孕产妇年龄与子痫前期的相关性及对妊娠结局影响的临床研究.docx

    [1]孕产妇年龄与子痫前期的相关性及对妊娠结局影响的临床研究    【Summary】目的：研究产妇人群中年龄与子痫前期（Preeclampsia,PE）发病率之间的相关性，同时分析年龄是否对患有子痫前期孕产妇的妊娠结局有一定的影响，从而对不同年龄阶段的孕产妇的孕期检查提出指导性意见方法：随机选取本院产科门诊及病房的孕产妇（726例）作为研究对象依据不同年龄分为：＜20岁组，20~24岁组、25~29 岁组、 30~34岁年龄组、35~39岁组和≥40岁年龄组统计各个年龄组子痫前期的发病率，采用20~24岁年龄组的PE发生率作为参考值，计算其余5个年龄组的PE相对风险比；统计不同年龄段PE发生率与平均年龄的相关性对子痫前期孕产妇进行随访，随访周期至分娩完成，统计发生了子痫前期的孕产妇的妊娠结局，依据孕产妇是否存在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎等妊娠不良结局分为妊娠结局良好及妊娠结局不良组，分析两组孕产妇年龄的差别结果：<20岁组，及≥40岁组的子痫前期的发病率分别达到11.11%，9.52%，发病率最低的是20~24岁组（1.15%），以20~24岁年龄组的PE发生率作为参考值，其余5个年龄组的PE相对风险比也是<20岁组，及≥40岁组比较高，其余各组的相对风险比随着年龄的增加而升高；不同年龄段PE发生率与平均年龄有相关性；从妊娠结局良好与不良分组中研究发现妊娠结局不良组的孕周明显小于妊娠结局良好的，说明妊娠结局不良的容易发生早产。

结论：<20岁孕妇及≥40岁的子痫前期的发病率都比较高，发病率最低的是20~24岁，之后发病率随着年龄段年龄的增加而逐渐升高，子痫前期的发病率与年龄有明显的相关性，发生子痫前期的孕妇中妊娠结局良好组与不良组的平均年龄未见明显差异Keys】子痫前期；妊娠结局；妊娠期高血压疾病Studyon the correlation between maternal age and preeclampsia and its influence on pregnancy outcomeLiao Nihong, Jiang Yan,Chen Yan,Huang Xuefang*(Guangdong Agriculture and reclamation Central hospital-Zhanjiang Cancer Hospital,Zhanjiang 524002,China）[Abstract]Objective: To study the correlation between the age of the maternal population and the incidence rate of preeclampsia（PE）, analyze whether the age has a certain impact on the pregnancy outcome of pregnant women with PE, so as to provide guidance for pregnant women at different age stages in the pregnancy examination. Methods: We selected 726 pregnant in the obstetric clinic and ward of our hospital as the research objects. According to different ages, they were pided into six groups:<20 year old group, 20-24 y, 25-29 y, 30-34 y, 35-39 y and≥40 y.The incidence rate of PE in each age group was counted,The incidence of PE in the 20-24 y was used as the reference value to calculate the relative risk ratio of PE in the remaining five age groups.The incidence of PE in different age groups was correlated with the average age.The follow-up of the pregnant women with PEwere finishedwhen they completed delivery.Counted the pregnancy outcomes of the pregnant women with PE, according to whether them had adverse pregnancy outcomes such as premature rupture of membranes, premature delivery, chorioamnionitis, amniotic cavity infection, postpartum endometritis.They were pided into two groups: good pregnancy outcome group and bad pregnancy outcome group.Found out the differense of the two group,s.Results: The incidence rate of PE in the group of<20 y and the group of≥40 yreached 11.11% and 9.52% , and the lowest incidence rate was in the group of 20-24 y (1.15%). Taking the incidence of PE in the 20-24 y as the reference value, the relative risk ratio of PE in the other five age groups were that the group<20 y and the group≥40 ywere9.66 and 8.28,the relative risk ratio of the other groups increased with age.The incidence of PE in different age groups was correlated with the average age.From the study of good and bad pregnancy outcomes, it was found that there were no differense with the tuo group,smaternal age.Conclusion: The incidence rate of PE was relatively high in women<20 y and those≥40 y. The lowest incidence rate was in 20-24 y, and then the incidence rate gradually increased with the increase of age. The incidence rate of PE is significantly related to age, the maternal age of the poor pregnancy outcome group and good poor pregnancy outcome group had no differense.[Keywords]Preeclampsia(PE); pregnancy outcome; hypertensive disorder complicating pregnancy（HDCP）妊娠期高血压疾病（hypertensive disorder complicating pregnancy，HDCP）是妊娠与高血压同时发生的疾病，我们国家的发病率大概为5%~12%，全世界的发病率为7%~12%[1]。

