Franceschini Nora, Savitz David A, Kaufman Jay S, Thorp John M
Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC 27599-7155, USA.
Am J Kidney Dis. 2005 Jun;45(6):1010-8. doi: 10.1053/j.ajkd.2005.02.030.
Vascular dysfunction has been hypothesized as a causal pathway for preeclampsia, impaired fetal growth, and early parturition. The relationship between increased urine albumin excretion (albuminuria), a marker of endothelial dysfunction, and preterm birth has not been fully evaluated.
We conducted a nested case-control study of 404 pregnancies from 1998 to 2000 within the Pregnancy, Infection and Nutrition cohort. Cases consisting of live births delivered before 37 weeks of gestation (preterm birth, n = 111) were compared with term births from the same cohort (n = 293). Albumin-creatinine ratio (in milligrams per gram) was measured in urine collected around 27 weeks of gestation. We compared risks for preterm birth in mothers with albuminuria with albumin levels of 3 to 20 mg/g and greater than 20 mg/g relative to those with albumin levels less than 3 mg/g by using logistic regression.
Median albuminuria was albumin level of 2.7 and 4.3 mg/g for term and preterm births, respectively. Albuminuria was strongly associated with preterm birth in a dose-response fashion, with adjusted odds ratios of 1.9 (95% confidence interval, 1.1 to 3.1) and 4.7 (95% confidence interval, 1.7 to 12.6) for albuminuria with albumin of 3 to 20 mg/g and greater than 20 mg/g, respectively. The association was present for both spontaneous and medically induced preterm births, but the effect was decreased and the dose-response relationship was eliminated by excluding high-risk groups and those with pregnancy complications.
Low levels of albuminuria are associated with preterm birth. The mechanism underlying this association warrants additional exploration.
血管功能障碍被认为是子痫前期、胎儿生长受限和早产的致病途径。作为内皮功能障碍标志物的尿白蛋白排泄增加（蛋白尿）与早产之间的关系尚未得到充分评估。
我们在妊娠、感染与营养队列中对1998年至2000年的404例妊娠进行了一项巢式病例对照研究。将妊娠37周前分娩的活产病例（早产，n = 111）与同一队列中的足月产病例（n = 293）进行比较。在妊娠约27周时收集的尿液中测量白蛋白肌酐比值（毫克/克）。通过逻辑回归比较白蛋白水平为3至20毫克/克和大于20毫克/克的蛋白尿母亲与白蛋白水平低于3毫克/克的母亲的早产风险。
足月产和早产的蛋白尿中位数分别为白蛋白水平2.7毫克/克和4.3毫克/克。蛋白尿与早产呈强烈的剂量反应关系，白蛋白水平为3至20毫克/克和大于20毫克/克的蛋白尿的校正比值比分别为1.9（95%置信区间，1.1至3.1）和4.7（95%置信区间，1.7至12.6）。这种关联在自然早产和医源性早产中均存在，但通过排除高危组和有妊娠并发症的人群，效应降低且剂量反应关系消除。
低水平蛋白尿与早产相关。这种关联的潜在机制值得进一步探索。
