切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 96 -100. doi: 10.3877/cma.j.issn.2095-3259.2021.02.007

论著

早发型与晚发型子痫前期的临床特点及母儿结局分析
毕石磊1, 张丽姿2, 杜丽丽1, 陈敦金1,()   
  1. 1. 广州医科大学附属第三医院妇产科 广东省产科重大疾病重点实验室 广州重症孕产妇救治中心 510150
    2. 南方医科大学南方医院妇产科,广州 510515
  • 收稿日期:2021-01-18 出版日期:2021-05-18
  • 通信作者: 陈敦金
  • 基金资助:
    国家自然科学基金(81830045); 国家重点研发计划资助(2016YFC1000405和2017YFC1001402); 广东省自然科学基金(2021A1515011039)

The clinical characteristics and maternal and neonatal outcomes of early and late onset preeclampsia

Shilei Bi1, Lizi Zhang2, Lili Du1, Dunjin Chen1,()   

  1. 1. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou Medical Center for Critical Pregnant Women, Guangzhou 510150, China
    2. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2021-01-18 Published:2021-05-18
  • Corresponding author: Dunjin Chen
引用本文:

毕石磊, 张丽姿, 杜丽丽, 陈敦金. 早发型与晚发型子痫前期的临床特点及母儿结局分析[J/OL]. 中华产科急救电子杂志, 2021, 10(02): 96-100.

Shilei Bi, Lizi Zhang, Lili Du, Dunjin Chen. The clinical characteristics and maternal and neonatal outcomes of early and late onset preeclampsia[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(02): 96-100.

目的

分析早发型与晚发型子痫前期的临床特征及母儿结局。

方法

收集2015年1月至2020年12月6年间在广州医科大学附属第三医院分娩的诊断为子痫前期的单胎孕产妇2693例的临床资料,采用回顾性研究方法分析早发型(873例)与晚发型子痫前期孕妇(1820例)的临床特征及母儿结局。

结果

早发型和晚发型子痫前期患者孕次比较[(2.68±1.58)次与(2.27±1.38)次,Z=-6.80,(P<0.05)],转诊患者比例(42% vs 6.3%, χ2=519.02,P<0.05),合并慢性高血压比例(2.4% vs 0.8%, χ2=12.31,P<0.05),剖宫产率(77.8% vs 60.1%, χ2=82.35,P<0.05),胎盘早剥率(0.9% vs 0.3%, χ2=3.93,P<0.05),重症监护病房入住率(9.7% vs 2.4%, χ2=69.3,P<0.05),住院天数(9.44±4.76)d与(6.30±5.15)d,Z=-20.52,(P<0.05),死胎发生率(22.3% vs 0.3%, χ2=381.1,P<0.05)。

结论

早发型子痫前期与晚发型子痫前期患者临床特点不同,母儿围产期结局不同,两种子痫前期类型应被区分对待。

Objective

To analyze the clinical characteristics and maternal and perinatal outcomes of early and late onset preeclampsia.

Methods

2693 pregnant women with preeclampsia who delivered in the Third Affiliated Hospital of Guangzhou Medical University from 2015 to 2020 were recruited. The clinical characteristics and maternal and neonatal outcomes of early onset (873 cases) and late onset preeclampsia (1820 cases) were analyzed.

Results

The gravidity(2.68±1.58 vs 2.27±1.38, Z=-6.80, P<0.05), patients referred to hospital(42% vs 6.3%, χ2=519.02, P<0.05), and patients with chronic hypertension(2.4% vs 0.8%, χ2=12.31, P<0.05) were higher in the early onset preeclampsia group than the late onset preeclampsia group (P<0.05). The rate of cesarean section(77.8% vs 60.1%, χ2=82.35, P<0.05), placental abruption(0.9% vs 0.3%, χ2=3.93, P<0.05), admission to ICU(9.7% vs 2.4%, χ2=69.3, P<0.05) and hospitalization days [(9.44±4.76) vs (6.30±5.15), Z=-20.52, P<0.05] were significantly higher in the early onset preeclampsia group. The incidence of stillbirth(22.3% vs 0.8%, χ2=381.1, P<0.05) and neonatal death was higher in the early onset preeclampsia than the late onset preeclampsia group.

Conclusions

The clinical characteristics, maternal and perinatal outcomes of patients complicated with early onset preeclampsia and late onset preeclampsia are different. From the perspective of clinical characteristics, maternal and perinatal outcomes, the two types of preeclampsia should be treated differently.

