[1]龚　洵,杨美桃,刘海意,等.子痫前期患者24 h尿蛋白定量与妊娠结局的相关性[J].新乡医学院学报,2017,34(9):808-812.[doi:10.7683/xxyxyxb.2017.09.007]
　GONG Xun,YANG Mei-tao,LIU Hai-yi,et al.Correlation between 24 h urinary protein quantitation and pregnancy outcome in patients with pre-eclampsia[J].Journal of Xinxiang Medical University,2017,34(9):808-812.[doi:10.7683/xxyxyxb.2017.09.007]
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子痫前期患者24 h尿蛋白定量与妊娠结局的相关性
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年9
页码:
808-812
栏目:
临床研究
出版日期:
2017-09-05

文章信息/Info

Title:
Correlation between 24 h urinary protein quantitation and pregnancy outcome in patients with pre-eclampsia
作者:
龚　洵; 杨美桃; 刘海意; 乔福元; 冯　玲; 邓东锐
（华中科技大学同济医学院附属同济医院妇产科，湖北　武汉　430030）
Author(s):
GONG Xun; YANG Mei-tao; LIU Hai-yi; QIAO Fu-yuan; FENG Ling; DENG Dong-rui
（Department of Obstetrics and Gynecology，Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology，Wuhan 430030，Hubei Province，China）
关键词:
子痫前期; 尿蛋白; 妊娠结局
Keywords:
pre-eclampsia; proteinuria; pregnancy outcome
分类号:
R714.2
DOI:
10.7683/xxyxyxb.2017.09.007
文献标志码:
A
摘要:
目的　探讨24 h尿蛋白定量与子痫前期患者妊娠结局的相关性。方法　选择同济医院2014年1月至2016年12月收治的子痫前期孕妇332例，依据24 h尿蛋白定量结果将患者分为微量蛋白尿组46例（24 h尿蛋白定量<0.3 g）、轻度蛋白尿组98例（0.3 g≤24 h尿蛋白定量<2.0 g）、中度蛋白尿组71例（2.0 g≤24 h尿蛋白定量<5.0 g）和重度蛋白尿组117例（24 h尿蛋白定量≥5.0 g），对4组患者的妊娠结局进行比较。结果　轻度蛋白尿组、中度蛋白尿组和重度蛋白尿组患者24 h尿蛋白定量及血清肌酐、尿素氮、尿酸水平显著高于微量蛋白尿组（P<0.05），分娩孕周显著短于微量蛋白尿组（P<0.05）；中度蛋白尿组患者24 h尿蛋白定量及血清尿素氮、尿酸水平显著高于轻度蛋白尿组（P<0.05），分娩孕周显著短于轻度蛋白尿组（P<0.05），但2组患者血清肌酐水平比较差异无统计学意义（P>0.05）；重度蛋白尿组患者24 h尿蛋白定量及血清肌酐、尿素氮、尿酸水平显著高于轻度蛋白尿组（P<0.05），分娩孕周显著短于轻度蛋白尿组（P<0.05）；重度蛋白尿组患者24 h尿蛋白定量显著高于中度蛋白尿组（P<0.05），但2组患者分娩孕周及血清肌酐、尿素氮、尿酸水平比较差异均无统计学意义（P>0.05）。4组患者剖宫产率及顺产率比较差异均无统计学意义（P>0.05）。中度蛋白尿组和重度蛋白尿组患者治疗性引产率显著高于轻度蛋白尿组和微量蛋白尿组（P<0.05），但轻度蛋白尿组与微量蛋白尿组患者治疗性引产率比较差异无统计学意义（P>0.05），重度蛋白尿组与中度蛋白尿组患者治疗性引产率比较差异无统计学意义（P>0.05）。微量蛋白尿组、轻度蛋白尿组、中度蛋白尿组和重度蛋白尿组患者并发症发生率分别为30.43%（14/46）、47.96%（47/98）、74.65%（53/71）、74.36%（87/117），中度蛋白尿组和重度蛋白尿组患者并发症发生率显著高于微量蛋白尿组和轻度蛋白尿组（P<0.05），微量蛋白尿组与轻度蛋白尿组患者并发症发生率比较差异无统计学意义（P>0.05），中度蛋白尿组与重度蛋白尿组患者并发症发生率比较差异无统计学意义（P>0.05）。轻度蛋白尿组早产及新生儿窒息发生率显著高于微量蛋白尿组（P<0.05），新生儿体质量显著低于微量蛋白尿组（P<0.05），但2组及围生儿死亡率及胎儿生长受限（FGR）、新生儿复苏不良发生率比较差异均无统计学意义（P>0.05）。中度蛋白尿组和重度蛋白尿组FGR、早产、新生儿窒息和新生儿复苏不良发生率及围生儿死亡率显著高于微量蛋白尿组（P<0.05），新生儿体质量显著低于微量蛋白尿组（P<0.05）。中度蛋白尿组FGR、早产和新生儿复苏不良发生率及围生儿死亡率显著高于轻度蛋白尿组（P<0.05），新生儿体质量显著低于轻度蛋白尿组（P<0.05），但2组新生儿窒息发生率比较差异无统计学意义（P>0.05）。重度蛋白尿组FGR、早产、新生儿窒息和新生儿复苏不良发生率及围生儿死亡率显著高于轻度蛋白尿组（P<0.05），新生儿体质量显著低于轻度蛋白尿组（P<0.05）。重度蛋白尿组新生儿窒息发生率显著高于中度蛋白尿组（P<0.05），但2组FGR、早产和新生儿复苏不良发生率及围生儿死亡率、新生儿体质量比较差异均无统计学意义（P>0.05）。结论　子痫前期患者24 h尿蛋白定量与妊娠结局密切相关，子痫前期患者应定期检测24 h尿蛋白定量。24 h尿蛋白定量>2.0 g时，母体并发症及围生儿预后不良发生率显著升高，但是诊断重度子痫前期的24 h尿蛋白定量界值尚需进一步大样本研究。
Abstract:
Objective　To investigate the correlation between 24 h urinary protein quantitation and pregnancy outcome in patients with pre-eclampsia.Methods　A total of 332 pre-eclampsia patients were selected in Tongji Hospital from January 2014 to December 2016.The patients were divided into microalbuminuria group（24 h urinary protein quantification<0.3 g，n=46），mild proteinuria group（0.3 g≤24 h urinary protein quantification <2.0 g，n=98），moderate proteinuria group（2.0 g≤24 h urinary protein quantification <5.0 g，n=71） and severe proteinuria group（24 h urinary protein quantification≥5.0 g，n=117） according to the results of 24 h urinary protein quantification.The pregnancy outcomes were compared between the four groups.Results　The 24 h urinary protein quantification and the serum creatinine，urea nitrogen，uric acid levels in the mild proteinuria group，moderate proteinuria group and severe proteinuria group were significantly higher than those in the microalbuminuria group （P<0.05）；and gestational week was significantly shorter than that in the microalbuminuria group （P<0.05）.The 24 h urinary protein quantification and serum urea nitrogen，uric acid levels in the moderate proteinuria group were significantly higher than those in the mild proteinuria group （P<0.05）；and gestational week was significantly shorter than that in the mild proteinuria group(P<0.05)；but there was no significant difference in serum creatinine level between the two groups （P>0.05）.The 24 h urinary protein quantification，serum creatinine，urea nitrogen and uric acid levels in the severe proteinuria group