探讨慢性肾病(chronic kidney disease，CKD)孕妇肾脏超声异常和肾脏功能及妊娠结局的相关性。

收集2017年1月至2021年12月于上海交通大学医学院附属仁济医院分娩的134例妊娠合并CKD患者的临床资料，根据孕16周前初次产检的肾脏超声结果分为肾脏超声正常100例(A组)和肾脏超声异常者34例(B组)。采用回顾性方法采集患者的临床信息、肾脏功能及妊娠结局等指标并进行分析。

(1)两组患者的收缩压分别为(125.6±15.2) mmHg vs (145.4±23.2) mmHg(t＝－4.649)，舒张压(79.4±11.7) mmHg vs (93.9±16.3) mmHg(t＝－4.782)，24 h蛋白尿880.8 mg vs 4519.5 mg(Z＝－5.052)，血清肌酐53.0 μmol/L vs 96.0 μmol/L(Z＝－5.832)，尿素氮3.7 mmol/L vs 6.2 mmol/L(Z＝－4.938)和尿酸320.0 μmol/L vs 452.0 μmol/L(Z＝－4.285)，P值均<0.001，差异有统计学意义；(2)两组患者的血清β2-微球蛋白值分别为2.0 mg/L vs 3.7 mg/L(Z＝－5.779)，尿微量白蛋白255.5 mg/L vs 1425.0 mg/L(Z＝－3.699)，尿免疫球蛋白G 35.4 mg/L vs 112.5 mg/L(Z＝－3.198)，尿转铁蛋白21.6 mg/L vs 148.5 mg/L(Z＝－4.132)，尿α1-微球蛋白14.9 mg/L vs 34.4 mg/L(Z＝－3.868)，尿β2-微球蛋白0.4 mg/L vs 5.0 mg/L(Z＝－5.439)和尿视黄醇结合蛋白0.4 mg/L vs 3.7 mg/L(Z＝－4.960)，P值均<0.001，差异有统计学意义；(3)B组子痫前期发生率70.6%(24/34)，A组为20.0%(20/100)，两组比较差异有统计学意义( χ²＝29.443，P<0.001)；(4)B组患者胎儿生长受限或小于胎龄儿发生率为17.6%，而A组仅为2.0%(χ²＝8.454，P＝0.004)，差异有统计学意义；(5)经相关性分析，肾脏超声异常与血压、血清β2-微球蛋白、肌酐、尿酸、蛋白尿、子痫前期发生率、胸腹腔积液发生率呈正相关，与分娩时间和胎儿体重呈负相关。

肾脏超声检查的异常可能是CKD孕妇出现不良临床状态和妊娠结局的敏感信号之一，建议CKD孕妇应积极完善肾脏超声检查。

To explore the impact of abnormal renal ultrasound image on renal function and pregnant outcome in pregnancies with chronic kidney disease(CKD).

One hundred cases of pregnancies with CKD complicated with normal renal ultrasound image (group A) and thirty-four cases of patients complicated with abnormal renal ultrasound image (group B) were enrolled. The data on clinical features and pregnant outcomes were collected.

(1) Statistical analysis of these results revealed there were significant differences in the average systolic blood pressure[(125.6±15.2)mmHg vs (145.4±23.2)mmHg, t=-4.649] and diastolic blood pressure[(79.4±11.7)mmHg vs (93.9±16.3)mmHg, t=-4.782] and the media of 24-hour proteinuria[880.8 mg vs 4519.5 mg, Z=-5.052], serum creatinin[53.0 μmol/L vs 96.0 μmol/L, Z=-5.832], Blood urea nitrogen[3.7 mmol/L vs 6.2 mmol/L, Z=-4.938] and serum uric acid[320.0 μmol/L vs 452.0 μmol/L, Z=-4.285] between two groups (P<0.001). (2) There was a significant difference in the media of serum β2-microglobulin[2.0 mg/L vs 3.7 mg/L, Z=-5.779] between the two group. For the urinary proteins, there were significant differences in the media of urinary microalbumin[255.5 mg/L vs 1425.0 mg/L, Z=-3.699], immunoglobulin G[35.4 mg/L vs 112.5 mg/L, Z=-3.198], transferrin [21.6 mg/L vs 148.5 mg/L, Z=-4.132], α1-microglobulin[14.9 mg/L vs 34.4 mg/L, Z=-3.868], β2-microglobulin[0.4 mg/L vs 5.0 mg/L, Z=-5.439] and retinol-binding protein[0.4 mg/L vs 3.7 mg/L, Z=-4.960] between two groups. (3) Over 70.6%(24/34) of patients in group B were superimposed with PE, while only 20% of patients in group A were superimposed with PE. And there was a significant difference between the two groups in the incidence of PE (χ²=29.443, P<0.001). The mean delivery time for patients in group A was (35.9±6.1) gestational weeks, which had a highly significant difference from the mean delivery time for patients in group B of (31.8±6.9) gestational weeks(t=3.289, P=0.001). (4)In follow-up visits, media of fetal weight varied significantly between the two groups (Z=-3.906, P<0.001). The proportion of FGR or SGA onset for patients in Group B was 17.6%, while the proportion of FGR or SGA onset for patients in Group A was only 2.0%(χ²=8.454, P=0.004). (5)There was a positive correlation between abnormal renal ultrasound image and blood pressure, serum β2-microglobulin, creatinine, uric acid, proteinuria, incidence of PE and pleural effusion, and ascites (P<0.005). There was a negative correlation between abnormal renal ultrasound images and the delivery time and weight of the fetus (P<0.001).

Abnormal renal ultrasound may be one of the sensitive signals of adverse clinical features and pregnant outcomes. It is suggested that every pregnancy with chronic kidney disease should actively accept a renal ultrasound examination during pregnancy.