Risk factors for persistent hypertension after the puerperium in pregnancies complicated with hypertensive disorders
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摘要:
目的探讨妊娠期高血压产妇出现产后持续性高血压的危险因素。 方法选择我院2005年1月~2013年1月间新发妊娠期高血压产妇出现产后持续性高血压的60例患者作为病例组，按1:2的比例配比产后6周未出现产后持续性高血压的患者120例作为对照组，比较两组相关指标的差异，对有显著差异的指标进行多元Logistic回归分析。 结果随访患者154例，其中对照组103例，病例组51例，平均年龄28.5±1.3岁，产后持续性高血压发病率为33.1%。两组患者在年龄、尿酸和肌酐方面具有统计学差异（P<0.05），多元Logistic回归分析结果显示年龄≥35岁、高血清肌酐及高血清尿酸为独立危险因素（P<0.05）。 结论对于年龄超过35岁、高尿酸和高肌酐的妊娠期高血压产妇，需密切监测和控制其产后血压，避免不良预后。 Abstract:Objective To explore the risk factors for persistent hypertension after the puerperium in pregnancies complicated with hypertensive disorders. Methods 60 cases who suffered hypertensive disorders in pregnancies were included as cases group. Controls, matched 2∶1 to cases, were selected from patients who did not develop hypertensive disorders. Related indexes were compared between the two groups and multiple Logistic regression analysis was applied to the confirmed indexes. Results 154 patients completed the postpartum 6-week follow-up, 103 cases in cases group and 51 cases in control group. The average age was 28.5±1.3 and the morbidity was 33.1%. There were significant differences between the two groups in age, uric acid and creatinine (P<0.05). Furthermore, age≥ 35, elevated uric acid and elevated creatinine were the independent risk factors of postpartum persistent hypertension based on multiple Logistic regression analysis (P<0.05). Conclusion Intensive surveillance and control should applied to postpartum blood pressure in pregnancy-induced hypertension with age≥ 35, elevated uric acid and elevated creatinine. -
Key words:
- hypertension /
- puerperium Pregnancy
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表 1 两组患者一般情况比较[n(%)]
年龄 初产妇 经产妇 高血压家族史 糖尿病 饮酒 <35岁 ≥ 35岁 病例组(n=51) 35(68.6) 16(31.4) 42(82.4) 9(17.6) 12(23.5) 1(2.0) 3(5.9) 对照组(n=103) 88(85.4) 15(14.6) 85(82.5) 18(17.5) 29(28.2) 4(3.9) 3(3.0) P 0.01 0.91 0.49 0.14 0.56 
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表 2 两组患者生化指标比较
尿酸(mmol/L) 尿酸升高 血小板计数(×109/L) 血小板降低 肌酐(mg/dl) 肌酐升高 尿素氮(mg/dl) 尿素氮升高 入组时蛋白尿 产后6周蛋白尿 病例组(n=51) 0.29±0.06# 21(41.2)* 209.9±114.2 6(11.6) 1.0±0.28 9(17.6) 25.5±16.5 6(11.8) 18(35.3)* 3(5.9) 对照组(n=103) 0.22±0.03 4(3.9) 197.4±104.8 10(9.7) 0.77±0.25 6(15.8) 24.1±15.2 12(11.7) 25(24.3) 4(3.9) t/χ2 243% 244% 85% 0.679 2.453 2.33 0.711 0.37 0.948 0.668 P 0.001 0.001 0.39 0.65 0.001 0.014 0.58 0.97 0.15 0.69 #计量资料,以均数±标准差描述;*计数资料,以n(%)描述.
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表 3 产后持续性高血压的多元Logistic回归分析
变量 回归系数（β） 标准（SE） Wald值 P 优势比（OR） OR95% CI 年龄≥ 35岁 465.00% 7.00% 4682.00% 0.001 14.89 3.2-67.8 血清肌酐 271.00% 44.00% 1673.00% 0.01 5.91 1.5-22.8 血清尿酸 156% 9% 477% 0.001 37.49 10.4-140.0 常数项 0.38 0.61 0.78
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