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目的分析接受规律产前检查的轻重度子痫前期(PE)发病的影响因素和早期临床特征,以及不同产前检查模式的影响,探讨延缓PE发展、降低重度PE发生的临床监控和干预时机。方法收集2008年1月至2011年12月在北京大学第三医院接受规律产前检查发生和诊治的238例PE病历临床资料,采用历史前瞻性队列分析方法对发生轻度PE(M-PE)与重度PE(S-PE)的风险因素和临床发病特征进行对比分析。并对比分析接受强化产前检查与常规产前检查病例间临床预警信息及PE发生孕期时段和诊断时限。结果 (1)轻与重度PE间发病风险因素及临床首发症状差异无统计学意义(P>0.05)。(2)单胎妊娠单纯性轻与重度PE早期临床特征分析:①诊断前预警信息:S-PE组在诊断前存在高血压前期、低蛋白血症、血小板(PLT)下降趋势比例高于M-PE组(P<0.05);S-PE组血清白蛋白<29 g/L、PLT下降大于40%比例显著高于M-PE组(P<0.05)。②S-PE组预警信息出现至临床症状出现时间短于M-PE组,预警信息出现至做出PE诊断标准时间也短于M-PE组(P<0.05)。(3)产前检查模式分析显示:强化产检组PE重度发病率低于常规产检组(P<0.05)。强化产检组发现临床症状早于常规产检组,但PE发生时间迟于常规产检组(P<0.05)。(4)多因素回归分析显示孕早期超重(OR 2.480,P=0.035),高血压前期(OR 3.304,P=0.046),低蛋白血症(OR 3.951,P=0.035)、PLT下降趋势(OR 2.582,P=0.047)、强化产检(OR 0.321,P=0.041)是子痫前期发病轻重的独立影响因素。结论发病前临床预警信息在轻与重度PE存在明显异质性。强化产检可显著降低S-PE发病率,提早发现临床症状,延缓S-PE发病时间。孕早期超重、高血压前期、胎儿生长受限、强化产检是影响子痫前期轻与重的独立因素。
Objective To analyze the influencing factors and early clinical features of preeclampsia on the incidence of severe preeclampsia (PE) and the influence of different modes of prenatal examination to explore the clinical monitoring and intervention timing to delay the development of PE and reduce the occurrence of severe PE. Methods The clinical data of 238 cases of PE patients receiving routine prenatal examination at the Third Hospital of Peking University from January 2008 to December 2011 were collected and analyzed by historical prospective cohort method for the diagnosis of mild PE (M-PE) And severe PE (S-PE) risk factors and clinical features of the incidence of comparative analysis. And comparative analysis of prenatal care and routine prenatal care to strengthen the clinical early warning information between cases and PE occurred during pregnancy and diagnosis of time. Results (1) There was no significant difference in the risk factors and the first symptom of clinical symptom between mild and severe PE (P> 0.05). (2) Analysis of the early clinical features of single mild and severe PE in singleton pregnancies: ①Pre-diagnosis warning information: The pre-diagnosis pre-diagnosis of hypertension, hypoproteinemia, PLT decreased more than M -PE group (P <0.05). The serum albumin <29 g / L in S-PE group was significantly higher than that in M-PE group (P <0.05). (2) The occurrence of clinical symptoms in S-PE group appeared shorter than that in M-PE group, and the time from early warning information to PE diagnosis standard was shorter than that in M-PE group (P <0.05). (3) The analysis of prenatal examination showed that the severe polyps incidence in PE group was lower than that in routine production (P <0.05). In the intensive test group, the clinical symptoms were found to be earlier than those in the routine test group, but the PE occurred later than the routine test group (P <0.05). (4) Multivariate regression analysis showed that in the first trimester of pregnancy, the incidence of overweight (OR 2.480, P = 0.035), prehypertension (OR 3.304, P = 0.046), hypoproteinemia (OR 3.951, 2.582, P = 0.047). Intensive childbirth (OR 0.321, P = 0.041) was an independent factor influencing the severity of preeclampsia. Conclusion Pre-onset clinical warning information has obvious heterogeneity in light and severe PE. Intensified health examination can significantly reduce the incidence of S-PE, early detection of clinical symptoms, delay the onset of S-PE. Early pregnancy is overweight, prehypertension, fetal growth restriction, intensive childbirth is an independent factor affecting the severity and severity of preeclampsia.