Pregnancy outcomes analysis of preeclampsia pregnant women with different 24 h proteinuria quantification

doi:10.3877/cma.j.issn.1673-5250.2019.02.014

Objective

To investigate the maternal and fetal pregnancy outcomes of preeclampsia (PE) pregnant women with different 24 h urine protein quantification.

Methods

A total of 190 PE pregnant women who gave birth at Guangdong Women and Children′s Hospital from January 2015 to December 2017 were selected into this study. According to 24 h urine protein guantification results of 109 pregnant women, they were divided into 3 groups: group A (n=53, 24 h urine protein guantification was 300-1 000 mg), group B (n=71, 24 h urine protein guantification was 1 001-2 000 mg) and group C (n=66, 24 h urine protein guantification was more than 2 000 mg). General clinical data (age, gravidity, parity, systolic blood pressure, diastolic blood pressure, platelet count, newborn birth weight and gestational age), biochemical indicators, such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), prothrombin time (PT) and activated partial thromboplastin time (APTT), and pregnancy outcomes, such as rates of vaginal delivery, cesarean section, placental abruption, blood transfusion treatment, antihypertensive therapy, fetal respiratory distress syndrome, neonates transferred into neonatal intensive care unit (NICU), premature birth, pleural effusion of pregnant women, eclampsia and HELLP syndrome of PE pregnant women were retrospectively analyzed. Kruskal-Wallis H rank-sum test was used to analyze the AST, ALT, LDH, blood urea nitrogen levels, PT and APTT in pregnant women of three groups. And chi-square test was used to analyze the rates of vaginal delivery, cesarean section, placental abruption, blood transfusion treatment, antihypertensive therapy, and fetal growth restriction among three groups. The study was in accordance with World Medical Association Declaration of Helsinki revised in 2013.

Results

① The urine output within 24 h of 190 PE pregnant women were 1 240-3 010 mL; 24 h urine protein quantification were 302-7 342 mg. The ratio of urine protein to creatinine was 0.31-5.60. There were no significant differences in the age, gravidity, parity, systolic blood pressure, diastolic blood pressure, platelet count, newborn birth weight, gestational age and proportion of pregnant women with severe PE among three groups (P>0.05). ② There were significant differences in LDH, blood urea nitrogen and APTT levels among three groups (χ²=25.980, P<0.001; χ²=14.770, P=0.001; χ²=16.569, P<0.001). ③The rates of newborns transferred to NICU in group A, group B and group C were 30.2% (16/53), 50.7% (36/71) and 68.2% (45/66), respectively, and the incidences of eclampsia were 0 (0/53), 0 (0/71) and 7.6% (5/66), receptively. There were significant differences among three groups in the rate of newborns transferred to NICU and the incidence of eclampsia (χ²=16.985, P<0.001; χ²=7.255, P=0.006).

Conclusions

Although 24 h urine protein quantification cannot determine the severity of PE, maternal and fetal complications should be treated more cautiously when 24 h urine protein quantification is high.

Key words: Pre-eclampsia, Pregnancy complications, Proteinuria, Pregnancy outcome, Pregnant women

表1 3组子痫前期孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	孕次[次，M(P₂₅～P₇₅) ]	产次[次，M(P₂₅～P₇₅) ]	收缩压(mmHg，±s)	舒张压(mmHg，±s)
A组	53	31.6±2.7	3(1～5)	2(1～5)	152.0±9.3	93.7±7.9
B组	71	31.2±2.3	2(1～5)	2(1～4)	151.3±8.1	92.9±7.7
C组	66	31.8±2.6	2(1～5)	1(1～4)	153.6±8.1	96.2±8.3
检验值	?	F＝0.173	χ²＝1.230	χ²＝4.350	F＝1.175	F＝2.772
P值	?	0.842	0.541	0.114	0.324	0.080
组别	例数	血小板计数(×10⁹/L，±s)	新生儿出生体重(g，±s)	孕龄(周，±s)	重度PE[例数(%)]
A组	53	232±91	2 532±112	35.9±2.5	23(43.4)
B组	71	228±85	2 527±136	35.5±2.5	28(39.4)
C组	66	239±79	2 525±125	35.3±3.2	31(47.0)
检验值	?	F＝2.463	F＝0.935	F＝0.073	χ²＝0.793
P值	?	0.104	0.405	0.930	0.673

表1 3组子痫前期孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	孕次[次，M(P₂₅～P₇₅) ]	产次[次，M(P₂₅～P₇₅) ]	收缩压(mmHg，±s)	舒张压(mmHg，±s)
A组	53	31.6±2.7	3(1～5)	2(1～5)	152.0±9.3	93.7±7.9
B组	71	31.2±2.3	2(1～5)	2(1～4)	151.3±8.1	92.9±7.7
C组	66	31.8±2.6	2(1～5)	1(1～4)	153.6±8.1	96.2±8.3
检验值	?	F＝0.173	χ²＝1.230	χ²＝4.350	F＝1.175	F＝2.772
P值	?	0.842	0.541	0.114	0.324	0.080
组别	例数	血小板计数(×10⁹/L，±s)	新生儿出生体重(g，±s)	孕龄(周，±s)	重度PE[例数(%)]
A组	53	232±91	2 532±112	35.9±2.5	23(43.4)
B组	71	228±85	2 527±136	35.5±2.5	28(39.4)
C组	66	239±79	2 525±125	35.3±3.2	31(47.0)
检验值	?	F＝2.463	F＝0.935	F＝0.073	χ²＝0.793
P值	?	0.104	0.405	0.930	0.673

