Relationship among potential maternal risk factors, prenatal care and characteristics of preeclampsia

目的 探讨母体潜在风险因素在不同级别医院以及是否规律产前检查与子痫前期发病特点的关系. 方法 回顾分析300例在北京大学第三医院分娩的单胎妊娠子痫前期患者的临床资料.其中在三级医院、基层医院规律行产前检查和无规律产前检查者分别为100、81和119例.比较不同临床风险因素、产前检查情况者的子痫前期诊断孕周、重症发生情况.连续变量以中位数和四分位间距表示,采用非参数检验,分类变量采用卡方检验. 结果 (1)在总体病例、单纯子痫前期和合并慢性高血压者中,三级医院规律产前检查者(分别为100、64、14例)的子痫前期发病孕周[分别为37.1(4.1)、37.3(1.7)、36.3(2.5)周]比基层医院规律产前检查(分别为81、54、9例)的发病孕周[分别为32.9(6.7)、33.8(6.1)、27.9(6.3)周,Z值分别为72.29、51.30和14.58,P均＜0.05]和无规律产前检查者(分别为119、85、19例)子痫前期发病孕周[分别为31.6(6.6)、31.9(6.7)、30.3(4.7)周,Z值分别为86.69、58.83和11.33,P均＜0.05]明显延后；三级医院规律产前检查者比无规律产前检查者重症病例在妊娠32周前的发生率[分别为13.0％(13/100)与55.5％(66/119)、9.4％(6/64)与50.6％(43/85)、35.7％(5/14)与89.5％(17/19),x2值分别为43.95、29.42和10.17,P＜0.05)及妊娠34周前的发生率[分别为17.0％(17/100)与65.5％(78/119)、14.1％(9/64)与61.2％(52/85)、42.9％(6/14)与94.7％(18/19),x2值分别为47.71、31.18和10.61,P＜0.05]发生的比例明显降低.(2)在无规律产前检查组和基层医院规律产前检查组内,合并慢性高血压亚组比单纯子痫前期亚组的发病孕周明显提前(Z值分别为26.61和22.82,P＜0.05)；无规律产前检查组中,合并慢性高血压亚组比单纯子痫前期亚组的重症在妊娠32周前(x2=9.11,P＜0.05)和妊娠34周前(x2=7.95,P＜0.05)所占比例明显升高. 结论 三级医院规律产前检查可延缓子痫前期诊断孕周以及延缓重症发生时间,尤其对于存在子痫前期发病临床风险因素者.应加强早孕期子痫前期发病的临床风险评估,并建立以患者为基础的个体化系列产前检查计划.Objective To investigate the relationship between potential maternal risk factors between potential maternal risk factors in different level hospitals as well as different prenatal care patterns and characteristics of preeclampsia. Methods A retrospective study of 300 preeclamptic singleton patients delivered in Peking University Third Hospital was performed.Patients were divided into three groups:regular prenatal care in tertiary hospitals (n =100),regular prenatal care in primary hospitals (n=81) and without prenatal care (n=119). The onset of preeclampsia and incidence of severe preeclampsia of different groups were analyzed. Non-parametric and Chi-square test were adopted for continuous and categorical variables respectively. Results (1) In total cases of preeclampsia subgroup (I-PE subgroup) and with chronic hypertension (CH subgroup),the diagnosis of preeclampsia was later in patient with regular prenatal care in tertiary hospital (patient-TH)[100,64 and 14 cases,37.1 (4.1),37.3 (1.7) and 36.3 (2.5) weeks respectively] than those with regular prenatal care in primary hospital (patient-PH) [81,54 and 9 cases,32.9 (6.7),33.8 (6.1)and 27.9(6.3) weeks respectively] (Z=72.29,51.30 and 14.58 respectively,P＜0.05) or the patient without regular prenatal care (patient-NP) [119,85 and 19 cases,31.6(6.6),31.9(6.7) and 30.3(4.7) weeks respectively] (Z=86.69,58.83 and 11.33 respectively,P＜0.05).The proportion of severe preeclampsia occurred earlier than 32 weeks [13.0％ (13/100) vs 55.5％ (66/119),9.4％(6/64) vs 50.6％(43/85),and 35.7％(5/14) vs 89.5％(17/19); x2=43.95,29.42 and 10.17respectively,P＜0.05] or earlier than 34 weeks [17.0％ (17/100) vs 65.5％ (78/119),14.1％(9/64) vs 61.2％(52/85) and 42.9％(6/14) vs 94.7％(18/19); x2 =47.71,31.18 and 10.61 respectively,P＜0.05] were lower in patient-TH than in patient-NP.(2) In patient-NP and patientPH,onset of preeclampsia was earlier in CH subgroup compared with I-PE subgroup (Z=26.61 and 22.82,P＜ 0.05). In patient-NP,the proportion of severe preeclampsia occurred earlier than 32 weeks (x2 =9.11,P＜0.05) or earlier than 34 weeks (x2 =7.95,P＜0.05) was higher in CH subgroup than in I-PE subgroup. Conclusions Regular prenatal care in tertiary hospital might effectively delay the onset of preeclampsia or severe preeclampsia,especially in patients with risk factors for preeclampsia. Assessment of risk factors for preeclampsia in early trimester should be strengthened and individualized prenatal care plan should be established.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)03147-1521