摘要
目的 分析重度子痫前期临床水肿发生类型及其与病情相关性,探讨重度子痫前期临床表现的异质性和不平行性.方法 对2002年2月至2009年2月北京大学第三医院的228例重度子痫前期患者,按水肿表现形式分为无水肿（A型）、单纯组织间隙水肿（B型）、单纯腔隙水肿（C型）、混合水肿即组织间隙与腔隙水肿并存（D型）.分析比较水肿类型在不同产前检查模式的临床表现、实验室检查指标、发病孕周、并发症和产科及围产结局,并且分析不同水肿类型与血白蛋白和尿蛋白峰值的关系.结果 86％（197例）患者存在不同形式的水肿.规律产前检查与未规律产前检查者比较,水肿类型构成比（P＜0.01）、并发症发生率（P＜0.01）、血白蛋白水平（P＜0.01）差异均有统计学意义（均P＜0.01）,尿蛋白峰值差异无统计学意义（P＞0.05）;早发型与晚发型患者比较,水肿类型构成比（P＜0.01）、尿蛋白峰值（P＜0.01）差异均有统计学意义（均P＜0.01）,血白蛋白水平、并发症发生率差异无统计学意义（P＞0.05）;各型水肿患者间比较,血白蛋白水平、尿蛋白峰值、并发症发生率、发病孕周及治疗性早产发生率差异均有统计学意义（均P ＜0.05）.胎盘早剥、心衰及HELLP综合征的发生率在不同水肿型间的差异均有统计学意义（均P＜0.05）;单纯组织间隙水肿程度与血白蛋白水平及并发症发生率存在相关性（均P＜0.05）,与尿蛋白峰值无相关性（P＞0.05）.结论 重度子痫前期在水肿临床表现形式多样,与发病类型和不同并发症发生存在相关性.加强规律产检和早期监查水肿可改善不良产科结局.
Objective The aim of this study was to analysis the clinical edema forms and explore the heterogeneity of edema in severe preeclampsia（PE）.Method From February 2002 to February 2009,Peking University Third Hospital admitted with severe preeclampsia 228 cases who were enrolled in this study.The form is divided into no edema （A-type）,pure interstitial edema （B-type）,a simple cavity gap edema （C-type） and mixed interstitial edema that coexist with lacunar edema （D-type）.Analysis and comparison of various types of edema in patients with different clinical manifestations of prenatal care models,laboratory parameters,the incidence of gestational age,complications and obstetric and perinatal outcomes,and analyze the relationship between different types of edema and albumins and the peak value of proteinuria.Results Edema was seen in 86% （197/228） of all of cases.Compared the cases who have regular prenatal care with those who have irregular care,differences were statistically significant in edema type composition ratio （P 〈 0.01） and the incidence of serious complications （P 〈 0.01）,and serum albumin levels （P 〈0.01）,but not in the peak value of proteinuria （P 〉 0.05） ; Compared early-onset PE and late-onset PE patients,differences were statistically significant in edema type composition ratio （P 〈 0.01） and peak value of proteinuria （P 〈 0.01）,but not in serum albumin levels and the incidence of serious complications （P 〉 0.05）.Comparison between the various types of edema,differences were statistically significant in serum albumin levels and peak value of proteinuria and incidence of serious complications and the gestational week at PE onset and the incidence of treatment preterm labor （P 〈 0.05）.Occurrence of placental abruption,heart failure and HELLP syndrome had statistical significance in different types of edema （P 〈 0.05）.The varying degrees of interstitial edema were correlated with serum albumin levels （r =-0.19,P 〈 0.05） and serious complication occurrence （r =-0.232,P 〈 0.05）,but no correlation displayed with the peak value of urinary protein （P 〉 0.05）.Conclusions The manifestations of edema were diverse in severe preeclampsia.The forms of edema were related to the PE onset of gestational age and serious complication involving in different organs.Strengthen prenatal care and early detection of edema may improve adverse obstetric outcomes.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第17期1342-1345,共4页
National Medical Journal of China
关键词
子痫前期
水肿
白蛋白
尿蛋白
Pre-Eclampsia
Edema
Albumins
Proteinuria
