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 (04) : 193 -196. doi: 10.3877/cma.j.issn.2095-3259.2021.04.001

专家论坛

子痫前期的临床争议问题
张慧丽1, 陈敦金1,()   
  1. 1. 510150 广州医科大学附属第三医院产科 广州危重孕产妇救治中心 广东省产科重大疾病重点实验室
  • 收稿日期:2021-07-20 出版日期:2021-11-18
  • 通信作者: 陈敦金
  • 基金资助:
    科技部"十三五"重大专项(2016YFC1000405); 广东省医学科学技术研究基金项目(A2020079); 广州市卫生健康科技项目(20201A011095); 广州医科大学附属第三医院博士启动科研项目(2018B03)

Preeclampsia: what is the clinical controversy

Huili Zhang1, Dunjin Chen1()   

  • Received:2021-07-20 Published:2021-11-18
  • Corresponding author: Dunjin Chen
引用本文:

张慧丽, 陈敦金. 子痫前期的临床争议问题[J/OL]. 中华产科急救电子杂志, 2021, 10(04): 193-196.

Huili Zhang, Dunjin Chen. Preeclampsia: what is the clinical controversy[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(04): 193-196.

子痫前期是妊娠期严重并发症之一,全球每年约有7万例孕产妇、50万例围产儿死于该疾病,因此子痫前期一直是产科医师关注的热点和重点。由于产科临床指南受到地域、科研水平和研究进展的时限性的影响,发布的指南常常与新近研究发生碰撞而产生争议。本文就目前关于子痫前期临床指南诊断和预防方面最具争议性的三个问题进行讨论,三个问题分别是子痫前期的血压阈值设定、蛋白尿程度与子痫前期预后和预防性使用阿司匹林起始时间及剂量问题。

Preeclampsia is a sever common complication of pregnancy, and is responsible for about 70000 maternal deaths and 500000 neonatal deaths. Therefore, preeclampsia always captured eyes of obstetricians. Due to the limitations of regional, scientific research level and research progress, the published guidelines are often conflicted with recent studies. This article discusses three of the most controversial issues concerning the diagnosis and prevention of preeclampsia in the current clinical guidelines, which included the threshold of blood pressure, the relationship between degree of proteinuria and prognosis of preeclampsia, and the preventive treatment with aspirin.