表1 早发型和晚发型子痫前期临床特征比较
表2 早发型和晚发型子痫前期孕妇结局比较
表3 早发型和晚发型子痫前期患者的新生儿结局比较
[1]
American College of Obestetricians and Gynecologist. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, No. 222 [J].Obstet Gynecol, 2020, 135(6): e237-e260.
[2]
Mol BWJ, Roberts CT, Thangaratinam S, et al. Pre-eclampsia [J]. Lancet, 2016, 387(10022):999-1011.
[3]
Phipps EA, Thadhant R, Benzing T, et al. Pre-eclampsia: pathogenesis, novel diagnostics and therapies [J]. Nat Rev Nephrol, 2019, 15(5): 275-289.
[4]
Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease [J]. Am J Obstet Gynecol, 2013, 209(6):544.e1-e12.
[5]
谢幸,孔北华,段涛.妇产科学 [M].9版,北京:人民卫生出版社,2018:83.
[6]
韩菊香.早发型子痫前期重度妊娠结局的临床分析[J].实用妇科内分泌杂志,2016,3(3):131-133.
[7]
成志,王子莲,罗小华,等.不同产前检查情况与重度子痫前期及子痫的临床分析 [J/CD].中华产科急救电子杂志,2015,4(4):230-233.
[8]
Seeho SK, Algert CS, Roberts CL, et al. Early-onset preeclampsia appears to discourage subsequent pregnancy but the risks may be overestimated [J]. Am J Obstet Gynecol, 2016, 215(6):785.e1-e8.
[9]
Jhee JH, Lee S, Park Y, et al. Prediction model development of late-onset preeclampsia using machine learning-based methods [J]. PLoS One, 2019, 14(8):e0221202.
[10]
Abalos E, Cuesta C, Carroli G, et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health [J]. BJOG, 2014, 121 (Suppl 1):14-24.
[11]
Abalos E, Cuesta C, Grosso AL, et al. Global and regional estimates of preeclampsia and eclampsia: a systematic review [J]. Eur J Obstet Gynecol Reprod Biol, 2013, 170(1):1-7.
[12]
Burton GJ, Redman CW, Roberts JM, et al. Pre-eclampsia: pathophysiology and clinical implications [J]. BMJ, 2019, 366:l2381.
[13]
Iacobelli S, Bonsante F, Robillard PY. Comparison of risk factors and perinatal outcomes in early onset and late onset preeclampsia: A cohort based study in Reunion Island [J]. J Reprod Immunol, 2017, 123:12-16.
[14]
Sites CK, Wilson D, Barsky M, et al. Embryo cryopreservation and preeclampsia risk [J]. Fertil Steril, 2017, 108(5): 784-790.
[15]
Gui J, Ling Z, Hou X, et al. In vitro fertilization is associated with the onset and progression of preeclampsia [J]. Placenta, 2020, 89:50-57.
[16]
Ananth CV. Ischemic placental disease: aunifying concept for preeclampsia, intrauterinegrowth restriction, and placental abruption [J]. Semin Perinatol, 2014,38(3):131-132.
[17]
Lisonkova S, Sabr Y, Mayer C, et al. Maternal morbidity associated with early-onset and late-onset preeclampsia [J]. Obstet Gynecol, 2014, 124(4): 771-781.
[18]
Lisonkova S, Joseph KS. incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease [J]. Am J Obstet Gynecol, 2013,209(6): 544.e1-544.e12.
[1] 钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[2] 黄蓉, 梁自毓, 祁文瑾. NLRP3炎症小体在胎膜早破孕妇血清中的表达及其意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 540-548.
[3] 何霞, 黄蓉, 祁文瑾. 胎膜早破孕妇胎盘与胎膜菌群丰度的高通量测序研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 549-555.
[4] 谢江燕, 王亚菲, 贺芳. 妊娠合并血栓性血小板减少性紫癜2例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 556-563.
[5] 徐婷婷, 詹泳池, 王晓东, 刘兴会. 电子胎心监测结果出现正弦波形的胎母输血综合征围生期结局分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 382-389.
[6] 韩肖燕, 杨桦. 中孕期孕妇血清胎盘生长因子水平低与胎儿不良预后的关系[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 398-402.
[7] 杜佳丽, 鲍睿, 乔春红, 韩伟. 中孕期宫颈功能不全孕妇经阴道紧急宫颈环扎术后不良妊娠结局预测模型构建[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 403-409.
[8] 谭娟, 谭建新, 邵彬彬, 王艳, 许争峰. 胎儿单基因遗传病无创产前检测的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 245-250.
[9] 李欣, 魏艺, 张娟, 张娟娟, 凌秀凤, 赵纯, 张媔秋. 高龄女性冻胚移植周期临床妊娠结局的影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 276-283.
[10] 薛静, 孙雅楠, 朱丽丽, 李淑红. 妊娠期急性脂肪肝孕产妇诊疗及其妊娠结局[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 312-321.
[11] 林雪, 陈锰, 杨梅琳, 刘兴会, 周红雨. 妊娠合并重症肌无力患者的围产结局和重症肌无力病情恶化的影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 125-132.
[12] 俞慧慧, 尹宗智. 妊娠期胃穿孔[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 209-213.
[13] 鲁珊, 姚蕴珊, 廖色坭, 陈子恩, 张一剑, 蓝健皓, 魏薇, 刘艳杨, 陈艳红, 陈敦金. 妊娠合并急性阑尾炎100例临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 214-219.
[14] 汪文雁, 郑剑兰, 朱丽慈. 体外受精-胚胎移植术后妊娠患者孕产期风险的临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 220-226.
[15] 胡淼, 杜丽丽, 张丽姿, 林琳, 张瑜亮, 古士锋, 古仲嘉, 赖思莹, 梁景英, 刘雨, 黄敏珊, 黄媛媛, 黄晴晴, 罗世君, 陈敦金. 体外受精/卵胞浆内单精子注射受孕患者胎盘植入分级及围产结局的研究[J/OL]. 中华产科急救电子杂志, 2024, 13(03): 183-189.
阅读次数
全文


摘要