摘要
目的:高血压是妊娠相关性急性肾损伤(pregnancy-related acute kidney injury,PR-AKI)的严重并发症,本研究旨在探讨高血压对PR-AKI患者预后及胎儿结局的影响。方法:连续收集2008年1月至2018年6月期间某院产科PR-AKI病例,采用1:1倾向评分匹配法选择同期正常血压和高血压患者进行随访,通过多因素Cox回归法分别评价匹配前后高血压对PR-AKI预后的影响。结果:在30680例孕产妇中126例确诊为PR-AKI,发病率为0.41%,年龄(29.04±2.32)岁,其中50例为高血压,占39.68%。使用倾向评分匹配法,两组共48对匹配成功,组间协变量达到平衡。匹配并调整相关临床因素后,Cox回归分析显示,与正常血压组相比,高血压组终末期肾病(end-stage renal disease,ESRD)风险增加(HR=2.951,95%CI:1.067~8.275;P=0.034),妊娠不良结局风险增加(HR=2.815,95%CI:1.271~6.233;P=0.009),胎儿不良结局风险增加(HR=1.437,95%CI:1.028~4.623;P=0.021)。结论:高血压是PRAKI患者ESRD、妊娠不良结局和胎儿不良结局事件的独立危险因素。
Objective:Hypertension is a serious complication of pregnancy-related acute kidney injury(PR-AKI).This study aimed to determine the effect of hypertension on the prognosis of PR-AKI,maternal outcomes,and fetal outcome.Methods:Patients with PR-AKI in a hospital from January 2008 to June 2018 were enrolled for this study.Patients with or without hypertension were grouped by 1:1 propensity matching score.The effect of hypertension on the prognosis of PR-AKI was evaluated by multivariate Cox regression before and after matching.Results:Of the 30680 women who attended the Department of Obstetrics,126 patients were diagnosed as PR-AKI,the incidence was 0.41%.The age was(29.04±2.32)years.There were 50 cases in the hypertension group,accounting for 39.68%.Using the propensity score method,48 pairs of patients were successfully matched,and the covariates between the two groups were balanced.After matching and adjusting for relevant clinical factors,Cox regression analysis showed that risk of end-stage renal disease(ESRD)was increased in the hypertension group compared with the normal blood pressure group(HR=2.951,95%CI 1.067 to 8.275,P=0.034).The risk of risk of adverse maternal outcome was increased(HR=2.815,95%CI 1.271 to 6.233,P=0.009),and the risk of fetal adverse outcome was increased(HR=1.437,95%CI 1.028 to 4.623,P=0.021).Conclusion:Hypertension is an independent risk factor for ESRD,adverse maternal outcomes,and adverse fetal outcomes in the PR-AKI patients.
作者
陈文航
李慧慧
周权
薛静
CHENWenhang;LI Huihui;ZHOU Quan;XUE Jing(Department of Nephrology,Xiangya Hospital,Central South University,Changsha 410008;Department of Science and Education,First People’s Hospital of Changde City,Changde Hunan 415000;Department of Scientific Research&Institute of Hospital Administration,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2020年第7期797-803,共7页
Journal of Central South University ：Medical Science
基金
国家自然科学基金(81600536)
湖南省自然科学基金(2018JJ3833)
中南大学湘雅医院管理研究基金(2019GL13)。
关键词
妊娠相关性急性肾损伤
预后
倾向评分匹配法
队列研究
pregnancy-related acute kidney injury
prognosis
propensity score matching
cohort study
