Abstract：Objective To analyze the differences of expected treatment time, influencing factors and maternal and infant outcomes between patients with chronic hypertension complicated with early onset severe preeclampsia (CHEOSP) and patients with early onset severe preeclampsia (EOSP). Methods Four hundred and ninety-three cases of singleton EOSP patients admitted to Maternal and Child Health Hospital of Anhui Medical University from January 2018 to January 2020 were selected as research objects. They were divided into CHEOSP group (group A) with 98 cases and EOSP group (group B) with 395 cases according to whether complicated with chronic hypertension. The general situation, expected treatment time, influencing factors and maternal and infant outcomes of two groups were compared. Results The proportion of multipara, systolic blood pressure and diastolic blood pressure in group A were higher than those in group B, and serum uric acid in group A was lower than that in group B, the differences were statistically significant (P < 0.05). Gestational age less than 28 weeks, the gestational age and delivery gestational age of group A were shorter than those of group B, and expected treatment time of group A was longer than that of group B, the differences were statistically significant (P < 0.05). Gestational age from 28 to 32 weeks, expected treatment time and delivery gestational age of group A were longer than those of group B, the differences were statistically significant (P < 0.05). Gestational age from 32 to 33+6 weeks, the gestational age of group A was shorter than that of group B, and expected treatment time and delivery gestational age of group A were longer than those of group B (P < 0.05). The incidence rate of hypoproteinemia, hydrothorax and ascites in group A were lower than those in group B, and the incidence rate of fetal growth restriction and fetal distress in group A were higher than those in group B (P < 0.05). Pearson product moment correlation showed that expected treatment time of group A and B was positively correlated with plasma albumin level (r = 0.800, 0.780, P < 0.01) and negatively correlated with 24 hours urinary protein level (r = -0.398, -0.433, P < 0.01). Conclusion Patients with CHEOSP have longer expected treatment time than those with EOSP alone, there is no serious complication on the basis of the disease itself. However, in the course of expected treatment, we should pay attention to the level of plasma albumin and the occurrence of complications such as pleural effusion and ascites. It may cause the termination of pregnancy.
刘敏 王海霞 陈先侠. 早发型重度子痫前期患者有无合并慢性高血压期待治疗的临床对比分析[J]. 中国医药导报, 2021, 18(11): 91-95.
LIU Min WANG Haixia CHEN Xianxia. Clinical comparative analysis of patients with early onset severe preeclampsia with or without chronic hypertension expectant treatment. 中国医药导报, 2021, 18(11): 91-95.
[1] ACOG practice bulletin No.202：gestational hypertension and preeclampsia [J]. Obstet Gynecol，2019，133（1）：e1-e25．
[2] Fu J，Li C，Gou W，et al. Expectant or outpatient management of preeclampsia before 34 weeks：safe for mother but associated with increased stillbirth risk [J]. J Hum Hypertens，2019，33（9）：664-670.
[3] 胡蓉，吴蔚，姚晴晴，等.子痫前期合并胎儿生长受限的母儿妊娠结局分析[J].现代妇产科进展，2017，26（11）：834-836.
[4] 谢幸，孔北华，段涛.妇产科学[M].9版.北京：人民卫生出版社，2018.
[5] 杨孜，张为远.《妊娠期高血压疾病诊治指南（2020）》解读[J].中华妇产科杂志，2020，55（6）：425-432.
[6] Rani DJ，Rani LJ，Poornima P. Evaluation of maternal and perinatal outcomes in elective termination of severe preeclampsia between 28 to 34 weeks in a tertiary care hospital—A retrospective study [J]. IAIM，2020，7（1）：1-6.
[7] Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy [J]. Obstet Gynecol，2013，122（5）：1122-1131.
[8] Xiao J，Shen F，Xue Q，et al. Is ethnicity a risk factor for developing preeclampsia? An analysis of the prevalence of preeclampsia in China [J]. J Hum Hypertens，2014，28（11）：694-698．
[9] Hoshino A，Obata S，Tochio A，et al. Efficacy of expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension before 34 weeks gestation [J]. Pregnancy Hypertens，2019，15：177-180.
[10] 苗晓.早发型子痫前期期待治疗对围生儿结局影响因素分析[J].首都医科大学学报，2015，36（3）：465-468.
[11] 郭静.早发型重度子痫前期合并胎儿生长受限期待治疗妊娠结局的相关研究[J].中国现代医生，2019，57（11）：79-81.
[12] Boeldt DS，Bird IM. Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia [J]. J Endocrinol，2017，232（1）：R27-R44.
[13] Pritchard N，Lino K，Gong YS，et al. Elabela/apela levels are not decreased in the maternal circulation or placenta among women with preeclampsia [J]. Am J Pathol，2018， 188（8）：1749-1753．
[14] 许翔，刘新秀，陈玲，等.妊娠期高血压和子痫前期对孕妇产后血管内皮功能的影响[J].中国医学影像学杂志，2020，28（4）：300-303.
[15] 李可，朱大伟，陈建昆，等.子痫前期发病机制与临床治疗研究进展[J].解放军医学杂志，2019，44（5）：423-429.
[16] Serrano NC，Quintero-Lesmes DC，Dudbridge F，et al. Family history of preeclampsia and cardiovascular disease as risk factors for pre-eclampsia：the GenPE case-control study [J]. Hypertens Pregnancy，2020，39（1）：56-63.
[17] Staff AC，Redman CW，Williams D，et al. Pregnancy and longterm maternal cardiovascular health：progress through harmonization of research cohorts and biobanks [J]. Hypertension，2016，67（2）：251-260.
[18] 周蓓，谢恺俐.子痫前期发病机制研究进展[J].中南大学学报：医学版，2020，45（9）：1136-1141.
[19] Lindstr?觟m L，Skjaerven R，Bergman E，et al. Chronic hypertension in women after perinatal exposure to preeclampsia，being born small for gestational age or preterm [J]. Paediatr Perinat Epidemiol，2017，31（2）：89-98.
[20] Conti-ramsden FI，Nathan HL，De Greeff A，et al. Pregnancy-related acute kidney injury in preeclampsia：risk factors and renal outcomes [J]. Hypertension，2019，74（5）：1144-1151.
[21] Hussein W，Lafayette RA. Renal function in normal and disordered pregnancy [J]. Curr Opin Nephrol Hypertens，2014，23（1）：46-53.
[22] Ronkainen J，Lowry E，Heiskala A，et al. Maternal hemo-globin associates with preterm delivery and small for gestational age in two Finnish birth cohorts [J]. Eur J Obstet Gynecol Repro Biol，2019，238：44-48.
[23] Bakrania B，Duncan J，Warrington JP，et al. The endothelin type A receptor as a potential therapeutic target in preeclampsia [J]. Int J Mol Sci，2017，18（3）：E522.
[24] 中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南（2015）[J].中华妇产科杂志，2015，50（10）：206-213.
[25] 蔡江美，夏亚娣.24 h尿蛋白定量对子痫前期孕妇发生不良妊娠结局的临床价值研究[J].中国妇幼保健，2019， 34（15）：3460-3462.
[26] Le Y，Ye J，Lin J. Expectant management of early-onset severe preeclampsia：a principal component analysis [J]. Ann Transl Med，2019，7（20）：519.
京公网安备 11010502046598号