摘要
目的探讨重度子癎前期(severe preeclampsia,S-PE)终末靶器官(end target organ)受累特点,分析早发型和晚发型重度子癎前期各种终末器官受累类型与围产结局的关系。方法对191例重度子癎前期的前瞻性观察研究资料进行分析总结。将S-PE起病时间以34孕周为界分为早发型S- PE(early-onset severe preeclampsia)和晚发型S-PE(late-onset severe preeclampsia)两组。根据器官受累情况分为单器官、两器官和多器官受累。分析比较两组一般临床资料、器官受累类型和并发症发生情况以及围产结局。结果 191例S-PE中有71．70％为单器官受累,明显高于两器官和多器官受累(P <0．05)。单器官受累患者中,早发型S-PE终末器官损害以胎盘(55．26％)和肝损害(15．79％)为主,而晚发型S-PE则以胎盘(18．42％)、心肺(10．53％)和脑损害(10.53％)为多。两组之间胎盘损害发生率在早发型组比晚发型组有显著增高(P<0．05)。两器官受累患者中,早发型终末器官损害以胎盘并肝损害为主,晚发型以心肺并肾损害为多。多器官受累类型中,早发型和晚发型各终末器官累及情况无明显差异。伴有器官受累者的胎儿及新生儿死亡率与无器官受累者相比均明显升高(P<0.05)。在伴有器官受累者中,早发型的胎儿及新生儿死亡率较晚发型明显升高(P<0．05);单器官受累的早发型较晚发型明显升高(P<0．05);两器官和多器官受累早发型与晚发型间无统计学意义(P>0．05)。早发型中各器官累及类型间胎儿及新生儿死亡率没有统计学意义(P>0．05);晚发型中则差异有统计学意义 (P<0．05),两器官和多器官受累较单器官受累明显升高。结论本研究显示重度子癎前期的终末器官受累存在着明显的不平行性。重度子癎前期发病时间、终止孕龄、疾病严重程度和器官受累等影响围产预后。个体的遗传异质性可能决定着不同的触发机制。
Objective To analyze the clinical characteristics of end target organ damage of severe preeclampsia （S-PE） and the relationship of different patterns of end organ damage and perinatal outcomes. Methods A prospective study was conducted in 191 pregnant women with S-PE. Early onset of S-PE was defined as those occurred at ≤34 weeks and late onset of S-PE as those at ≤34 weeks. The clinical data were evaluated. The relations between the pattern of end organ damage and maternal outcomes and perinatal mortality and morbidities were analyzed. Results 71.70% of all 191 S-PE cases were involved in single organ systemic damage, and the rate was higher than those involved in two or more end organ damage. In those women with single end organ damage, placenta （55.26%） and liver（15.79%） were the two main organs concerned in early onset group; while in late onset group they were placental（18. 42%, compared with the early onset group P〈0. 05）, cardiopul monary（10. 53%） and encephalic damage（10.53%）. In those women with two organs involved, placental and hepatic damage were the dominate damages in the early onset group and cardiopulmonary and nephric damage in late onset ones. In patient with multiple organ damage, no difference was found among different patterns of end organ damage. Perinatal mortality was much higher in patients with end organ damage than those without and those in the early onset group was higher than those of the late onset ones in single organ involved（P〈0.05）. However, no difference in the perinatal mortality was shown among those of two and multiple end organ involved, the same results was obtained in those in the early onset group with different patterns of end organ damage. In late onset group, perinatal mortality was much higher in two and multiple end organ damage patterns than those involved in single organ damage. Conclusions There is remarkable unparallel patterns in end organ damage involved in S-PE. Perinatal outcomes are strictly associated with the onset of S-PE, gestation at birth and the severity of disease as well as the status of end organ damage. Genetic heterogeneity may play a role in different trigger mechanism.
出处
《中华围产医学杂志》
CAS
2006年第1期10-14,共5页
Chinese Journal of Perinatal Medicine
关键词
子痫前期
妊娠结局
Pre-eclampsia
Pregnancy outcome
