Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system.
Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system.
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DOI：
10.1371/journal.pone.0173420
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Michelsen TM
中科院分区：
文献类型：
--
作者：
Majak GB;Reisæter AV;Zucknick M;Lorentzen B;Vangen S;Henriksen T;Michelsen TM
肾移植后怀孕的妇女是先兆子痫的高危人群。确定先兆子痫对肾移植妇女妊娠结局和移植物功能的影响，并预测哪些妇女需要更有针对性的随访和可能的治疗干预，可以改善孕产妇和新生儿的结局。在这项回顾性队列研究中，我们对1969年至2013年挪威肾移植后的所有妊娠进行了研究，我们使用病历来确定预测先兆子痫的临床特征。纳入175例妊娠，其中65例诊断为先兆子痫。先兆子痫孕妇产后血清肌酐水平明显升高，早产、剖腹产和小于胎龄儿的风险更高。在最终的多变量模型中，慢性高血压（aOR = 5.02 [95% CI，2.47-10.18]），既往子痫前期（aOR = 3.26 [95% CI，1.43-7.43]），血清肌酐升高（≥125 μmol/L）（aOR = 5.79 [95%CI，1.91-17.59]）是先兆子痫的预后因素。根据这个模型，当这些因素都不存在时，风险为19%，当存在一个时，风险为45-59%，当存在两个时，风险为80-87%，当所有三个都存在时，风险为96%。我们认为，肾移植妇女妊娠期先兆子痫的风险可以用这些变量预测，这些变量在妊娠开始时很容易获得。
Women pregnant following kidney transplantation are at high risk of preeclampsia. Identifying the effects of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women, and predicting which women will require more targeted follow-up and possible therapeutic intervention, could improve both maternal and neonatal outcome. In this retrospective cohort study of all pregnancies following kidney transplantation in Norway between 1969 and 2013, we used medical records to identify clinical characteristics predictive of preeclampsia. 175 pregnancies were included, in which preeclampsia was diagnosed in 65. Pregnancies with preeclampsia had significantly higher postpartum serum creatinine levels, higher risks of preterm delivery, caesarean delivery, and small for gestational age infants. In the final multivariate model chronic hypertension (aOR = 5.02 [95% CI, 2.47–10.18]), previous preeclampsia (aOR = 3.26 [95% CI, 1.43–7.43]), and elevated serum creatinine (≥125 μmol/L) at the start of pregnancy (aOR = 5.79 [95% CI, 1.91–17.59]) were prognostic factors for preeclampsia. Based on this model the risk was 19% when none of these factors were present, 45–59% risk when one was present, 80–87% risk when two were present, and 96% risk when all three were present. We suggest that the risk of preeclampsia in pregnancies in kidney transplanted women can be predicted with these variables, which are easily available at the start of pregnancy.