發(fā)布時(shí)間：2018-04-30 10:33

  本文選題：不典型子癇前期 + 典型子癇前期��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 分析不典型子癇前期（Atypical Preeclampsia，APE）危險(xiǎn)因素及圍產(chǎn)結(jié)局。 方法 整理和分析2010年1月~2013年12月于福建省婦幼保健院住院分娩的365例孕產(chǎn)婦，根據(jù)是否同時(shí)檢出高血壓和蛋白尿分不典型子癇前期組73例、典型子癇前期組146例和對(duì)照組146例。其中不典型子癇前期組再分為單純高血壓組50例和單純蛋白尿組23例。采用病例對(duì)照研究方法，分析三組孕產(chǎn)婦臨床資料。 結(jié)果 1、不典型子癇前期組的臨床特征：不典型子癇前期組中產(chǎn)前出現(xiàn)癥狀者64例（87.67%），產(chǎn)后出現(xiàn)癥狀者9例（12.32%）。單純蛋白尿者23例（31.51%），單純高血壓者50例（68.49%），可復(fù)性后部腦病綜合征（Posterior ReversibleEncephalopathy Syndrome，PRES）2例（2.74%），毛細(xì)血管滲漏綜合征（CapillaryLeak Syndrome，CLS）1例（1.37%）。以FGR、LDH升高、PLT減少、肝功能損害、腹水、全身水腫、頭暈頭痛、視物模糊為首發(fā)表現(xiàn)者分別為5例（6.85%），31例（42.46%），8例（10.96%），19例（26.02%），1例（1.37%），1例（1.37%），9例（12.32%）、1例（1.37%）。 2、三組孕婦一般情況比較：三組孕婦年齡比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型組和典型組分娩孕周與對(duì)照組比較，均顯著減少，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）；不典型組分娩孕周與典型組比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。不典型組和典型組與對(duì)照組孕期收縮壓、舒張壓、平均動(dòng)脈壓比較，均顯著升高，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）；不典型組與典型組各血壓值比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型子癇前期組孕前體質(zhì)量指數(shù)（BodyMass index，BMI）、入院時(shí)BMI、孕期增加體質(zhì)量、孕期BMI增加值與對(duì)照組比較，均顯著增加，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型組孕前BMI與典型子癇前期組比較顯著減少，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。典型子癇前期組孕前BMI、入院時(shí)BMI、孕期增加體質(zhì)量、孕期BMI增加值與對(duì)照組比較，均顯著增加，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。與對(duì)照組比較，不典型組和典型組孕次均增多、產(chǎn)次均減少，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型組孕次與典型組比較，顯著增多，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。不典型組產(chǎn)次與典型組比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 3、三組孕婦血紅蛋白、肝腎功能、血脂結(jié)果比較：與對(duì)照組比較，不典型組孕期甘油三酯（Triglyceride，TG）、丙氨酸氨基轉(zhuǎn)移酶（Alanine Aminotrans-ferase，ALT）、尿酸（Uric Acid，UA）、肌酐（Creatinine，Cr）、乳酸脫氫酶（LactateDehydrogenase，LDH）、肌酸激酶（Creatine Kinase，CK）、肌酸激酶同工酶-MB（Creatine Kinase MB，CKMB）均顯著升高，高密度脂蛋白（High DensityLipoprotein，HDL）、載脂蛋白B（Apolipoprotein-B，ApoB）、總蛋白（Total Protein，TP）、白蛋白（Albumin，ALB）、前白蛋白（Pre albumin，PA）、血紅蛋白（Hemoglobin，HGB）、比較均顯著降低，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。典型組與對(duì)照組TG、總膽固醇（Total Cholesterol，TC）、載脂蛋白A1（Apolipoprotein-A1，ApoA1）、ALT、UA、Cr、LDH、CK、CKMB比較，均顯著升高，，HDL、ApoB、TP、ALB、PA、HGB比較，均顯著降低，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型組與典型組各指標(biāo)比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（均P0.05）。 4、不典型子癇前期組發(fā)病危險(xiǎn)因素：不典型組與對(duì)照組比較，單因素Logistic回歸分析結(jié)果顯示，孕期BMI增加值≥6kg/m2、年齡≥35歲、生活居住地位于農(nóng)村、初中以下文化程度、無(wú)職業(yè)、孕次≥2次、初產(chǎn)、有異常妊娠史、不規(guī)律產(chǎn)檢、多胎妊娠、胎兒性別為女與不典型子癇前期發(fā)生相關(guān)，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）；多因素Logistic回歸分析結(jié)果顯示：孕期BMI增加值≥6kg/m2（OR=4.287，95%CI：1.54~11.94）初產(chǎn)（OR=3.247，95%CI：1.22~9.44）、孕次≥2次（OR=3.63，95%CI：1.58~10.86）、生活居住地為農(nóng)村（OR=4.74，95%CI：1.73~13.00）是不典型子癇前期的獨(dú)立危險(xiǎn)因素。不典型組與典型組比較，單因素Logistic回歸分析顯示：孕次≥2次、初產(chǎn)與不典型子癇前期發(fā)病相關(guān)（均P0.05）；多因素Logistic回歸分析結(jié)果顯示：孕次≥2次是不典型子癇前期獨(dú)立危險(xiǎn)因素（OR=1.908，95%CI：0.91~4.01）。 5、三組孕婦終末器官損害、分娩方式比較：不典型組HELLP綜合征（Hemolysis Elevated Liver enzymes and Low Platelets syndrome，HELLP syn-drome）、血小板減少癥、產(chǎn)后出血、肝功能損害發(fā)生率均高于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）；典型組HELLP綜合征、產(chǎn)后出血、貧血、羊水量異常及產(chǎn)褥感染發(fā)生率均高于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）；不典型組血小板減少、肝功能損害、貧血發(fā)生率與典型組比較均顯著升高，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型組羊水量異常發(fā)生率，與典型組比較，顯著減少，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。三組剖宮產(chǎn)發(fā)生率兩兩較，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。