目的 研究不同类型,包括早发型、晚发型及重度、轻度的子痫前期孕妇的血尿酸并探讨其同妊娠结局的相关性.方法 选取桐乡市妇幼保健院2015年至2017年期间收治的100例住院分娩的子痫前期孕妇,根据孕妇的发病孕周,将孕妇分为早发型组(48例)、晚发型组(52例);根据孕妇子痫前期的严重程度,将孕妇分为重度组(57例)、轻度组(43例).观察并记录孕妇分娩前1个月病情最严重血尿酸水平;妊娠后母体结局,包括子痫前期、妊娠并发症如胸腹腔积液、严重低蛋白血症、肝功能不全、肾功能不全、心功能不全等;围生儿结局如新生儿低出生体质量、围生儿死亡、新生儿窒息、胎儿宫内窘迫等.并对其相关性进行探讨与分析.结果 早发型患者血尿酸水平显著高于晚发型患者(t=7.400,P<0.05),重度组患者血尿酸水平显著高于轻度组患者(t=6.660,P<0.05).将子痫前期孕妇分为血尿酸>357μmol/L组和血尿酸≤357μmol/L组,血尿酸>357μmol/L组子痫前期妊娠母体结局妊娠并发症、胸腹腔积液、严重低蛋白血症、肝功能不全、肾功能不全和心功能不全发生率均显著高于血尿酸≤357μmol/L组(χ2值分别为10.191、11.213、17.735、12.452、18.443、9.436,均 P<0.05).血尿酸>357μmol/L组子痫前期妊娠围生儿医源性早产、新生儿出生低体质量、围生儿死亡、新生儿窒息和胎儿宫内窘迫发生率均显著高于血尿酸≤357μmoL/组(χ2值分别为11.211、15.912、15.561、9.434、10.194,均 P<0.05).Logistic回归分析结果表明血尿酸水平对子痫前期、妊娠并发症、胸腹腔积液、严重低蛋白血症、肝功能不全、肾功能不全和心功能不全有重要预测作用(OR值为1.008~1.027,均 P<0.05).血尿酸水平对医源性早产、新生儿出生低体质量、围生儿死亡、新生儿窒息和胎儿宫内窘迫有重要预测作用(OR值为1.008~1.015,均P<0.05).约登指数最高的界值确定血清中血尿酸测定胸腹腔积液、肝功能不全、肾功能不全、医源性早产、新生儿窒息和多个妊娠并发症的灵敏度及特异度,灵敏度分别为85.31%、76.50%、80.03%、75.03%、91.70% 和92.89%,特异度分别为69.10%、64.62%、76.54%、72.64%、61.56% 和74.94%.子痫前期孕妇不良母胎和围生儿结局的AUC差异具有统计学意义(χ2=11.283, P=0.000).结论 血尿酸水平升高与引发子痫前期不良妊娠结局有密切关系,而不同类型的子痫前期孕妇的血尿酸不相同,因此可以通过检测子痫前期孕妇的血尿酸水平预估可能出现的妊娠结局,并对妊娠时机的终止适时作出合理的选择和判断,值得临床高度重视与广泛推行.%Objective To study the serum uric acid in pregnant women with different types of preeclampsia,including early onset, late onset,severe and mild preeclampsia,and its relation with pregnancy outcomes.Methods Altogether 100 pregnant women with preeclampsia hospitalized in Tongxiang Maternal and Child Health Care Hospital from 2015 to 2017 were selected and divided into early onset group(48 cases)and late onset group(52 cases)based on onset gestational age,and severe group(67 cases)and mild group(43 cases)based on severity of preeclampsia.Serum uric acid during most serious period of disease at one month before delivery was observed and recorded.Maternal outcomes including preeclampsia,pregnancy complications such as pleural effusion and ascites,severe hypoproteinemia,hepatic insufficiency,renal insufficiency and cardiac insufficiency and perinatal infant outcomes such as neonatal low birth weight,perinatal infant mortality,neonatal asphyxia and fetal distress were recorded. Relations between serum uric acid and pregnancy outcomes were discussed and analyzed.Results Level of serum uric acid in patients with early onset preeclampsia was significantly higher than that in patients with late onset preeclampsia(t=7.400,P<0.05),and serum uric acid level in severe group was significantly higher than that in mild group(t = 6.660,P < 0.05).Patients with preeclampsia were divided into blood uric acid >357μmol/L group and blood uric acid ≤357μmol/L group.For maternal outcomes of patients with preeclampsia,incidences of pregnancy complications,pleural effusion and ascites,severe hypoproteinemia,hepatic insufficiency,renal insufficiency and heart insufficiency in serum uric acid > 35μmol/L group were significantly higher than those in blood uric acid ≤357μmol/L group(χ2value was 10.191,11.213,17.735,12.452,18.443 and 9.436,respectively,all P<0.05).Incidences of iatrogenic premature birth,low birth weight,perinatal mortality,neonatal asphyxia,fetal distress of perinatal infant in preeclampsia pregnancy in blood uric acid >357μmol/L group were significantly higher than those in blood uric acid ≤357μmol/L group(χ2value was 11.211,15.912,15.561,9.434 and 10.194,respectively,all P< 0.05).Logistic regression analysis showed that level of serum uric acid played an important role in predicting preeclampsia,pregnancy complications,pleural effusion and ascites,severe hypoproteinemia,hepatic insufficiency,renal insufficiency and cardiac insufficiency(OR value ranged 1.008-1.027,all P< 0.05).Serum uric acid level had an important effect on predicting iatrogenic preterm birth,neonatal low birth weight,perinatal mortality,neonatal asphyxia and fetal distress(OR value ranged 1.008-1.015,all P<0.05).Sensitivity and specificity of serum uric acid in determining pleural effusion and ascites,hepatic insufficiency,renal insufficiency,iatrogenic premature delivery,neonatal asphyxia and multiple pregnancy complications were defined by highest Youden index value. Sensitivity was 85.31%,76.50%,80.03%,75.03%,91.70% and 92.89%,respectively,and specificity was 69.10%,64.62%, 76.54%,72.64%,61.56% and 74.94%,respectively.Difference in AUC of adverse maternal and perinatal outcomes in preeclampsia was statistically significant(χ2=11.283,P=0.000).Conclusion Elevated level of serum uric acid is closely related to adverse pregnancy outcomes in preeclampsia,and serum uric acid level in patients with different types of preeclampsia is different, so pregnancy outcomes in pregnant women with preeclampsia can be predicted through detection of blood uric acid level,which also helps for timely and reasonable choice and judgment on termination of pregnancy.It is worthy of clinical attention and wide implementation.
展开▼
