晚孕期孕妇合并低蛋白血症的不良妊娠结局及其影响因素分析

doi:10.3877/cma.j.issn.1673-5250.2015.03.020

目的

探讨晚孕期孕妇合并低蛋白血症的不良妊娠结局及其影响因素。

方法

选取2011年1月至2014年7月北京市通州区妇幼保健院收治的经过生化检查确认为晚孕期合并低蛋白血症的86例孕妇为研究对象，按照血清白蛋白检测水平，将其分为重度低蛋白血症亚组(Ⅰ组，n＝39)和轻度低蛋白血症组(Ⅱ组，n＝47)。选取本院同期收治的50例健康晚孕期孕妇纳入对照组(n＝50)。对3组孕妇的疾病构成比、妊娠不良结局(早产、胎儿生长受限、胎盘早剥等)、生化检查指标进行分析。此外，对晚孕期合并低蛋白血症孕妇不良妊娠结局影响因素进行非条件多因素logistic回归分析。3组孕妇的平均年龄比较，差异无统计学意义(P>0.05)。本研究遵循的程序符合北京市通州区妇幼保健院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象的知情同意，并与之签署临床研究知情同意书。

结果

①86例晚孕期合并低蛋白血症孕妇的主要病因为子痫前期(53.5%)，其次为肝脏疾病(12.8%)及多胎妊娠(11.6%)。子痫前期、非子痫前期及对照组孕妇的血清总蛋白、白蛋白、前白蛋白(PA)比较，差异有统计学意义(P<0.05)。②Ⅰ组、Ⅱ组及对照组孕妇在总蛋白、白蛋白、PA、尿酸、丙氨酸转氨酶(ALT)、乳酸脱氢酶(LDH)、肌酐、尿素氨、Mg^2＋、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等方面比较，差异均有统计学意义(P<0.05)，且Ⅰ组孕妇在早产、胎儿生长受限、胎盘早剥等不良妊娠结局发生率等方面显著高于Ⅱ组及对照组(P<0.05)。③非条件多因素logistic回归分析结果显示，低蛋白血症是晚孕期合并低蛋白血症孕妇不良妊娠结局的高危因素(OR＝1.261；P<0.05)。

结论

子痫前期是导致晚孕期孕妇合并低蛋白血症的重要因素。低蛋白血症孕妇常伴多种生化指标异常，且对妊娠结局造成不利影响，是母婴不良妊娠结局的高危因素，临床早期评估晚期孕妇合并低蛋白血症对于避免或降低妊娠不良结局发生率具有重要意义。

关键词: 低蛋白血症, 妊娠末期, 妊娠结局, 危险因素

Objective

To investigate adverse pregnancy outcomes of pregnant women with hypoproteinemia in the third trimester and its influencing factors.

Methods

A total of 86 cases of pregnant women who were diagnosed as hypoalbuminemia in the third trimester in the Tongzhou Maternal & Child Health Hospital from January 2011 to July 2014 were included into this study. All of those 86 cases of pregnant women were divided into severe hypoalbuminemia groups (Ⅰ group, n=39) and mild hypoalbuminemia group (Ⅱ group, n=47) according to serum albumin levels. At the same time, 50 cases of healthy pregnancy women in the third trimester were chosen as control group (n=50). There was no significant difference among three groups in the aspect of mean age (P>0.05). The adverse pregnant results, indexes of biochemical examination, and constituent ratio of main diseases of pregnant women with hypoalbuminemia during the third trimester were analyzed. Furthermore, correlation between eclampsism and hypoproteinemia, non-conditional multivariate logistic regression analysis were also analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Tongzhou Maternal & Child Health Hospital. Informed consent was obtained from each patient.

Results

① The main disease of pregnant women with hypoalbuminemia during the third trimester was preeclampsia (53.5%), followed by liver diseases (12.8%) and multiple pregnancies (11.6%). There were significant differences among preeclampsia pregnant women, non-preeclampsia pregnant women and control group in serum total protein, albumin and prealbumin (PA) (P<0.05). ② There were significant differences among Ⅰgroup, Ⅱ group and control group in total protein, albumin, PA, uric acid, alamine aminotransferase (ALT), lactate dehydrogenase (LDH), serum creatinine, blood urea nitrogen (BUN), Mg²⁺ , triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) (P<0.05). And the incidence rates of preterm birth, fetal growth restriction, placental abruption and other adverse pregnancy outcomes inⅠ group were higher than those in Ⅱ group and control group, with significant differences (P<0.05). ③Non-conditional multivariable logistic regression analysis showed that hypoalbuminemia was the highest risk factor of adverse pregnancy outcomes among pregnant women with hypoproteinemia in the third trimester (OR=1.261, P<0.05).

