摘要
目的研究肾脏功能指标与妊娠期慢性肾脏病孕妇不良妊娠的关系。方法回顾性分析2017年5月到2020年5月在淮北矿工总医院待产的130例慢性肾脏病孕妇临床资料,按照其妊娠结局发生情况将其分为无不良妊娠组(n=70)和不良妊娠组(n=60)。分析不良妊娠结局发生情况,比较两组年龄、孕前体重指数(BMI)、孕次、产次、慢性肾脏病分期、血肌酐、血尿素氮、24 h尿蛋白定量、血红蛋白(Hb)以及是否合并妊娠期高血压、妊娠期糖尿病、产前慢性肾脏病等临床资料;利用受试者工作特征(ROC)分析血肌酐、血尿素氮、24 h尿蛋白定量、Hb预测慢性肾脏病孕妇不良妊娠的价值,将有差异信息纳入Logistic回归分析模型进一步明确慢性肾脏病孕妇发生不良妊娠的危险因素。结果本组妊娠合并慢性肾脏病孕妇不良妊娠发生率为46.16%,主要包括流产、早产、非早产原因引起的新生儿死亡、孕妇肾功能恶化等,分别占调查总数的13.85%、20.00%、3.08%、9.23%。不良妊娠组年龄≥33岁、慢性肾脏病分期Ⅲ~Ⅳ期、合并妊娠期高血压、产前慢性肾脏病患者比率及血肌酐、血尿素氮、24 h尿蛋白定量水平显著高于无不良妊娠组,Hb水平显著低于无不良妊娠组,差异均有统计学意义(P<0.05)。经ROC分析,血肌酐、血尿素氮、24 h尿蛋白定量、Hb预测慢性肾脏病孕妇不良妊娠的下曲线面积分别为0.689、0.765、0.912、0.849。经Logistic回归性分析证实年龄≥33岁、慢性肾脏病分期Ⅲ~Ⅳ期、合并妊娠期高血压、产前慢性肾脏病、血肌酐≥68.33μmol/L、血尿素氮≥4.21 mmol/L、24 h尿蛋白定量≥0.94 g/d、Hb <127.60 g/L是慢性肾脏病孕妇发生不良妊娠结局的危险因素。结论妊娠合并慢性肾脏病孕妇不良妊娠发生率为可达到46.15%,且年龄、慢性肾脏病分期、妊娠期高血压、产前慢性肾脏病发生情况及其血肌酐、血尿素氮、24 h尿蛋白定量、Hb水平均可能影响孕妇妊娠结局,需引起临床医师密切关注。
Objective To study the relationship between kidney function indexes and poor pregnancy in pregnant women with chronic kidney disease. Methods The clinical data of 130 pregnant women with chronic kidney disease who were expected to give birth in Huaibei Miners General Hospital from May 2017 to May 2020 were retrospectively selected and divided into the non-adverse pregnancy group(n = 70) and the adverse pregnancy group(n = 60). The occurrence of adverse pregnancy outcomes was analyzed,the age,pre-pregnancy body mass index(BMI),pregnancy times,parity,chronic kidney disease stage,blood creatinine(Scr),blood urea nitrogen(BUN),24 h urine protein quantification,hemoglobin(Hb) and whether it is combined with clinical data such as gestational hypertension,gestational diabetes,prenatal chronic kidney disease,etc were compared. The ROC was used to analyze the value of Scr,BUN,24 h urine protein quantification,and Hb in predicting adverse pregnancy in pregnant women with chronic kidney disease. The difference information was incorporated into the Logistic regression analysis model to further clarify the risk factors of adverse pregnancy in pregnant women with chronic kidney disease. Results The incidence of adverse pregnancy in this group of pregnant women with chronic kidney disease was 46. 16%,mainly including miscarriage,premature delivery,neonatal death caused by non-premature birth,and deterioration of the renal function of pregnant women,which accounted for 13. 85%,20. 00%,3. 08%,9. 23% of the total number of investigations,respectively. The proportion of patients with poor pregnancy age ≥33 years old,chronic kidney disease stage Ⅲ to Ⅳ,hypertension during pregnancy,prenatal chronic kidney disease,and the quantitative levels of Scr,BUN,and 24 h urine protein were significantly higher than those of the group without adverse pregnancy. Hb level Significantly lower than the group without adverse pregnancy,the difference was statistically significant(P<0.05). After ROC analysis,the lower curve areas of Scr,BUN,24 h urine protein quantification,and Hb predicting unhealthy pregnancy in pregnant women with chronic kidney disease were 0. 689,0. 765,0. 912,and 0. 849,respectively. Logistic regression analysis confirmed that age ≥33 years old,chronic kidney disease stage Ⅲ ~ Ⅳ,complicated with pregnancy-induced hypertension,prenatal chronic kidney disease,Scr≥68. 33 μmol/L,BUN≥4. 21 mmol/L,24 h urine protein quantitative ≥0. 94 g/d and Hb <127. 60 g/L are risk factors for adverse pregnancy outcomes in pregnant women with chronic kidney disease. Conclusion The incidence of adverse pregnancy in pregnant women with chronic kidney disease can reach 46. 15%,and age,stage of chronic kidney disease,gestational hypertension,incidence of prenatal chronic kidney disease and SCR,bun,24 h urine protein,Hb levels may affect the pregnancy outcome of pregnant women,which should be paid close attention to by clinicians.
作者
李晓焱
臧学利
应龙
LI Xiao-yan;ZANG Xue-li;YING Long(Department of Obstetrics and Gynecology,Huaibei Miners General Hospital,Huaibei Anhui 235000,China)
出处
《临床和实验医学杂志》
2021年第16期1741-1745,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省教育厅重点课题项目(编号:KJ2019A1086)。
关键词
妊娠期慢性肾脏病
妊娠结局
血肌酐
尿氮素
尿蛋白定量
Chronic kidney disease of pregnancy
Pregnancy outcome
Serum creatinine
Urine nitrogen
Urine protein quantitative
