中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (06): 397-402.doi: 10.3969/j.issn.1671-4091.2017.06.010

• 临床研究 • 上一篇    下一篇

子痫前期患者的肾脏远期预后随访调查

张丽洁1,张爱华1   

  1. 1. 北京大学第三医院肾内科
  • 收稿日期:2017-03-27 修回日期:2017-04-25 出版日期:2017-06-12 发布日期:2017-06-14
  • 通讯作者: 张爱华 zhangaihua0982@sina.com E-mail:zhangaihua0982@sina.com
  • 基金资助:

    国家自然基金委项目资助(项目编号81170706, 81341022, 81570663)，北京市科学技术委员会项目资助（项目编号SCW 2009-8）

Investigation of long-term renal outcome in women with preeclampsia

  • Received:2017-03-27 Revised:2017-04-25 Online:2017-06-12 Published:2017-06-14

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摘要： 目的观察子痫前期患者肾脏远期预后情况。方法采用回顾性队列研究，选取2005～2011 年在北京大学第三医院产科住院分娩时诊断为子痫前期的患者，观察肾脏长期预后，分析遗留肾脏损害、高血压的危险因素。结果①子痫前期患者产后出院时39.4%(121/307)的患者尿蛋白转阴，产后3 个月仍有49.2%(151/307)患者尿蛋白未转阴。②截止到随访结束，307 例子痫前期患者中，5 例(1.6%)患者产后持续尿蛋白阳性，共18 例(5.9%)患者仍遗留高血压，所有随访患者肾功能均正常。③Logistic多元回归分析显示：子痫前期患者产后3 月尿蛋白未转阴的危险因素是产前尿蛋白定量≥3.0g/24h(HR =3.560，95% CI 1.694～7.482，P=0.001)、收缩压≥155mmHg(HR=2.031，95% CI 1.049～3.934，P=0.036)、子痫前期分期为重度(HR=2.580，95% CI 1.166～5.708，P=0.019)；远期遗留高血压的危险因素是产前收缩压≥160mmHg(HR=7.875，95% CI 2.081～29.794,P=0.002)、血红蛋白≥123g/L(HR=3.517，95% CI 1.170～10.577,P=0.025)；但因病例数较少未能分析出远期遗留蛋白尿的危险因素。结论绝大部分单纯子痫前期患者肾脏远期预后相对良好，仅少数子痫前期孕妇产后长期遗留持续蛋白尿(5/307 例，1.6%)、高血压(18/307 例，5.9%)。我们的研究首次发现产前尿蛋白定量≥3.0g/24h、收缩压≥155mmHg、子痫前期分期为重度是子痫前期患者产后3 月尿蛋白未转阴的危险因素；而产前收缩压≥160mmHg、血红蛋白≥123g/L，是子痫前期患者远期遗留高血压的危险因素，而由于远期遗留蛋白尿的病例数较少，尚没有发现远期遗留蛋白尿的危险因素。子痫前期患者更远期的肾脏预后需要更大样本更长期的随访研究确定。

关键词: 子痫前期, 蛋白尿, 血压, 随访

Abstract: Objectives The purpose of this retrospective cohort study was to investigate the long-term renal outcome in women with preeclampsia. Methods In this retrospective cohort study, patients with preeclampsia between 2005 and 2011 and hospitalized in Obstetric Department of Peking University Third Hospital were recruited. The recovery of renal function and blood pressure after delivery was observed. The risk factors for persistent renal damage and hypertension after delivery were analyzed. Results ①The postpartum urinary protein was negative at discharge from the hospital in 39.4% (121/307) preeclampsia patients. Proteinuria persisted after 3 months in 49.2% (151/307) preeclampsia patients. ② Until the latest follow-up study, 5 patients (5/307, 1.6%) still had proteinuria, 18 patients (18/307, 5.9%) still had hypertension, and all participants had normal renal function. ③Multivariate logistic regression showed that the risk factors for continuous proteinuria after delivery for 3 months were prepartum urinary protein ≥3.0 g/24h (HR=3.560, 95% CI 1.694～7.482, P=0.001), prepartum systolic blood pressure (SBP) ≥155 mmHg (HR=2.031, 95% CI 1.049～3.934, P=0.036) and severe preeclampsia (HR=2.580, 95% CI 1.166～5.708, P=0.019); the risk factors for long-term hypertension were prepartum SBP ≥160 mmHg (HR=7.875, 95% CI 2.081～29.794, P=0.002) and hemoglobin level ≥123 g/L (HR=3.517, 95% CI 1.170～10.577, P=0.025). We could not find out the risk factors for persistent proteinuria due to the small samples. Conclusions The long-term renal outcome was optimistic in most preeclampsia women. Proteinuria (5/307, 1.6%) and hypertension (18/307, 5.9%) persisted in only a few patients. The risk factors for continuous proteinuria after delivery for 3 months were prepartum urinary protein ≥3.0 g/24h, prepartum SBP ≥155 mmHg and severe preeclampsia. The risk factors for long-term hypertension were prepartum SBP ≥160 mmHg and hemoglobin level ≥123 g/L. Longer follow- up period and larger samples are required to find out the risk factors for long-term renal outcome in preeclampsia women.

Key words: Preeclampsia, proteinuria, blood pressure, follow-up