Schiff E, Friedman S A, Mercer B M, Sibai B M
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103.
Am J Obstet Gynecol. 1993 Nov;169(5):1096-101. doi: 10.1016/0002-9378(93)90262-h.
Our purpose was to determine whether there is an increased incidence of pulmonary maturity in premature fetuses of preeclamptic women compared with fetuses of matched controls.
A matched cohort study design was used. One hundred twenty-seven strictly defined preeclamptic women who had undergone amniocentesis for pulmonary maturity assessment were matched for gestational age, race, and infant gender to nonhypertensive women with preterm labor who had undergone the same procedure. Patients with multiple gestation, ruptured membranes, diabetes, or prior glucocorticoid treatment were excluded. Lung maturity was assessed with the Lumadex foam stability index test, the lecithin/sphingomyelin ratio, and the TDx fetal lung maturity assay. In addition, the occurrence of respiratory distress syndrome was assessed in 69 of the 127 matched pairs who were also matched for mode of delivery and amniocentesis-to-delivery interval.
There was no significant difference in the incidence of an immature result between the preeclamptic and matched control groups (39.4% vs 38.6%). Likewise, women with mild (n = 63) and severe (n = 64) preeclampsia or with small-for-gestational-age (n = 26) and appropriate-for-gestational-age (n = 101) infants, when analyzed separately, showed no differences in comparison with their matched controls. When analyzed by gestational age subgroups, no specific gestational age range was associated with accelerated maturity. The incidence of respiratory distress syndrome in the 69 matched pairs was slightly, but not significantly, higher in the preeclampsia group (relative risk 1.43, 95% confidence interval 0.94 to 2.37).
This study does not support the contention that fetuses of preeclamptic women exhibit accelerated lung maturation.
我们的目的是确定与匹配对照组的胎儿相比，子痫前期孕妇早产胎儿的肺成熟发生率是否增加。
采用匹配队列研究设计。127名因评估肺成熟度而接受羊膜穿刺术的严格定义的子痫前期孕妇，根据孕周、种族和婴儿性别与接受相同手术的早产非高血压孕妇进行匹配。排除多胎妊娠、胎膜破裂、糖尿病或既往接受糖皮质激素治疗的患者。采用Lumadex泡沫稳定性指数试验、卵磷脂/鞘磷脂比值和TDx胎儿肺成熟度测定法评估肺成熟度。此外，在127对匹配组中的69对中，还根据分娩方式和羊膜穿刺术至分娩间隔进行匹配，评估呼吸窘迫综合征的发生情况。
子痫前期组和匹配对照组不成熟结果的发生率无显著差异（39.4%对38.6%）。同样，分别分析轻度子痫前期（n = 63）和重度子痫前期（n = 64）或小于胎龄儿（n = 26）和适于胎龄儿（n = 101）的孕妇时，与匹配对照组相比无差异。按孕周亚组分析时，则无特定孕周范围与加速成熟相关。子痫前期组69对匹配组中呼吸窘迫综合征的发生率略高，但无显著差异（相对危险度1.43，95%可信区间0.94至2.37）。
本研究不支持子痫前期孕妇的胎儿肺成熟加速这一观点。