Conclusions

Preeclampsia plays an important role in the progress of pregnant women with hypoproteinemia in the third trimester. Pregnant women with hypoalbuminemia often accompanied by a variety of abnormal biochemical indicators and adverse pregnant outcomes. Early clinical evaluation of pregnant women with hypoalbuminemia in the third trimester has important significance for avoiding or descresing the incidence rate of adverse pregnant outcomes.

Key words: Hypoproteinemia, Pregnancy trimester, third, Pregnancy outcome, Risk factors

表1 晚孕期孕妇合并低蛋白血症的疾病构成比[例数(%)]

Table 1 Constituent ratio of main diseases of pregnant women with hypoalbuminemia during the third trimester [case (%)]

主要疾病	构成比
子痫前期	46 (53.5)
肝脏疾病	11 (12.8)
多胎妊娠	10 (11.6)
妊娠期糖尿病	6(7.0)
胎膜早破	4(4.7)
妊娠期蛋白尿	4(4.7)
高龄初产	2(3.5)
贫血	2(3.5)
围生期心肌病	1(1.2)
总计	86(100.0)

表1 晚孕期孕妇合并低蛋白血症的疾病构成比[例数(%)]

Table 1 Constituent ratio of main diseases of pregnant women with hypoalbuminemia during the third trimester [case (%)]

主要疾病	构成比
子痫前期	46 (53.5)
肝脏疾病	11 (12.8)
多胎妊娠	10 (11.6)
妊娠期糖尿病	6(7.0)
胎膜早破	4(4.7)
妊娠期蛋白尿	4(4.7)
高龄初产	2(3.5)
贫血	2(3.5)
围生期心肌病	1(1.2)
总计	86(100.0)

表2 子痫前期与低蛋白血症的关系(±s)

Table 2 Relationship between eclampsism and hypoproteinemia(±s)

项目	例数	总蛋白(g/L)	ALB(g/L)	PA(mg/L)
子痫前期孕妇	46	49.7±5.0^{a b}	19.5±3.2^{a b}	170.1±46.2^{a b}
非子痫前期孕妇	40	55.9±4.6^a	26.3±3.8^a	147.7±40.4^a
对照组	50	62.7±4.2	33.2±3.7	216.2±38.6
F值	?	95.881	176.569	201.673
P值	?	<0.05	<0.05	<0.05

表2 子痫前期与低蛋白血症的关系(±s)

Table 2 Relationship between eclampsism and hypoproteinemia(±s)

项目	例数	总蛋白(g/L)	ALB(g/L)	PA(mg/L)
子痫前期孕妇	46	49.7±5.0^{a b}	19.5±3.2^{a b}	170.1±46.2^{a b}
非子痫前期孕妇	40	55.9±4.6^a	26.3±3.8^a	147.7±40.4^a
对照组	50	62.7±4.2	33.2±3.7	216.2±38.6
F值	?	95.881	176.569	201.673
P值	?	<0.05	<0.05	<0.05

表3 3组孕妇生化检查指标比较(±s)

Table 3 Comparison of indexes of biochemical examination among three groups (±s)

组别	例数	总蛋白(g/L)	白蛋白(g/L)	PA(mg/L)	尿酸(μmol/L)	ALT(IU/L)	LDH(IU/L)	肌酐(μmol/L)	尿素氮(mmol/L)	GLU(mmol/L)	K^＋(mmol/L)	Na^＋(mmol/L)	Cl^－(mmol/L)	Mg^2＋(mmol/L)	TG(mmol/L)	TC(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)
Ⅰ组	39	47.2±4.7^ab	19.2±3.7^ab	166.7±40.7	393.6±110.6^ab	44.5±17.5^ab	259.2±101.7^ab	72.7±21.5^ab	5.5±1.7^ab	5.2±1.2	4.1±0.5	136.7±35.6	107±21.6	1.3±0.4^ab	4.4±1.9^ab	7.7±2.2^ab	1.7±0.5^a	3.2±1.3^ab
Ⅱ组	47	53.6±4.9^a	25.1±4.0^a	144.2±44.1	306.3±95.6^a	25.7±15.7^a	189.5± 62.6^a	64.5±33.0^a	3.7±1.3^a	5.1±0.8	3.9±0.4	137.7±45.2	108.4±25.7	0.9±0.2^a	2.8±1.1	5.9±1.3^a	1.6±0.6^a	2.4±0.9
对照组	50	62.7±3.2	33.2±3.7	216.2±38.6	271.3±65.7	14.5± 8.6	132.8± 34.7	48.8±10.2	2.9±0.9	5.3±0.8	3.9±0.3	136.3±52.7	103.9±31.0	0.8±0.1	2.9±1.6	5.3±1.4	2.1±0.7	2.2±0.6
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表3 3组孕妇生化检查指标比较(±s)

