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中华肾病研究电子杂志 ›› 2014, Vol. 03 ›› Issue (06) : 322 -327. doi: 10.3877/cma.j.issn.2095-3216.2014.06.008

论著

妊娠相关急性肾损伤回顾性分析
刘玉梅1, 姜珍珍1, 黄亚娟2, 汪年松1,()   
  1. 1.200233 上海交通大学附属第六人民医院肾脏风湿科
    2.200233 上海交通大学附属第六人民医院妇产科
  • 出版日期:2014-12-15
  • 通信作者: 汪年松
  • 基金资助:
    国家自然科学基金面上项目(81270824)上海市科委基础研究重大项目(11DJ1400101)上海市科委重大课题(11DZ1973103)

Retrospective analysis of pregnancy-related acute kidney injury

Yumei Liu1, Zhenzhen Jiang1, Yajuan Huang1, Niansong Wang1,()   

  1. 1.Department of Nephrology, Shanghai Jiao Tong University Sixth People's Hospital, Shanghai 200233, China
  • Published:2014-12-15
  • Corresponding author: Niansong Wang
引用本文:

刘玉梅, 姜珍珍, 黄亚娟, 汪年松. 妊娠相关急性肾损伤回顾性分析[J/OL]. 中华肾病研究电子杂志, 2014, 03(06): 322-327.

Yumei Liu, Zhenzhen Jiang, Yajuan Huang, Niansong Wang. Retrospective analysis of pregnancy-related acute kidney injury[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2014, 03(06): 322-327.

目的

探讨我国妊娠相关急性肾损伤(PR-AKI)的发病率、病因及预后。

方法

回顾性分析上海交通大学附属第六人民医院自2004 年7 月至2013 年2 月在产科和肾脏科住院的18 589 例汉族妊娠女性,记录符合PR-AKI 定义患者的临床表现和实验室检查,应用方差分析和Friedman M 检验对其基线、产前和产后临床及实验室结果进行分析比较,同时统计分析PR-AKI 的发病情况、病因及妊娠结局。 检索中、英文数据库,纳入符合PR-AKI 诊断、研究对象为中国妊娠女性且研究样本量≥10 例的文献,进行相应的统计分析。

结果

上海交通大学附属第六人民医院有18 例患者符合PR-AKI 诊断;PR-AKI 患者终止妊娠前相关指标与基线水平比较,平均动脉压、血清肌酐、尿素氮、尿蛋白明显增加,血小板明显减少,差异有统计学意义(P<0.05);患者终止妊娠7 d 时尿蛋白明显减少,血小板明显增加,差异有统计学意义(P<0.05);平均动脉压、血清肌酐、尿素氮呈下降趋势,血清白蛋白呈上升趋势。 PR-AKI 的发生率为0.97‰,最常见的原因为重度子痫前期;13 例产后7d 好转,2 例肾功能恶化,无死亡病例;15 例妊娠结局不良(15/19,1 例为双胎妊娠),6 例为死胎或新生儿死亡(6/19)。 共检索到15 966 篇文献,纳入30 篇符合标准的文献进行分析:我国各地区PRAKI 的发生率为0.30‰~6.82‰;引起我国PR-AKI 常见的病因为妊娠高血压病(48.9%)和产后出血(13.9%);PR-AKI 的好转率为81.4%,病死率为13.5%,肾功能恶化率为5.1%;死胎率为26.9%。

结论

关于PR-AKI 研究的证据级别较低,PR-AKI 值得引起重视,经积极诊治,母体预后情况较好,但妊娠结局较差。

Objective

To investigate the incidence, causes, and prognosis of pregnancy-related acute kidney injury (PR-AKI) in China.

Methods

A retrospective analysis, for 18, 589 cases of Han ethnic women from both the Obstetric and Nephrology Departments of the Shanghai Jiao Tong University Sixth People's Hospital from July 2004 to February 2013, was performed. Data of patients that conformed to the PR-AKI definition were recorded such as clinical manifestation and laboratory examinations. Variance analysis and Friedman M test were applied to analyze clinical and laboratory results of baseline, at antepartum, and at postpartum. At the same time, statistical analysis was also performed for PR-AKI incidence, causes, and pregnancy outcomes. After retrieval in Chinese and English databases, literature that was in accord with PR-AKI diagnosis, whose research subjects were Chinese women and sample size was 10 or more cases, were included for the research.

Results

From the Shanghai Jiao Tong University Sixth People's Hospital, 18 patients were diagnosed with PR-AKI. Compared with the baseline levels of patients,before termination of pregnancy, the mean arterial pressure, serum urea nitrogen, creatinine, and urine albumin increased significantly (P<0.05), while the platelet count decreased significantly (P<0.05). At 7 days postpartum, the urinary protein decreased significantly (P<0.05); hemoglobin and platelet increased significantly (P<0.05); the mean arterial pressure, serum urea nitrogen, and creatinine, were in a decline;and serum albumin was on the rise. The incidence of PR-AKI was 0. 97 ‰, whose most common cause was severe preeclampsia. At 7 days postpartum, improvement was shown in 13 cases, and renal function aggravated in 2 cases, without deaths; adverse pregnancy outcome was seen in 15 cases (78.9%), stillbirth or neonatal mortality was 31.6% (6/19). After the retrieval of 15 966 papers, 30 papers that conformed to the standard were included for analysis: the incidence of PR-AKI in our country ranged from 0.30‰ to 6.82‰;the most common causes of PR-AKI in our country were pregnancy hypertension (48.9%) and postpartum hemorrhage (13.9%); the improvement rate of PR-AKI was 81.4%; mortality was 13.5%; the percent of renal function deterioration was 5.1%; and the percent of stillbirth was 26.9%.

Conclusion

The evidence level of studies on PR-AKI was rather low. PR-AKI is worthy of attention. The prognosisofmaternal condition was good after positive treatment, but the pregnancy outcome was usually poor.

表1 妊娠相关急性肾损伤患者终止妊娠前的临床表现及实验室检查
表2 妊娠相关急性肾损伤患者终止妊娠前相关指标与基线水平比较(±s)
表3 妊娠相关急性肾损伤患者终止妊娠后不同时间与终止妊娠前相关指标比较(±s)
表4 妊娠相关急性肾损伤患者终止妊娠后存活新生儿情况
表5 文献报道的妊娠相关急性肾损伤病因
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