不典型組和典型組，視網(wǎng)膜病變發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 6、三組胎兒及新生兒結(jié)局比較：不典型組胎兒窘迫、FGR、新生兒畸形、轉(zhuǎn)NICU（Neonatal Intensive Care Unit, NICU）、早產(chǎn)發(fā)生率與對(duì)照組比較均顯著升高，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）；不典型組轉(zhuǎn)NICU發(fā)生率比典型組高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；典型組死胎、胎兒窘迫、FGR、新生兒畸形、早產(chǎn)發(fā)生率與對(duì)照組比較均顯著升高，差異均有統(tǒng)計(jì)學(xué)意義（均P0.05）。 結(jié)論 1、孕期BMI增加值≥6kg/m2、孕次≥2次、初產(chǎn)、生活居住地位于農(nóng)村是不典型子癇前期的獨(dú)立危險(xiǎn)因素。對(duì)具備這些危險(xiǎn)因素者，及時(shí)采取針對(duì)性的預(yù)防措施，可有效降低不典型子癇前期的發(fā)生率。 2、不典型子癇前期母兒預(yù)后不良。應(yīng)該提高對(duì)不典型子癇前期的認(rèn)識(shí)，對(duì)存在危險(xiǎn)因素的孕婦，及時(shí)采取針對(duì)性的預(yù)防措施，改善母兒結(jié)局。
[Abstract]:objective
Objective to analyze the risk factors and perinatal outcomes of Atypical Preeclampsia (APE).
Method
365 pregnant and parturient women who were hospitalized in Fujian Provincial Maternity and Child Care Center in December ~2013 January 2010 were analyzed. According to whether 73 cases of hypertension and proteinuria were detected at the same time, 146 cases of typical preeclampsia group and 146 cases were in control group. The atypical preeclampsia group was divided into 50 cases of simple hypertension group and simple protein. 23 cases in the urine group. The clinical data of three groups of pregnant women were analyzed by case control study.
Result
1, the clinical characteristics of the atypical preeclampsia group: 64 cases (87.67%) before the preeclampsia group, 9 (12.32%) postpartum symptoms, 23 cases of simple proteinuria (31.51%), 50 patients with simple hypertension (68.49%), and 2 patients (Posterior ReversibleEncephalopathy Syndrome, PRES), 2 cases (2.74%), hair CapillaryLeak Syndrome (CLS) was 1 cases (1.37%). With FGR, LDH elevation, PLT decrease, liver function damage, ascites, whole body edema, dizziness headache, and blurred headache, 5 cases (6.85%), 31 cases (42.46%), 19 cases (26.02%), 1 cases (1.37%), 1 cases (1.37%).
2, three groups of pregnant women general comparison: the three groups of pregnant women age comparison, the difference was not statistically significant (all P0.05). The typical group and typical group of pregnancy weeks compared with the control group, both significantly decreased, the difference was statistically significant (all P0.05), the difference between the typical group and the typical group, the difference was not statistically significant (P0.05). The systolic pressure, diastolic pressure and mean arterial pressure in the typical group and the control group were all significantly higher, and the difference was statistically significant (all P0.05). The difference was not statistically significant (all P0.05) in the atypical group and the typical group (both BodyMass index, BMI), BMI at admission and the increase of pregnancy. Compared with the control group, the body mass and the BMI increase during pregnancy were all significantly increased (all P0.05). The pre eclampsia BMI in the atypical group was significantly lower than the typical preeclampsia group (P0.05). The pre eclampsia group was BMI before pregnancy, BMI at admission, increased body mass during pregnancy, and the BMI increase during pregnancy compared with the control group. The difference was statistically significant (all P0.05). Compared with the control group, both the atypical group and the typical group increased, the production times were decreased, the difference was statistically significant (P0.05). The difference was statistically significant (P0.05) in the untypical group and the typical group. The difference between the atypical group and the typical group was different from that of the typical group. Study meaning (P0.05).
