Shen Jie, Yang Zi, Wang Jia-lue
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Fu Chan Ke Za Zhi. 2012 Jun;47(6):405-11.
To investigate the effect of clinical risk factors including maternal underlying medical conditions on the development of preeclampsia (PE) in order to improve and strengthen the early assessment of high clinical risk population of PE.
Clinical observational data of patients with PE in Peking University Third Hospital from November 2008 to January 2011 were analyzed. Comparative analysis was made among medical conditions with PE (M-PE) sub-group and isolated PE (I-PE) sub-group and non-PE pregnancy with or without medical conditions (control group).
Totally 159 cases, 43.09% (159/369) of total cases of PE had high clinical risk factors (multiple pregnancy and medical conditions) and 32.3% (97/300) of singleton PE accompanied with medical conditions. The incidence of PE in singleton pregnancies with medical conditions was significantly higher than those without medical conditions [15.0% (97/646) versus 4.45% (210/4719), P < 0.05]. In M-PE sub-group, the average age [(31.7 ± 4.5) versus (29.3 ± 5.2) year-old] and body mass index (BMI) in first trimester [(26.0 ± 5.6) versus (23.3 ± 3.7) kg/m(2)], the proportion with previous preeclampsia [11% (11/97) versus 4.9% (10/203)] and pregnancy loss in third trimester [11% (11/97) versus 3.0% (6/203)], were higher than those of I-PE sub-group (all P < 0.05). The onset of preeclampsia in M-PE sub-group was earlier than I-PE (32.9 versus 34.4 gestation weeks, P < 0.05). The proportion serious cases of PE occurring before 32 gestational weeks were higher in M-PE than that of I-PE sub-group [45% (44/97) versus 34.0% (69/203), P < 0.05]. Multivariate regression analysis showed that previous history of late pregnancy loss and irregular prenatal care were clinical risk factors for early-onset PE whether early-onset was defined as < 34 or < 32 gestational weeks respectively (all P < 0.05); medical conditions were risk factors for PE if early-onset was defined as < 32 gestational weeks (OR = 1.718, 95%CI: 1.005 - 2.937, P = 0.048).
Multiple pregnancies and pregnancies with medical conditions exceed one-third of total subjects of PE. The onset of PE in subjects with maternal underlying medical conditions was earlier which is the subgroup should not be ignored. The difference of early pregnancy BMI may show the maternal heterogeneity in early onset and late onset of preeclampsia. Assessment of clinical risk factors including the underlying medical disorders for preeclampsia in early trimester should be strengthened.
探讨包括孕妇基础疾病在内的临床危险因素对子痫前期（PE）发生发展的影响，以改进和加强对PE高临床风险人群的早期评估。
分析2008年11月至2011年1月北京大学第三医院PE患者的临床观察资料。对合并PE的内科疾病（M-PE）亚组、孤立性PE（I-PE）亚组以及有或无内科疾病的非PE妊娠（对照组）的内科情况进行对比分析。
PE患者共159例，占PE总病例数的43.09%（159/369）有高临床危险因素（多胎妊娠和内科疾病），单胎PE伴有内科疾病的占32.3%（97/300）。有内科疾病的单胎妊娠中PE的发生率显著高于无内科疾病者[15.0%（97/646）对4.45%（210/4719），P<0.05]。M-PE亚组的平均年龄[（31.7±4.5）岁对（29.3±5.2）岁]和孕早期体重指数（BMI）[（26.0±5.6）kg/m²对（23.3±3.7）kg/m²]、既往子痫前期比例[11%（11/97）对4.9%（10/203）]以及孕晚期流产比例[11%（11/97）对3.0%（6/203）]均高于I-PE亚组（均P<0.05）。M-PE亚组子痫前期的发病早于I-PE亚组（32.9孕周对34.4孕周，P<0.05）。32孕周前发生的PE严重病例比例M-PE亚组高于I-PE亚组[45%（44/97）对34.0%（69/203），P<0.05]。多因素回归分析显示，既往晚期妊娠丢失史和产前检查不规律是早发型PE的临床危险因素，无论早发型分别定义为<34孕周或<32孕周（均P<0.05）；若早发型定义为<32孕周，内科疾病是PE的危险因素（OR=1.718，95%CI：1.005 - 2.937，P=0.048）。
多胎妊娠和合并内科疾病的妊娠占PE总研究对象的三分之一以上。有孕妇基础疾病的PE患者发病较早，该亚组不容忽视。孕早期BMI的差异可能显示子痫前期早发型和晚发型孕妇的异质性。应加强对包括基础内科疾病在内的子痫前期临床危险因素在孕早期的评估。