子痫前期是妊娠期特有的疾病，是导致妊娠不良结局的主要原因之一，严重者可致母儿死亡子痫前期有个“二阶段模式”学说，该学说2009年由Redman提出，这也是目前公认的子痫前期发病机制[18]，他认为是胎盘发育异常功能障碍和胎盘释放多种活性因子进入母体血液循环，引起血管内皮细胞受损，全身小动脉粥样硬化，从而使血管收缩舒张失衡致血压升高等，引发子痫前期一系列临床表型我国的指南在2012年版中将子痫前期定义为妊娠高血压合并蛋白尿或器官功能障碍[15]，直到2020版指南中对子痫前期的定义并未发生改变[16]本研究的目的是确定本院产妇人群中年龄与子痫前期发病率之间的相关性，同时分析年龄是否对患有子痫前期孕产妇的妊娠结局有一定的影响，从而对不同年龄阶段的孕产妇的孕期检查提出指导性意见1资料与方法1.1 资料研究对象：本院产科门诊及病房的孕产妇（726例）作为研究对象依据不同年龄分为：＜20岁组，20~24岁组、25~29 岁组、 30~34岁年龄组、35~39岁组和≥40岁年龄组纳入标准：①在妇产科行产前诊断而住院的单胎妊娠产妇；②非辅助生殖技术受孕(IVF)的妇女；③无个人或家族染色体异常；④无不良孕产史；⑤无前次妊娠出现并发症或合并症的，如贫血，肝炎，甲状腺功能异常，高血压和糖尿病等；⑥ 非多胎妊娠（双胞胎，三胞胎）。

排除标准：①拒绝签署知情同意书；②排除患有内分泌功能异常、血栓及相关性疾病史或家族史、肝肾疾病患者；③双胎或多胎；④口服避孕药史、不良妊娠史、既往具有高血压史、近期服用过纤溶药、糖尿病史；⑤正在治疗的子痫前期患者或患有其他可能影响孕产妇的凝血及纤溶系统的疾病的患者1.2方法1.2.1统计各个年龄组子痫前期的发病率，采用20~24岁年龄组的PE发生率作为参考值，计算其余5个年龄组的PE相对风险比；统计不同年龄段PE发生率与平均年龄的相关性对子痫前期孕产妇进行随访，随访周期至分娩完成，统计发生了子痫前期的孕产妇的妊娠结局，依据孕产妇是否存在胎膜早破、早产、绒毛膜羊膜炎、羊膜腔感染、产后子宫内膜炎等妊娠不良结局分为妊娠结局良好及妊娠结局不良组，分析两组孕产妇年龄的差别1.2.2统计学处理 数据采用SPSS25.0统计学软件进行数据处理分析，其中对于符合正态分布的计量资料采取t检验，其中组间比较采用成组t检验且利用均数±标准差（）表示；计数资料采用X2检验；检验标准设定为α=0.05，P<0.05认为差异具有统计学意义2结果2.1 各个年龄组子痫前期的发病率六个年龄段中，我们发现<20岁组，及≥40岁组的发病率都比较高，分别达到11.11%，9.52%，发病率最低的是20~24岁组的，子痫前期发病率为1.15%，之后随着年龄段年龄的增加而逐渐升高。

以20~24岁组的PE发生率作为参考值，计算出<20岁组，及≥40岁组的风险比分别为RR=9.66，RR=8.28，25~29岁组RR=1.85，30~34岁组RR=2.92，35-39岁组RR=4.89以20~24岁组的PE发生率作为对照组，各组相对于对照组的校正卡方检验分别为：20~24岁组X2=0.587，P=0.444；25~29岁组X2=0.018，P=0.892；30~34岁组X2=0.482，P=0.488；35-39岁组X2=4.711，P=0.03；≥40岁组X2=1.。