3, three groups of pregnant women hemoglobin, liver and kidney function, blood lipid results: compared with the control group, Triglyceride, TG, Alanine Aminotrans-ferase, ALT, Uric Acid (UA), creatinine (Creatinine, Cr), and lactate dehydrogenase (LactateDehydrogenase, LDH), and creatine kinase K), the creatine kinase isozyme -MB (Creatine Kinase MB, CKMB) increased significantly, high density lipoprotein (High DensityLipoprotein, HDL), apolipoprotein B (Apolipoprotein-B, ApoB), albumin, precursor protein, hemoglobin, and all the differences were all significantly reduced. Both typical group and control group TG, total cholesterol (Total Cholesterol, TC), apolipoprotein A1 (Apolipoprotein-A1, ApoA1), ALT, UA, Cr, LDH, respectively, were all significantly lower, the difference was statistically significant (all). The differences of the typical group and the typical group were all compared. There was no statistical significance (all P0.05).
4, the risk factors of the atypical preeclampsia group: the untypical group and the control group, the result of single factor Logistic regression analysis showed that the increase value of BMI in pregnancy was more than 6kg/m2, the age was more than 35 years old, the living place was in the rural area, the education level below junior high school, no occupation, pregnant times more than 2 times, primary birth, abnormal pregnancy history, irregular pregnancy test, multiple pregnancy, fetus. The gender was associated with atypical preeclampsia, and the difference was statistically significant (P0.05). The results of multiple factor Logistic regression analysis showed that the increase of BMI in pregnancy was more than 6kg/m2 (OR=4.287,95%CI:1.54~11.94) primary production (OR=3.247,95%CI:1.22~9.44), pregnancy more than 2 times (OR=3.63,95%CI:1.58~10.86), and living place in rural area (OR=4.). 74,95%CI:1.73~13.00) was an independent risk factor for atypical preeclampsia. Compared with the typical group, the untypical group Logistic regression analysis showed that the first pregnancy was more than 2 times, and the primary birth was associated with the atypical preeclampsia (P0.05). The multiple factor Logistic regression analysis showed that the pregnancy rate was more than 2 times in the atypical preeclampsia. Factors (OR=1.908,95%CI:0.91~4.01).
5, three groups of pregnant women end organ damage, delivery methods: HELLP syndrome (Hemolysis Elevated Liver enzymes and Low Platelets syndrome, HELLP syn-drome), thrombocytopenia, postpartum hemorrhage, liver function damage rate is higher than the control group, difference is statistically significant (all P0.05); typical group syndrome, The incidence of postpartum hemorrhage, anemia, amniotic fluid volume and puerperal infection were all higher than that of the control group, the difference was statistically significant (all P0.05); the incidence of anemia in the atypical group was significantly higher than that in the typical group (all P0.05). The abnormal rate of amniotic fluid in the atypical group, and the typical group The difference was statistically significant (P0.05). The incidence of caesarean section in three groups was 22, and the difference was statistically significant (P0.05). There was no significant difference in the incidence of retinopathy in the atypical and typical groups (P0.05).
6, three groups of fetal and neonatal outcomes were compared: untypical group fetal distress, FGR, neonatal malformation, NICU (Neonatal Intensive Care Unit, NICU), the incidence of premature birth was significantly higher than the control group, the difference was statistically significant (all P0.05), the atypical group was higher than the typical group, the difference was statistically significant (P0.05); The incidence of fetal death, fetal distress, FGR, neonatal malformation and preterm birth in the typical group were significantly higher than those in the control group (P0.05).
conclusion
1, the increased value of BMI in pregnancy, more than 6kg/m2, more than 2 times of pregnancy, primary birth and living in rural areas are independent risk factors for atypical preeclampsia. For those with these risk factors, taking timely and targeted preventive measures can effectively reduce the incidence of atypical preeclampsia.
2, the prognosis of the mothers and children in the preeclampsia preeclampsia is poor. We should improve the understanding of the atypical preeclampsia and take the targeted preventive measures in time for pregnant women with risk factors to improve the maternal and child outcomes.

【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.244

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