摘要
目的了解妊娠晚期孕妇低蛋白血症的发生状况,探讨低蛋白血症的发生原因及相关因素,并对低蛋白血症可能造成的不良妊娠结局进行分析。方法总结7651例孕产妇血清学生化检查结果,将总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)定量值作为分组标准。设定三者定量值均在参考值范围内的孕产妇为对照组(A组);三者定量值均低于参考值者为低蛋白血症组,又根据病因学将低蛋白血症组分为子痫前期组和非子痫前期组。分析各组生化指标的变化,并对妊娠结局(医源性早产率、胎儿生长受限率、胎盘早剥发生率)进行分析。结果低蛋白血症组95例,其中子痫前期组51例,非子痫前期组44例。孕晚期低蛋白血症病因前3位分别为子痫前期(53.7%)、多胎妊娠(13.7%)、肝脏疾病(12.6%)。3组间总蛋白、白蛋白、前白蛋白差异有统计学意义,随低白蛋白严重程度A/G呈倒置趋势。子痫前期中早产45例(88.2%),FGR27例(52.9%),胎盘早剥9例(18%)。非子痫前期组中早产16例(36.4%),FGR10例(22.7%),胎盘早剥3例(6.8%)。对照组中无早产、胎盘早剥发生,有1例孕妇出现FGR,差异有统计学意义。Logistic回归分析显示,非子痫前期组早产、胎盘早剥、FGR发生的OR值分别为13.1、52.8、3.82。结论子痫前期、多胎妊娠、肝脏疾病等是造成孕晚期低蛋白血症的重要原因。低蛋白血症可并发机体多种生化指标异常。随低蛋白血症严重程度加重,胎儿生长受限率、胎盘早剥发生率、医源性早产率增加,低蛋白血症是患者发生上述不良妊娠结局的高危因素。
Objective To investigate the situation of pregnant women with hypoproteinemia in the late trimester and to analyze the possible causes. The associated factors with bypoproteinemia and its possible effect on pregnancy outcomes. Methods The serum biochemical parameters including total protein（TP）,albumin（ALB）,pre-albumin（PA）,glucose （GLU）,lipids （HDL -C,LDL -C,TG,CHO）,alanine aminotransferase （ALT）,urea nitrogen （BUN）,creatinine （CR）,uric acid （UA）,lactate dehydmgenase （LDH）,electmlyte （K＋,Na＋ ,C1-,Mg＋＋）were tested for the venous blood samples of inpatient pregnant women at the late trimester.. Patients were divided based on the value of TP,ALB and PA. Group 1 （the control group） was composed of inpatient whose test results were in normal limits as the control group. Patients with hypoproteine- mia the level of TP,ALB and PA was lower than normal limit as the study group. The study group was further divided into 2 groups the preeclampsiagroup（group 2） and the non-preeclampsia group （group 3）. Results Amount to 95 cases collected, 51 cases were in group 2 and 44 cases were in group 3, respectively. The major three causes for hypoalbuminemia were preeclampsia（53.7%）, multiple pregnancy（13.7%） and liver disease 12.6%. There were significant in TP,ALB and PA levels between the 3 groups. There was a tendency of increasing of A/G ratio with the severity of hypoproteinemia. There was significant difference in almost all of the biochemical indicatom except glucose and LDL-C level among the three groups. There were 45 preterm labor（88.2%）,27 fetal growth retardation（52.9%）, 9 placenta abruption（18%） in group 2 and 16 （36.4%）,10 （22.7%）,and 3 （6.8%） group 3 respectively. No preterm and placenta abruption happened in the control group besides one c with FGR. The odds ratios for preterm labor, placenta abruption and FGR of group 3 were 13.1,52.8 and 3.82 respectively compared with the control group by logistic single factor regression analysis. The ORs for preterm labor, placenta abruption and FGR of group 2 were 0.000, 13.824 and 0.072 respectively compared with those of group 3 by similar analysis. Conclusion Preeclampsia is the most common cause of late trimester hypoproteinemia. The pregnancy complications such as preterm labor, fetal growth retardation and placenta abruption increased with the severity of hypoproteinemia. Hypoproteinemia maybe a high risk factor leading to pathological pregnancy outcome.
出处
《北京医学》
CAS
2012年第5期363-367,共5页
Beijing Medical Journal
关键词
孕晚期
低蛋白血症
生化指标
妊娠结局
Late trimester Hypoproteinemia Biochemical indicator Pregnancy outcome