[1]
Rana S, Lemoine E, Granger JP, et al. Preeclampsia: Pathophysiology, Challenges, and Perspectives [J]. Circ Res, 2019124(7):1094-1112.
[2]
Pierik E, Prins JR, van Goor H, et al. Dysregulation of Complement Activation and Placental Dysfunction: A Potential Target to Treat Preeclampsia?[J]. Front Immunol, 2020, 10:1-14.
[3]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [J]. Hypertension, 201871(6): e13-e115.
[4]
Sisti G, Colombi I. New blood pressure cut off for preeclampsia definition: 130/80 mmHg [J]. Eur J Obstet Gynecol Reprod Biol, 2019, 240: 322-324.
[5]
中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠高血压期疾病诊治指南(2020) [J]. 中华妇产科杂志2020, 55(4): 227-238.
[6]
American College of Obetricians and Gynecologists′ Committee. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia Obstet Gynecol [J]. Obstet Gynecol2019133(1):e1-e25.
[7]
Sisti G, Williams B. Body of Evidence in Favor of Adopting 130/80 mmHg as New Blood Pressure Cut-Off for All the Hypertensive Disorders of Pregnancy [J]. Medicina (Kaunas), 2019, 55(10):1-6.
[8]
Hu J, Li Y, Zhang B, et al. Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension-Associated Risks for Newborns and Mothers [J]. Circ Res, 2019, 125(2):184-194.
[9]
He D, Wu S, Zhao H, et al. High normal blood pressure in early pregnancy also contribute to early onset preeclampsia and severe preeclampsia [J]. Clin Exp Hypertens, 2018, 40(6):539-546.
[10]
Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance [J]. Am J Obstet Gynecol, 2020:1-16.
[11]
Phillips JK, McBride CA, Hale SA, et al. Examination of Prepregnancy and Pregnancy Urinary Protein Levels in Healthy Nulliparous Women [J]. Reprod Sci, 2017, 24(3): 407-412.
[12]
Kattah A, Milic N, White W, et al. Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia [J]. Am J Physiol Regul Integr Comp Physiol, 2017313(4):R418-R424.
[13]
Folk DM. Hypertensive Disorders of Pregnancy: Overview and Current Recommendations [J]. J Midwifery Womens Health, 2018, 63(3):289-300.
[14]
Li B, Lin L, Yang H, et al. The value of the 24-h proteinuria in evaluating the severity of preeclampsia and predicting its adverse maternal outcomes [J]. Hypertens Pregnancy, 2018, 37(3):118-125.
[15]
Kim MJ, Kim YN, Jung EJ, et al. Is massive proteinuria associated with maternal and fetal morbidities in preeclampsia?[J]. Obstet Gynecol Sci, 201760(3):260-265.
[16]
Meher S, Duley L, Hunter K, et al. Antiplatelet therapy before or after 16 weeks′ gestation for preventing preeclampsia: an individual participant data meta-analysis [J]. Am J Obstet Gynecol, 2017, 216(2):121-128.e2.
[17]
Finnegan C, Breathnach FM. The Role of Aspirin for Preeclampsia Prevention in Women with Diabetes [J]. Curr Diab Rep, 2020, 20(12):1-6.
[18]
Ma′ayeh M, Costantine MM. Prevention of preeclampsia [J]. Semin Fetal Neonatal Med, 2020, 25(5):1-12.
[19]
Sisti G. Maternal Outcomes Associated With Lower Range Stage 1 Hypertension [J]. Obstet Gynecol, 2019, 133(1):190.
[20]
Gu W, Lin J, Hou YY, et al. Effects of low-dose aspirin on the prevention of preeclampsia and pregnancy outcomes: A randomized controlled trial from Shanghai, China [J]. Eur J Obstet Gynecol Reprod Biol, 2020, 248:156-163.
[21]
Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis [J]. Am J Obstet Gynecol, 2018, 218(3):287-293.e1.
[22]
Tapp S, Guerby P, Girard M, et al. A Pilot Randomized Trial Comparing the Effects of 80 versus 160 mg of Aspirin on Midtrimester Uterine Artery Pulsatility Index in Women with a History of Preeclampsia[J]. J Obstet Gynaecol Can, 202042(12):1498-1504.
[1] 梁越, 董晓秋, 李奇默, 李岩, 姚金来, 朴雪梅. 孕11~13+6周子宫动脉与左心室参数对子痫前期的预测模型构建与验证[J/OL]. 中华医学超声杂志(电子版), 2024, 21(01): 42-48.
[2] 陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[3] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[4] 李博, 马秀岩, 孙杰. lncRNA TINCR对滋养层HTR-8/SVneo细胞生物学行为的影响及其机制[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(03): 167-172.
[5] 杨竞, 周光文. 肝硬化门静脉高压症治疗后再出血危险因素分析及预测模型构建[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 296-301.
[6] 刘起帆, 蒋安. 肝硬化门静脉高压症门静脉压力无创测量进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 270-275.
[7] 刘国龙, 王鹏, 谭超, 杨辉, 彭菊红. 神经外科机器人辅助双通道颅内血肿清除术治疗高血压性脑出血[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 254-256.
[8] 景方坤, 周建波, 王全才, 黄海韬, 李岩峰, 徐杨熙. 神经导航引导下治疗基底节高血压脑出血的短期疗效预测[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 154-159.
[9] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[10] 张舒沁, 赵扬玉. 体外受精-胚胎移植与妊娠期高血压疾病[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 79-83.
[11] 庄旭, 丁立, 许丽, 张宁, 张羽, 林建华. 慢性肾病孕妇肾脏超声异常与不良妊娠结局的相关性研究[J/OL]. 中华产科急救电子杂志, 2024, 13(02): 100-105.
[12] 李剑琦. 血清无细胞RNA铁死亡相关基因预测早发型子痫前期的初步研究[J/OL]. 中华产科急救电子杂志, 2024, 13(01): 49-54.
[13] 刘鑫, 裴思雨, 李志强, 陈成文, 傅硕, 卢领, 孙楠楠, 程守全, 谢冰, 张诗文, 王诚. 靶向药物联合缺损修复在成人先天性心脏病相关重度肺动脉高压的应用[J/OL]. 中华心脏与心律电子杂志, 2024, 12(02): 86-93.
[14] 刘文玲. 重视直立性低血压的诊断与处理[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 403-405.
[15] 王永彬, 贾彦迅, 尹轶广. 神经导航结合3D重建技术引导神经内镜血肿清除术对高血压脑出血患者的影响[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(02): 153-156.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?