were significantly higher than those in the mild proteinuria group （P<0.05）；and the gestational week was significantly lower than that in the mild albuminuria group （P<0.05）.The 24 h urinary protein quantification in the severe proteinuria group was significantly higher than that in the moderate proteinuria group （P<0.05），but there was no significant difference in the gestational week and serum creatinine，urea nitrogen，uric acid levels between the two groups （P>0.05）.There was no significant difference in the rates of cesarean section and spontaneous labor between the four groups （P>0.05）.The rate of induced labor in the moderate proteinuria group and the severe proteinuria group was significantly higher than that in the mild albuminuria group and the microalbuminuria group （P<0.05）.There was no significant difference in the rate of induced labor between the mild proteinuria group and the microalbuminuria group （P>0.05）.There was no significant difference in the rate of induced labor between the severe proteinuria group and the moderate proteinuria group （P>0.05）.The incidence of complications in microalbuminuria group，mild proteinuria group，moderate proteinuria group and severe proteinuria group was 30.43% （14/46），47.96% （47/98），74.65% （53/71） and 74.36% （87/117） respectively；the incidence of complications in the moderate proteinuria group and the severe proteinuria group was significantly higher than that in the microalbuminuria group and the mild albuminuria group （P<0.05），but there was no significant difference in the incidence of complications between microalbuminuria group and mild albuminuria group （P>0.05），there was no significant difference in the incidence of complications between the moderate proteinuria group and the severe proteinuria group （P>0.05）.The incidences of premature birth and neonatal asphyxia in the mild proteinuria group were significantly higher than that in the microalbuminuria group （P<0.05），and the body mass of the neonates was significantly lower than that in the microalbuminuria group （P<0.05），but there was no significant difference in the perinatal mortality rate and the incidences of fetal growth restriction(FGR) and poor neonatal resuscitation between the two groups （P>0.05）.The incidences of FGR，premature birth，neonatal asphyxia，poor neonatal resuscitation and the perinatal mortality in the moderate proteinuria group and severe proteinuria group were significantly higher than those in the microalbuminuria group （P<0.05）；and neonatal body mass was significantly lower than that in the microalbuminuria group （P<0.05）.The incidences of FGR，premature birth and poor neonatal resuscitation and perinatal mortality in the moderate proteinuria group were significantly higher than those in the mild proteinuria group （P<0.05）；and the neonatal body mass was significantly lower than that in the mild proteinuria group （P<0.05）；but there was no significant difference in the neonatal asphyxia incidence between the two groups （P>0.05）.The incidences of FGR，premature birth，neonatal asphyxia，poor neonatal resuscitation and perinatal mortality in the severe proteinuria group were significantly higher than those in the mild proteinuria group （P<0.05）；and the body mass of the newborns was significantly lower than that in the mild albuminuria group （P<0.05）.The incidence of neonatal asphyxia in the severe proteinuria group was significantly higher than that in the moderate proteinuria group （P<0.05），but there was no significant difference in the incidences of FGR，premature birth，poor neonatal resuscitation，perinatal mortality and neonatal body mass between the two groups （P>0.05）.Conclusion　The of 24 h urinary protein quantitation is closely related to the pregnancy outcome in patients with pre-eclampsia，the 24 h urinary protein quantification should be regularly detected in the patients with pre-eclampsia.When the urinary protein quantitation is more than 2.0 g，the incidences of maternal complications and poor prognosis of the perinatal infants is significantly higher，but the boundary value of the 24 h urinary protein quantitation for the diagnosis of severe pre-eclampsia still needs further large sample study.

