Lyu X, Zhang W Y, Zhang J X, Wei Y Q, Guo X L, Cui S H, Yan J Y, Zhang X Y, Qiao C, Zhou R, Gu W R, Chen X X, Yang Z, Li X T, Lin J H
Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
Zhonghua Fu Chan Ke Za Zhi. 2023 Jun 25;58(6):416-422. doi: 10.3760/cma.j.cn112141-20230218-00073.
To explore the influencing factors of pregnancy-induced hypertensive disorders in pregnancy (HDP) with organ or system impairment in pregnant women, and to analyze and compare the differences of HDP subtypes in different regions of China. A total of 27 680 pregnant women with HDP with complete data from 161 hospitals in 24 provinces, autonomous regions and municipalities were retrospectively collected from January 1, 2018 to December 31, 2018. According to their clinical manifestations, they were divided into hypertension group [a total of 10 308 cases, including 8 250 cases of gestational hypertension (GH), 2 058 cases of chronic hypertension during pregnancy] and hypertension with organ or system impairment group [17 372 cases, including 14 590 cases of pre-eclampsia (PE), 137 cases of eclampsia, 2 645 cases of chronic hypertension with PE]. The subtype distribution of HDP in East China (6 136 cases), North China (4 821 cases), Central China (3 502 cases), South China (8 371 cases), Northeast China (1 456 cases), Southwest China (2 158 cases) and Northwest China (1 236 cases) were analyzed. By comparing the differences of HDP subtypes and related risk factors in different regions, regional analysis of the risk factors of HDP pregnant women with organ or system impairment was conducted. (1) The proportions of HDP pregnant women with organ or system impairment in Northeast China (79.05%, 1 151/1 456), Central China (68.42%, 2 396/3 502) and Northwest China (69.34%, 857/1 236) were higher than the national average (62.76%, 17 372/27 680); the proportions in North China (59.18%, 2 853/4 821), East China (60.85%, 3 734/6 136) and South China (59.56%, 4 986/8 371) were lower than the national average, and the differences were statistically significant (all <0.05). (2) Univariate analysis showed that the proportions of primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history in the hypertension with organ or system impairment group were higher than those in the hypertension group, and the differences were statistically significant (all <0.05). Multivariate logistic regression analysis showed that primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history were independent risk factors for HDP pregnant women with organ or system impairment (all <0.05). (3) Primipara: the rates of primipara in Northeast China, North China and Southwest China were higher than the national average level, while those in South China, Central China and Northwest China were lower than the national average level. Non-Han nationality: the rates of non-Han nationality in Northeast China, North China and Northwest China were higher than the national average, while those in East China, South China and Central China were lower than the national average. Non-urban household registration: the rates of non-urban household registration in Northeast China, North China, and Southwest China were lower than the national average, while those in East China, Central China were higher than the national average. Irregular prenatal examination: the rates of irregular prenatal examination in North China, South China and Southwest regions were lower than the national average level, while those in Northeast China, Central China and Northwest China were higher than the national average level. History of PE: the incidence rates of PE in Northeast China, North China, South China and Southwest China were lower than the national average level, while those in Central China and Northwest China were higher than the national average level. Primiparas, non-Han, non-urban household registration, irregular prenatal examination, and PE history are risk factors for HDP pregnant women with organ or system impairment. Patients in Northeast, Central and Northwest China have more risk factors, and are more likely to be accompanied by organ or system function damage. It is important to strengthen the management of pregnant women and reduce the occurrence of HDP.
探讨妊娠合并器官或系统损害的妊娠期高血压疾病（HDP）的影响因素，并分析比较中国不同地区HDP亚型的差异。回顾性收集2018年1月1日至2018年12月31日来自24个省、自治区、直辖市161家医院的27680例资料完整的妊娠合并HDP孕妇。根据临床表现，将其分为高血压组[共10308例，包括妊娠期高血压（GH）8250例、妊娠合并慢性高血压2058例]和合并器官或系统损害的高血压组[17372例，包括子痫前期（PE）14590例、子痫137例、妊娠合并慢性高血压并发PE 2645例]。分析了华东地区（6136例）、华北地区（4821例）、华中地区（3502例）、华南地区（8371例）、东北地区（1456例）、西南地区（2158例）和西北地区（1236例）HDP的亚型分布。通过比较不同地区HDP亚型及相关危险因素的差异，对合并器官或系统损害的HDP孕妇的危险因素进行区域分析。（1）东北地区（79.05%，1151/1456）、华中地区（68.42%，2396/3502）和西北地区（69.34%，857/1236）合并器官或系统损害的HDP孕妇比例高于全国平均水平（62.76%，17372/27680）；华北地区（59.18%，2853/4821）、华东地区（60.85%，3734/6136）和华南地区（59.56%，4986/8371）低于全国平均水平，差异有统计学意义（均<0.05）。（2）单因素分析显示，合并器官或系统损害的高血压组初产妇、非汉族、非城镇户籍、产前检查不规律及有PE病史的比例高于高血压组，差异有统计学意义（均<0.05）。多因素logistic回归分析显示，初产妇、非汉族、非城镇户籍、产前检查不规律及有PE病史是合并器官或系统损害的HDP孕妇的独立危险因素（均<0.05）。（3）初产妇：东北地区、华北地区和西南地区初产妇比例高于全国平均水平，而华南地区、华中地区和西北地区低于全国平均水平。非汉族：东北地区、华北地区和西北地区非汉族比例高于全国平均水平，而华东地区、华南地区和华中地区低于全国平均水平。非城镇户籍：东北地区、华北地区和西南地区非城镇户籍比例低于全国平均水平，而华东地区、华中地区高于全国平均水平。产前检查不规律：华北地区、华南地区和西南地区产前检查不规律比例低于全国平均水平，而东北地区、华中地区和西北地区高于全国平均水平。PE病史：东北地区、华北地区、华南地区和西南地区PE发病率低于全国平均水平，而华中地区和西北地区高于全国平均水平。初产妇、非汉族、非城镇户籍、产前检查不规律及PE病史是合并器官或系统损害的HDP孕妇的危险因素。东北地区、华中地区和西北地区的患者危险因素较多，更易伴有器官或系统功能损害。加强孕妇管理、降低HDP的发生具有重要意义。
