Stamilio David M, Sehdev Harish M, Macones George A
Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Am J Perinatol. 2003 Jan;20(1):41-8. doi: 10.1055/s-2003-37953.
The primary objective of this study was to determine whether having the sickle cell trait is independently associated with preeclampsia. We performed a retrospective cohort study of 1998 pregnant patients who either did or did not have the sickle cell trait. All patients were screened for the sickle trait using the "Sickledex" test. Data on neonatal and maternal outcome, including preeclampsia, and potential confounding variables were abstracted from medical records. Unadjusted, stratified, and multiple logistic regression analyses were used to identify interactions, and confounding between multiple variables and the association between sickle cell trait and preeclampsia. With an anticipated 6.5% rate of preeclampsia, and alpha = 0.05, this cohort study has 80% power to detect a relative risk (RR) of 2.3 for preeclampsia. Univariate analysis revealed that the two cohorts were similar with regard to primiparity, maternal age, chronic diseases, birth weight, and gestational age at delivery, but the sickle cell trait cohort was more likely to have gestational diabetes and had a higher mean body mass index (BMI). In the univariate analysis, the sickle cell trait cohort was not at increased risk for preeclampsia [unadjusted RR = 0.5, 95% CI (0.2-1.6)]. After controlling for potential confounding variables with logistic regression analysis, sickle trait was not independently associated with preeclampsia [adjusted RR = 0.5, 95% CI (0.2- 1.6)]. In contrast to prior work, these data suggest that the sickle cell trait is not an independent risk factor for preeclampsia or postpartum complications. In fact, the data are more consistent with the sickle trait being protective for developing preeclampsia.
本研究的主要目的是确定携带镰状细胞性状是否与子痫前期独立相关。我们对1998例有或没有镰状细胞性状的孕妇进行了一项回顾性队列研究。所有患者均使用“Sickledex”试验筛查镰状性状。从医疗记录中提取了包括子痫前期在内的新生儿和母亲结局以及潜在混杂变量的数据。采用未调整、分层和多元逻辑回归分析来识别相互作用、多个变量之间的混杂以及镰状细胞性状与子痫前期之间的关联。鉴于子痫前期的预期发生率为6.5%，且α = 0.05，本队列研究有80%的把握度检测到子痫前期的相对风险（RR）为2.3。单因素分析显示，两组在初产情况、母亲年龄、慢性病、出生体重和分娩时的孕周方面相似，但镰状细胞性状组更易患妊娠期糖尿病，且平均体重指数（BMI）更高。在单因素分析中，镰状细胞性状组患子痫前期的风险未增加[未调整RR = 0.5，95%可信区间（0.2 - 1.6）]。经逻辑回归分析控制潜在混杂变量后，镰状性状与子痫前期无独立关联[调整RR = 0.5，95%可信区间（0.2 - 1.6）]。与先前的研究不同，这些数据表明镰状细胞性状不是子痫前期或产后并发症的独立危险因素。事实上，数据更倾向于表明镰状性状对子痫前期的发生具有保护作用。