参考文献/References:

［1］　NI S，ZHANG Y，DENG Y，et al.AGT M235T polymorphism contributes to risk of preeclampsia：evidence from a meta-analysis［J］.J Renin Angiotensin Aldosterone Syst，2012，13（3）：379-386.
［2］　MUNIZ L，LUIZON M R，PALEI A C T，et al.eNOS tag SNP haplotypes in hypertensive disorders of pregnancy［J］.DNA Cell Bio，2012，31（12）：1665-1670.
［3］　庄旭，叶太阳，林建华.子痫前期易感基因研究进展与展望［J］.实用妇产科杂志，2014，30（9）：664-667.
［4］　中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南（2012 版）［J］.中华妇产科杂志，2012，47（6）：476-480.
［5］　中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南（2015版）［J］.中华妇产科杂志，2015，50（10）：721-728.
［6］　谢幸.妇产科学［M］.8版.北京：人民卫生出版社，2013：64.
［7］　王卫平.儿科学［M］.8版.北京：人民卫生出版社，2013：104.
［8］　TUFNEL D J，SHENNAN A H，WAUGH J J S，et al.The management of severe preeclampsia/eclampsia［M］.UK：Royal College of Obstetricians and Gynaecologists Press，2006：1-11.
［9］　ACOG COMMITTEE ON PRACTICE BULLETINS.ACOG practice bulletin.Diagnosis and management of preeclampsia and eclampsia［J］.Obstet Gynecol，2002，99（1）：159-167.
［10］　SIBAI B M，STELLA C L.Diagnosis and management of atypical preeclampsia-eclampsia［J］.Am J Obstet Gynecol，2009，200（5）：481.
［11］　AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS，TASK FORCE ON HYPERTENSION IN PREGNANCY.Hypertension in pregnancy.Report of the American College of obstetricians and gynecologists′ task force on hypertension in pregnancy［J］.Obstet Gynecol，2013，122（5）：1122-1131.
［12］　MAGEE L A，PELS A，HELEWA M，et al.Diagnosis，evaluation，and management of the hypertensive disorders of pregnancy：executive summary［J］.J Obstet Gynaecol Can，2014，36（7）：575-576.
［13］　ZHUANG X，CHEN Y Y，ZHOU Q，et al.Qualitative analysis of diagnostic value of 24 h proteinuria for preeclampsia［J］.CMJ，2015，128（22）：2998-3002.
［14］　KIM M J，KIM Y N，JUNG E J，et al.Is massive proteinuria associated with maternal and fetal morbidities in preeclampsia［J］.Obstet Gynecol Sci，2017，60（3）：260-265.
［15］　MATEUS J，NEWMAN R，SIBAI B M，et al.Massive urinary protein excretion associated with greater neonatal risk in preeclampsia［J］.AJP Rep，2017，7（1）：e49-e58.

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更新日期/Last Update: 2017-09-05