摘要
目的探讨妊娠期高血压疾病(HDCP)孕妇合并可逆性后部白质脑病综合征(RPLS)的危险因素以及围产儿结局。方法回顾性分析2012年1月~2017年1月在我院诊断为妊娠期高血压疾病并行头颅MRI筛查的孕妇88例,根据影像学检查结果分为合并RPLS组(43例)和未合并RPLS组(45例)。比较两组孕妇并发症发生率及围产儿结局,并应用多因素Logistic回归分析孕期血压、产龄等因素,分析妊娠期高血压疾病合并RPLS的危险因素。结果合并RPLS组孕妇中入院时高血压3级比例和肌酐、尿酸、谷丙转氨酶、谷草转氨酶、乳酸脱氢酶水平升高,出现妊娠期糖尿病、子痫、HELLP综合征、产后出血和死胎、早产儿发生率均较未合并RPLS组多(P均<0.05)。多因素Logistic回归分析显示,入院时血小板减少(OR=2.703,95%CI为0.758~0.995,P=0.003)、尿酸水平升高(OR=1.015,95%CI为1.002~1.018,P=0.045)、血清白蛋白降低(OR=0.993,95%CI为0.945~1.132,P=0.008)、高血压3级(OR=12.524,95%CI为0.003~105.785,P=0.007)是妊娠期高血压疾病合并RPLS的独立危险因素。结论妊娠期高血压疾病孕妇合并RPLS可以增加子痫、产后出血发生率和死胎、早产儿不良结局发生率,血小板减少、血清白蛋白降低、高血压3级、尿酸是妊娠期高血压疾病合并RPLS的危险因素,应针对危险因素进行干预,降低妊娠期高血压疾病合并RPLS的发生率。
Objective To explore risk factors and perinatal outcomes of reversible posterior leukoencephalopathy syndrome（RPLS） in women with hypertensive disorder complicating pregnancy（HDCP）. Methods The data of 88 women with hypertensive disorder complicating pregnancy in our hospital and screened by cranial MRI from January 2012 to January 2017 was retrospectively analyzed. And all them were divided into RPLS group（43 cases） and cranial MRI normal group（45 cases） according to the MRI results. The incidence of maternal complications and perinatal outcomes were compared between two groups, the risk factors of RPLS in women with HDCP included blood pressure, birth age and other factors were analyzed by multivariate Logistic regression analysis. Results In the RPLS group, the ratio of stage 3 hypertension, levels of serum creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase of pregnant women at the time of admission were increased, the incidence of gestational diabetes, eclampsia, HELLP syndrome, postpartum hemorrhage and stillbirth, preterm infants were higher than cranial MRI normal group（P 〈0.05）. In multivariate Logistic regression analysis, there was strong evidence that low counts of platelets（OR=2.703, 95%CI 0.758-0.995, P=0.003）, elevated uric acid level（OR=1.015, 95%CI 1.002-1.018, P=0.045）, lower serum albumin（OR=0.993, 95%CI 0.945-1.132, P=0.008）, and stage 3 hypertension（OR=12.524, 95%CI 0.003-105.785, P=0.007） were independently associated with RPLS in pregnant women with HDCP. Conclusion RPLS in pregnant women with HDCP can increase the incidence of postpartum hemorrhage, eclampsia, stillbirth and premature infants; thrombocytopenia, lower serum albumin, stage 3 hypertension, and uric acid were risk factors for RPLS with HDCP. According to the risk factors, interventions should be carried out to reduce the incidence of RPLS with HDCP.
作者
颜露春
叶蔚
严兆华
张娜
曹春燕
YAN Luchun;YE Wei;YAN Zhaohua;ZHANG Na;CAO Chunyan(Department of Obstetrics and Gynecology,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524023,Chin)
出处
《中国医药科学》
2018年第14期15-19,共5页
China Medicine And Pharmacy
基金
广东省湛江市科技攻关计划项目(2017B01046)
关键词
可逆性后部白质脑病综合征
妊娠期高血压疾病
围产儿
危险因素
Reversible posterior leukoencephalopathy syndrome
Hypertensive disorder complicating pregnancy
Perinatal infant
Risk factors
