Shi Jun-mei, Yang Zi, Chen Lei, Wang Jia-lüe
Department of Obstetrics, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 May;44(5):337-40.
To identify the early warning signs of severe preeclampsia (SPE).
A case-control (1:2) observational study was conducted. Forty-seven pregnant women with SPE, who attended the prenatal clinics of Peking University Third Hospital regularly from Jan. 2002 to Dec. 2007, were selected as the study group, including 12 early onset and 35 late onset ones. The control group consisted of 94 healthy singleton pregnant women at the same period. Clinical data were collected and analyzed.
(1) The basal body mass index (BMI) showed no difference between the study and control group [(23.27 +/- 4.31) kg/m(2) vs (21.52 +/- 3.09) kg/m(2), P > 0.05]. (2) The net increase of BMI in the study group before the onset of SPE was higher than that in the control [(5.60 +/- 2.17) kg/m(2) vs (4.85 +/- 1.52) kg/m(2), P < 0.05] and the increase of BMI per week was also higher [(0.74 +/- 0.41) kg/(m(2).w)(-1) vs (0.23 +/- 0.18) kg/(m(2).w)(-1), P < 0.01]. The sensitivity and specificity of BMI increase per week in predicting SPE was 84% and 81% at a cut-off value of 0.39 kg/(m(2).w)(-1), respectively, and 79% and 91% at 0.41 kg/(m(2).w)(-1) correspondingly. (3) During the third trimester and before the onset of SPE, the weight gain per week in the study group was higher than that of the control [(0.93 +/- 0.70) kg vs (0.63 +/- 0.20) kg, P < 0.01]. Significant difference was also found in the net weight gain between the two groups (P < 0.01), but not in the percentage of women with excessive weight gain (> 0.50 kg/w) [60% (25/42) in the study group vs 63% (53/84) in the control group, P > 0.05]. (4) Higher percentage of women experienced pre-hypertension in the study group than in the controls [17% (8/47) vs 5% (5/94), P < 0.01]. (5) In the study group, 53% (25/47) of the women had edema before SPE onset, but the figure dropped to 18% (17/94) in the controls (P < 0.01). (6) Eight women in the study group and one in the control group suffered from hypoproteinemia before SPE onset with the average level of plasma albumin of (32.6 +/- 1.6) g/L and (38.4 +/- 2.1) g/L (P < 0.01), respectively. (7) Proteinuria was reported in 10 cases (21%) in the study group and 4 (4%) in the controls (P < 0.01). (8) Logistic regression analysis showed that the risk factors for SPE included edema (OR = 6.16, 95%CI: 2.29 - 16.57), pre-hypertension (OR = 6.21, 95%CI: 1.56 - 24.77), proteinuria (OR = 9.68, 95%CI: 1.86 - 50.30), and weight gain > 0.85 kg/w during the third trimester (OR = 11.60, 95%CI: 3.54 - 37.97).
Edema, excessive weight gain, pre-hypertension and hypoproteinemia are early warning signs of SPE. Pregnant women with the above signs required close monitoring during prenatal care.
识别重度子痫前期（SPE）的早期预警信号。
进行了一项病例对照（1:2）观察性研究。选取2002年1月至2007年12月期间定期到北京大学第三医院产前门诊就诊的47例SPE孕妇作为研究组，其中早发型12例，晚发型35例。对照组由同期94例健康单胎孕妇组成。收集并分析临床资料。
（1）研究组与对照组的基础体重指数（BMI）无差异[（23.27±4.31）kg/m² 对 （21.52±3.09）kg/m²，P>0.05]。（2）SPE发病前研究组BMI的净增加值高于对照组[（5.60±2.17）kg/m² 对 （4.85±1.52）kg/m²，P<0.05]，且每周BMI的增加值也更高[（0.74±0.41）kg/（m²·w）⁻¹ 对 （0.23±0.18）kg/（m²·w）⁻¹，P<0.01]。每周BMI增加值预测SPE的敏感度和特异度在截断值为0.39 kg/（m²·w）⁻¹时分别为84%和81%，在0.41 kg/（m²·w）⁻¹时相应为79%和91%。（3）孕晚期及SPE发病前，研究组每周体重增加高于对照组[（0.93±0.70）kg 对 （0.63±0.20）kg，P<0.01]。两组间体重净增加也有显著差异（P<0.01），但体重增加过多（>0.50 kg/w）的女性比例无差异[研究组60%（25/42）对对照组63%（53/84），P>0.05]。（4）研究组发生妊娠高血压前期的女性比例高于对照组[17%（8/47）对5%（5/94），P<0.01]。（5）研究组中53%（25/47）的女性在SPE发病前有水肿，而对照组这一比例降至18%（17/94）（P<0.01）。（6）研究组8例女性和对照组1例女性在SPE发病前患有低蛋白血症，血浆白蛋白平均水平分别为（32.6±1.6）g/L和（38.4±2.1）g/L（P<0.01）。（7）研究组10例（21%）出现蛋白尿，对照组4例（4%）出现蛋白尿（P<0.01）。（8）Logistic回归分析显示，SPE的危险因素包括水肿（OR = 6.16，95%CI：2.29 - 16.57）、妊娠高血压前期（OR = 6.21，95%CI：1.56 - 24.77）、蛋白尿（OR = 9.68，95%CI：1.86 - 50.30）以及孕晚期体重增加>0.85 kg/w（OR = 11.60，95%CI：3.54 - 37.97）。
水肿、体重过度增加、妊娠高血压前期和低蛋白血症是SPE的早期预警信号。有上述体征的孕妇在产前检查期间需要密切监测。
