Shen Y, Yang Z, Chen Y, Shi Y Y
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Sep 25;52(9):586-593. doi: 10.3760/cma.j.issn.0529-567X.2017.09.003.
To investigate the effect of blood pressure (BP) control level on perinatal outcomes in women with mild-moderate gestational hypertension (GHp). Totally, 344 women diagnosed initially as mild-moderate GHp who delivered in Peking University Third Hospital from January 2012 to December 2016 were recruited. They were divided into four groups according to the stabilized level of BP during pregnancy. (1) Group A: BP130/80 mmHg (1 mmHg=0.133 kPa) ; (2) Group B: BP (130-139) / (80-89) mmHg; (3) Group C: BP (140-149) / (90-99) mmHg; (4) Group D: BP (150-159) / (100-109) mmHg. The clinical profile and incidence of severe GHp, pre-eclampsia with proteinuria (PE+Upro), severe pre-eclampsia (sPE), small-for-gestational age (SGA) were compared among the four groups. Student -test was preformed to normal distributive data and Kruskal-Wallis test was used to non-normally distributed variables. Chi-square test was used in count data. Logistic regression analysis was adopted for multiple-factor analysis. (1) The incidence of severe GHp in group A was lower than group B (0.05). The incidences of severe GHp and sPE in the group B was lower than those in group C (0.05). While there was no difference in the incidence of PE+Upro and SGA among the four groups (0.05). And the incidence of severe GHp in group D had no difference with group A, B, C (0.05). (2) In the 48 patients who used medications to control BP, the occurence of severe GHp in those whose initial BP was (140-149) / (90-99) mmHg was lower than those of ≥160/110 mmHg (0.05). But the incidence of severe GHp had no significant difference between patients whose initial BP was (140-149) / (90-99) mmHg and patients whose initial BP was (150-159) / (100-109) mmHg (0.05). The initial BP level had no impact on the incidence of PE+Upro, sPE and SGA (0.05). (3) Multivariate logistic regression analysis showed that the BP level before using medications (3.566, 95%: 1.080-11.771, =0.037) and the BP level maintained (4.787, 95%: 1.115-20.551, =0.035) were independent factor that affected the incidence of severe GHp. Edema (2.651, 95% : 1.628-4.316 =0.000), fetal growth restriction (FGR; 1.103, 95% : 1.427-5.914, =0.002) and the onset gestational age of GHp (0.755, 95%: 0.578-0.985, =0.038) were independent factors that affected the incidence of PE+Upro. The tendency of FGR (17.787, 95%: 1.833-40.396 =0.000), history of PE (5.294, 95%: 1.086-25.800, =0.039) and the BP level during pregnancy (2.109, 95%: 1.274-3.491, =0.004) were independent factors affecting the incidence of sPE. FGR tendency was independent factor affecting the incidence of SGA (25.622, 95%: 2.596-252.864, =0.005). A satisfied control of BP is helpful to reduce severe GHp and sPE, but the incidence of SGA does not affected.
探讨血压（BP）控制水平对轻度至中度妊娠期高血压（GHp）女性围产期结局的影响。共纳入2012年1月至2016年12月在北京大学第三医院分娩的344例初诊为轻度至中度GHp的女性。根据孕期血压稳定水平将她们分为四组。（1）A组：血压<130/80 mmHg（1 mmHg = 0.133 kPa）；（2）B组：血压（130 - 139）/（80 - 89）mmHg；（3）C组：血压（140 - 149）/（90 - 99）mmHg；（4）D组：血压（150 - 159）/（100 - 109）mmHg。比较四组的临床资料以及重度GHp、蛋白尿性先兆子痫（PE + Upro）、重度先兆子痫（sPE）、小于胎龄儿（SGA）的发生率。对正态分布数据采用t检验，对非正态分布变量采用Kruskal - Wallis检验。计数资料采用卡方检验。采用逻辑回归分析进行多因素分析。（1）A组重度GHp的发生率低于B组（P < 0.05）。B组重度GHp和sPE的发生率低于C组（P < 0.05）。四组间PE + Upro和SGA的发生率无差异（P > 0.05）。D组重度GHp的发生率与A、B、C组无差异（P > 0.05）。（2）在48例使用药物控制血压的患者中，初始血压为（140 - 149）/（90 - 99）mmHg者重度GHp的发生率低于初始血压≥160/110 mmHg者（P < 0.05）。但初始血压为（140 - 149）/（90 - 99）mmHg的患者与初始血压为（150 - 159）/（100 - 109）mmHg的患者重度GHp的发生率无显著差异（P > 0.05）。初始血压水平对PE + Upro、sPE和SGA的发生率无影响（P > 0.05）。（3）多因素逻辑回归分析显示，用药前血压水平（3.566，95%置信区间：1.080 - 11.771，P = 0.037）和维持的血压水平（4.787，95%置信区间：1.115 - 20.551，P = 0.035）是影响重度GHp发生率的独立因素。水肿（2.651，95%置信区间：1.628 - 4.316，P = 0.000）、胎儿生长受限（FGR；1.103，95%置信区间：1.427 - 5.914，P = 0.002）和GHp发病孕周（0.755，95%置信区间：0.578 - 0.985，P = 0.038）是影响PE + Upro发生率的独立因素。FGR倾向（17.787，95%置信区间：1.833 - 40.396，P = 0.000）、子痫前期病史（5.294，95%置信区间：1.086 - 25.800，P = 0.039）和孕期血压水平（2.109，95%置信区间：1.274 - 3.491，P = 0.004）是影响sPE发生率的独立因素。FGR倾向是影响SGA发生率的独立因素（25.622，95%置信区间：2.596 - 252.864，P = 0.005）。满意的血压控制有助于降低重度GHp和sPE的发生率，但不影响SGA的发生率。