表2 3组子痫前期孕妇的生化指标比较[M(P₂₅～P₇₅) ]

组别	例数	AST水平(U/L)	ALT水平(U/L)	LDH水平(U/L)	血尿素氮水平(mg/dL)	PT(s)	APTT(s)
A组	53	42(9～440)	50(5～699)	224(150～878)	8.6(4.8～22.6)	11.5(9.4～13.7)	27.9(21.0～36.4)
B组	71	40(11～186)	48(4～179)	285(147～831)	9.7(5.0～18.0)	11.1(9.1～14.3)	25.4(20.4～32.6)
C组	66	38(10～75)	46(4～54)	324(168～722)	10.5(5.0～18.0)	11.0(8.3～16.1)	21.7(22.5～47.9)
χ²值	?	2.120	3.481	25.980	14.770	0.279	16.569
P值	?	0.346	0.175	<0.001	0.001	0.248	<0.001

表2 3组子痫前期孕妇的生化指标比较[M(P₂₅～P₇₅) ]

组别	例数	AST水平(U/L)	ALT水平(U/L)	LDH水平(U/L)	血尿素氮水平(mg/dL)	PT(s)	APTT(s)
A组	53	42(9～440)	50(5～699)	224(150～878)	8.6(4.8～22.6)	11.5(9.4～13.7)	27.9(21.0～36.4)
B组	71	40(11～186)	48(4～179)	285(147～831)	9.7(5.0～18.0)	11.1(9.1～14.3)	25.4(20.4～32.6)
C组	66	38(10～75)	46(4～54)	324(168～722)	10.5(5.0～18.0)	11.0(8.3～16.1)	21.7(22.5～47.9)
χ²值	?	2.120	3.481	25.980	14.770	0.279	16.569
P值	?	0.346	0.175	<0.001	0.001	0.248	<0.001

表3 3组子痫前期孕妇的妊娠结局比较[例数(%)]

组别	例数	阴道分娩	剖宫产术分娩	胎盘早剥	输血治疗	降血压治疗	胎儿宫内生长受限
A组	53	19(35.8)	34(64.2)	1(1.9)	1(1.9)	30(56.6)	2(3.8)
B组	71	27(38.0)	44(62.0)	1(1.4)	1(1.4)	45(63.3)	6(8.5)
C组	66	21(31.8)	45(68.2)	4(6.0)	3(4.5)	48(72.7)	10(15.2)
χ²值	?	0.589	0.589	2.328	1.338	3.439	4.575
P值	?	0.745	0.745	0.331	0.531	0.185	0.115
组别	例数	胎儿呼吸窘迫综合征	孕妇胸腔积液	新生儿转入NICU	早产	子痫	HELLP综合征
A组	53	2(3.8)	7(13.2)	16(30.2)	30(56.6)	0(0)	0(0)
B组	71	8(11.3)	4(5.6)	36(50.7)	38(53.5)	0(0)	1(1.4)
C组	66	10(15.2)	8(12.1)	45(68.2)	52(78.8)	5(7.6)	1(1.5)
χ²值	?	4.107	2.440	16.985	1.486	7.255	0.964
P值	?	0.129	0.314	<0.001	0.498	0.006	0.667

表3 3组子痫前期孕妇的妊娠结局比较[例数(%)]

组别	例数	阴道分娩	剖宫产术分娩	胎盘早剥	输血治疗	降血压治疗	胎儿宫内生长受限
A组	53	19(35.8)	34(64.2)	1(1.9)	1(1.9)	30(56.6)	2(3.8)
B组	71	27(38.0)	44(62.0)	1(1.4)	1(1.4)	45(63.3)	6(8.5)
C组	66	21(31.8)	45(68.2)	4(6.0)	3(4.5)	48(72.7)	10(15.2)
χ²值	?	0.589	0.589	2.328	1.338	3.439	4.575
P值	?	0.745	0.745	0.331	0.531	0.185	0.115
组别	例数	胎儿呼吸窘迫综合征	孕妇胸腔积液	新生儿转入NICU	早产	子痫	HELLP综合征
A组	53	2(3.8)	7(13.2)	16(30.2)	30(56.6)	0(0)	0(0)
B组	71	8(11.3)	4(5.6)	36(50.7)	38(53.5)	0(0)	1(1.4)
C组	66	10(15.2)	8(12.1)	45(68.2)	52(78.8)	5(7.6)	1(1.5)
χ²值	?	4.107	2.440	16.985	1.486	7.255	0.964
P值	?	0.129	0.314	<0.001	0.498	0.006	0.667

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