【好文推荐】子痫前期的危险因素:西班牙队列研究的结果

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在《母胎医学杂志（英文）》2021年第二期中，Maria del Mar Gil教授携团队发表了题为“子痫前期的危险因素:来自西班牙5000名孕妇队列研究的结果”的论著。确定了西班牙子痫前期(PE)和早产型子痫前期的发生率，并确定疾病发展的危险因素。中英文摘要如下：

通讯作者

Hospital Universitario de Torrejón

Associate Professor / Consultant in Fetal Medicine  and Obstetrics

Maria M Gil

Risk Factors for Preeclampsia: Results from a Cohort of Over 5000 Pregnancies in Spain

Author: Cuenca, Diana; Rolle, Valeria; de Paco Matallana, Katy; Valiño, Nuria; Revello, Rocio; Adiego, Begoña; Mendoza, Manel; Santacruz, Belen; Gil, Maria del Mar

Citation: Cuenca D, Rolle V, de Paco Matallana K, Valiño N, Revello R, Adiego B, Mendoza M, Santacruz B, Gil MM. Risk Factors for Preeclampsia: Results from a Cohort of Over 5000 Pregnancies in Spain. Maternal Fetal Med 2021;3(2):100–106. doi: 10.1097/FM9.0000000000000098.

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Abstract

ObjectiveTo determine the incidence of preeclampsia (PE) and preterm PE in Spain and to identify the risk factors for developing the disease.MethodsThis is a multicenter prospective cohort study performed at six maternity units across Spain. Women with singleton pregnancies attending their first-trimester routine visit at the hospital were offered participation. Maternal and pregnancy characteristics, including mean arterial pressure, as well as ultrasound findings were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for subsequent development of PE.ResultsA total of 5868 pregnancies were recruited for this study, including 174 (3.0%) cases of PE, 47 (0.8%) cases of preterm PE and 127 (2.2%) cases of term PE. Median maternal age was 33.9 years (interquartile range: 30.1 to 36.9) and median gestational age at the routine visit was 12.7 weeks (interquartile range: 12.3 to 13.0). However, 293 (5.0%) of the women were on aspirin treatment during pregnancy, likely reducing the true incidence of the disease. As expected, increasing body mass index (P < 0.001), uterine artery pulsatility index (P = 0.011) and mean arterial pressure (P < 0.001), assisted conception (P = 0.013), previous personal (P < 0.001) or family history of PE (P = 0.024) and chronic hypertension (P = 0.001) were identified as independent risk factors for developing subsequent PE during pregnancy. Screening for PE by maternal factors alone leads to a detection rate of 36.8% (64/174) at 10.0% (587/5868) screen positive rate.ConclusionIn Spain, 3.0% of singleton pregnancies are complicated by PE and 0.8% require delivery before term due to its severity. Screening of PE by risk factors alone is only able to detect about 40% of total PE at 10% screen-positive rate.

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摘要

目的

确定西班牙子痫前期(PE)和早产型子痫前期的发生率，并确定疾病发展的危险因素。

方法

本研究为一项多中心前瞻性队列研究，在西班牙的六家产科中心进行。邀请在医院接受前三个月例行检查的单胎妊娠妇女参与本次研究。记录产妇及妊娠特征，包括平均动脉压，以及超声检查结果。采用单因素和多因素logistic回归分析来确定发生PE的独立危险因素。

结果

本研究共纳入5868例孕妇，其中子痫前期174例(3.0%)，早产型子痫前期47例(0.8%)，足月型子痫前期127例(2.2%)。孕妇年龄的中位数为33.9岁(四分位间距:30.1-36.9)，常规随访时记录胎龄中位数为12.7周(四分位间距:12.3 - 13.0)。然而，293名(5.0%)妇女在怀孕期间服用阿司匹林，这可能降低了疾病的真实发病率。与预期的一样，体重指数(P<0.001)、子宫动脉搏动指数(P=0.011)、平均动脉压(P<0.001)、辅助生殖技术受孕(P=0.013)、既往史(P<0.001)或家族史(P=0.024)和慢性高血压(P=0.001)被确定为妊娠期间发生子痫前期的独立危险因素。仅采用母体因素筛查PE的检出率为36.8%(64/174)，筛查阳性率为10.0%(587/5868)。

结论

在西班牙，有3.0%的单胎妊娠并发子痫前期, 0.8%的单胎妊娠因重度子痫前期需要在足月前分娩。在仅通过危险因素筛查子痫前期时，筛查阳性率仅为10%，检测出的患病人数约为总患病人数的40%。

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