Table 3 Comparison of indexes of biochemical examination among three groups (±s)

组别	例数	总蛋白(g/L)	白蛋白(g/L)	PA(mg/L)	尿酸(μmol/L)	ALT(IU/L)	LDH(IU/L)	肌酐(μmol/L)	尿素氮(mmol/L)	GLU(mmol/L)	K^＋(mmol/L)	Na^＋(mmol/L)	Cl^－(mmol/L)	Mg^2＋(mmol/L)	TG(mmol/L)	TC(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)
Ⅰ组	39	47.2±4.7^ab	19.2±3.7^ab	166.7±40.7	393.6±110.6^ab	44.5±17.5^ab	259.2±101.7^ab	72.7±21.5^ab	5.5±1.7^ab	5.2±1.2	4.1±0.5	136.7±35.6	107±21.6	1.3±0.4^ab	4.4±1.9^ab	7.7±2.2^ab	1.7±0.5^a	3.2±1.3^ab
Ⅱ组	47	53.6±4.9^a	25.1±4.0^a	144.2±44.1	306.3±95.6^a	25.7±15.7^a	189.5± 62.6^a	64.5±33.0^a	3.7±1.3^a	5.1±0.8	3.9±0.4	137.7±45.2	108.4±25.7	0.9±0.2^a	2.8±1.1	5.9±1.3^a	1.6±0.6^a	2.4±0.9
对照组	50	62.7±3.2	33.2±3.7	216.2±38.6	271.3±65.7	14.5± 8.6	132.8± 34.7	48.8±10.2	2.9±0.9	5.3±0.8	3.9±0.3	136.3±52.7	103.9±31.0	0.8±0.1	2.9±1.6	5.3±1.4	2.1±0.7	2.2±0.6
P值	?	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	>0.05	>0.05	>0.05	>0.05	<0.05	<0.05	<0.05	<0.05	<0.05

表4 3组孕妇的不良妊娠结局比较[例数(%)]

Table 4 Comparison of adverse pregnant results among three groups [case(%)]

组别	例数	早产	胎盘早剥	胎儿生长受限
Ⅰ组	39	30(76.9)^{a b}	7(17.9)^a	20(51.3)^{a b}
Ⅱ组	47	15(31.9)^a	3 (6.4)	11(23.4)^a
对照组	50	1 (2.0)	0 (0.0)	1 (2.0)
χ²值	?	32.893	14.287	19.028
P值	?	<0.05	<0.05	<0.05

表4 3组孕妇的不良妊娠结局比较[例数(%)]

Table 4 Comparison of adverse pregnant results among three groups [case(%)]

组别	例数	早产	胎盘早剥	胎儿生长受限
Ⅰ组	39	30(76.9)^{a b}	7(17.9)^a	20(51.3)^{a b}
Ⅱ组	47	15(31.9)^a	3 (6.4)	11(23.4)^a
对照组	50	1 (2.0)	0 (0.0)	1 (2.0)
χ²值	?	32.893	14.287	19.028
P值	?	<0.05	<0.05	<0.05

表5 影响晚孕期合并低蛋白血症孕妇不良妊娠结局的非条件多因素logistic回归分析

Table 5 Non-conditional multivariate logistic regression analysis of pregnant women with hypoproteinemia in the third trimester

变量	β	SE	Wald χ²值	df	P值	OR	95%CI
常数项	0.497	0.216	26.910	1	0.000	0.441	－
低蛋白血症	0.232	0.112	4.601	1	0.038	1.261	1.048～1.623
子痫前期	0.896	0.335	14.891	1	0.000	2.487	1.357～4.672
分娩孕龄	0.197	0.087	5.261	1	0.023	1.218	1.063～1.493

表5 影响晚孕期合并低蛋白血症孕妇不良妊娠结局的非条件多因素logistic回归分析

Table 5 Non-conditional multivariate logistic regression analysis of pregnant women with hypoproteinemia in the third trimester

变量	β	SE	Wald χ²值	df	P值	OR	95%CI
常数项	0.497	0.216	26.910	1	0.000	0.441	－
低蛋白血症	0.232	0.112	4.601	1	0.038	1.261	1.048～1.623
子痫前期	0.896	0.335	14.891	1	0.000	2.487	1.357～4.672
分娩孕龄	0.197	0.087	5.261	1	0.023	1.218	1.063～1.493

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Analysis of adverse pregnancy outcomes of pregnant women with hypoproteinemia in the third trimester and its influencing factors

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Analysis of adverse pregnancy outcomes of pregnant women with hypoproteinemia in the third trimester and its influencing factors