慢性肾脏病妊娠患者先兆子痫的危险因素探讨

目的探讨慢性肾脏病患者妊娠先兆子痫的危险因素，为预测妊娠风险和鉴别诊断提供依据。方法回顾性分析医院妊娠前已患慢性肾脏病的孕妇资料，按是否发生先兆子痫分为先兆子痛组（30例）和对照组（45例），比较各项临床指标，用回归模型分析危险因素。结果两组间在妊娠年龄、原发病类型、妊娠前及妊娠20周后血压及蛋白尿水平、妊娠20周后血尿酸水平上有明显差别。结论非适龄妊娠、妊娠前慢性肾脏病控制欠佳以及免疫性肾小球疾病（如IgA肾病或狼疮性肾炎）是发生先兆子痫的危险因素，这类孕妇若在妊娠20周后发生2级以上的高血压和蛋白尿翻倍。且伴有血尿酸水平增加，则高度提示发生先兆子痫的可能。

Risk Factors of Preeclampsia in Pregnant Patients with Chronic Kidney Disease

Objective To analyze the risk factors of preeclampsia in pregnant women with chronic kidney disease and to provide the evidences for differential diagnosis. Methods The pregnancy cases were analyzed retrospectively. The patients were grouped into preeclampsia group （n =30） and control group （n =45）. The data between the two groups were compared and the risk factors of preeclampsia onset were analyzed by a regression model. Results The ratio of age, categories of basal glomerular diseases, levels of blood pressure, proteinuria before or 20 weeks after pregnancy and levels of uric acid were significant different between the two groups. Conclusion Pregnancy at inadequate age, uncontrolled chronic kidney disease prior to pregnancy and immune- associated glomerular diseases, such as IgA nephropathy and lupus nephritis, are all risk factors for preeclampsia. The women with these factors are at high risk to develop preeclampsia when they have more severe hypertension more than grade 2, doubled proteinuria and increased levels of uric acid.