Morikawa Mamoru, Ohkuchi Akihide, Iriyama Takayuki, Mimura Kazuya, Watanabe Kazushi, Ushida Takafumi, Nohira Tomoyoshi, Matsubara Keiichi, Kawabata Ikuno, Maki Shintaro, Naruse Katsuhiko, Suzuki Hirotada, Ariyoshi Yu, Seki Hiroyuki, Atsuhiro Ichihara, Saito Shigeru
Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Osaka, Japan.
Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Hypertens Res. 2025 Sep 1. doi: 10.1038/s41440-025-02360-3.
This study aimed to determine the association between proteinuria severity and maternal/neonatal outcomes among preeclamptic women with hypertension with proteinuria. We retrospectively assessed 721 women at 11 institutions. All participants had singleton pregnancies and delivered at ≥22 gestational weeks. They were diagnosed with preeclampsia (excluding superimposed preeclampsia) after 20 gestational weeks and had results from a spot urine protein/creatinine ratio test at delivery. The severe proteinuria significantly increased the frequency of preterm delivery in the both women of severe and nonsevere hypertension (72.3% vs. 49.9%, 57.5% vs. 24.8%, p < 0.001, respectively). In the nonsevere hypertension and severe proteinuria group comparison with the severe hypertension and nonsevere proteinuria group, the frequency of women with pulmonary edema/pleural effusion onset was significantly higher (15.0% vs. 5.8%, p = 0.041) and the median serum albumin was significantly lower (2.6 g/dL vs. 2.8 g/dL, p < 0.001). Furthermore, the serum albumin was the laboratory findings with the highest relationship to u-P/C ratio at delivery. Women with preeclampsia with severe hypoalbuminemia had a significant high risk of developing severe proteinuria and pulmonary edema/pleural effusion at delivery than those without severe hypoalbuminemia, respectively. However, severe hypoalbuminemia was not the risk factor for severe hypertension in women with preeclampsia. Women with preeclampsia with severe proteinuria would have worse maternal outcome (pulmonary edema and/or pleural effusion induced by hypoalbuminemia) than those with severe hypertension. In conclusion, obstetricians should be aware of the risk of maternal pulmonary edema/pleural effusion in cases of preeclampsia with nonsevere hypertension with severe proteinuria.
本研究旨在确定伴有蛋白尿的子痫前期高血压女性中蛋白尿严重程度与母婴结局之间的关联。我们对11家机构的721名女性进行了回顾性评估。所有参与者均为单胎妊娠，且在≥22孕周分娩。她们在孕20周后被诊断为子痫前期（不包括叠加子痫前期），并在分娩时进行了随机尿蛋白/肌酐比值检测。严重蛋白尿显著增加了重度和非重度高血压女性的早产频率（分别为72.3%对49.9%，57.5%对24.8%，p<0.001）。与重度高血压和非重度蛋白尿组相比，非重度高血压和重度蛋白尿组肺水肿/胸腔积液发作的女性频率显著更高（15.0%对5.8%，p = 0.041），血清白蛋白中位数显著更低（2.6g/dL对2.8g/dL，p<0.001）。此外，血清白蛋白是与分娩时尿蛋白/肌酐比值关系最密切的实验室检查结果。子痫前期伴严重低白蛋白血症的女性在分娩时发生严重蛋白尿和肺水肿/胸腔积液的风险分别显著高于无严重低白蛋白血症的女性。然而，严重低白蛋白血症不是子痫前期女性重度高血压的危险因素。子痫前期伴严重蛋白尿的女性比重度高血压女性的孕产妇结局更差（低白蛋白血症引起的肺水肿和/或胸腔积液）。总之，产科医生应意识到子痫前期伴非重度高血压和严重蛋白尿病例中孕产妇发生肺水肿/胸腔积液的风险。
