组和自然受孕组胎儿宫内情况与新生儿结局[例(%)]

组别	例数	胎儿窘迫	羊水少	生长受限	新生儿窒息	死胎
IVF-ET组	58	15(25.9)	17(29.3)	24(41.4)	8(17.0)	0(1)
自然受孕组	100	19(19.0)	25(25.0)	26(26.0)	6(7.5)	1(1)
χ²值	?	－1.008	－0.589	－1.997	－1.648	－0.762
P值	?	0.313	0.556	0.046	0.099	0.446

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Analysis of clinical characteristics of preeclampsia patients after in vitro fertilization and embryo transfer

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Analysis of clinical characteristics of preeclampsia patients after in vitro fertilization and embryo transfer