Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: a retrospective cohort study
Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: a retrospective cohort study
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DOI：
10.1111/j.1471-0528.2011.03232.x
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发表时间：
2012-03-01
影响因子：
5.8
通讯作者：
Brown, M. A.
中科院分区：
文献类型：
--
作者：
Hawkins, T. L-A;Roberts, J. M.;Brown, M. A.
目的探讨高血压病孕妇高尿酸血症、血药浓度与母儿结局的关系。设计一个高血压妊娠数据库的回顾性分析。建立澳大利亚主要产科单位圣乔治医院。人口1880名无潜在高血压或肾脏疾病的孕妇，转诊为先兆子痫或妊娠高血压。方法收集每个孕妇转诊和分娩时的人口学、临床和生化数据。根据诊断(先兆子痫或妊娠期高血压)对妇女进行分组，并用Logistic回归分析确定尿酸、血红蛋白、红细胞压积与不良结局的关系；P<；0.01水平用于统计学意义。主要结局衡量不良母婴结局的组合。结果在患有良性生长激素(无蛋白尿或任何其他先兆子痫的孕妇临床特征)的妇女中，经妊娠校正的高尿酸血症与小孕年龄婴儿(OR 2.5；95%CI 1.3-4.8)和早产儿(OR 3.2；95%可信区间1.4-7.2)，但无不良母体结局。在高血压孕妇(先兆子痫或妊娠期高血压)的整个队列中，随着尿酸浓度的增加，不良母亲结局(OR 2.0；95%CI 1.6~2.4)和不良胎儿结局(OR 1.8；95%CI 1.5~2.1)的风险增加。经妊娠校正的高尿酸血症为这些关联提供了额外的证据。结论：高尿酸血症仍是一项重要的研究结果，因为高尿酸血症可增加孕妇，尤其是胎儿的不良结局风险；后者，即使在没有任何其他先兆子痫特征的妊娠期高血压患者中也是如此。
Objective To examine the relationship between hyperuricaemia, haemoconcentration and maternal and fetal outcomes in hypertensive pregnancies.Design Retrospective analysis of a database of hypertensive pregnancies.Setting St George Hospital, a major obstetric unit in Australia.Population A cohort of 1880 pregnant women without underlying hypertension or renal disease, referred for management of preeclampsia or gestational hypertension.Methods Demographic, clinical and biochemical data at time of referral and delivery were collected for each pregnancy. Women were grouped according to diagnosis ( pre- eclampsia or gestational hypertension) and logistic regression analysis was used to determine the relationship between uric acid, haemoglobin, haematocrit and adverse outcomes; an a level of P < 0.01 was used for statistical significance.Main outcome measures Composites of adverse maternal and fetal outcomes.Results In women with ` benign' GH (without proteinuria or any other maternal clinical feature of pre-eclampsia) gestation-corrected hyperuricaemia was associated with increased risk of a small-forgestational- age infant (OR 2.5; 95% CI 1.3-4.8) and prematurity (OR 3.2; 95% CI 1.4-7.2), but not with adverse maternal outcome. In the whole cohort of hypertensive pregnant women (those with pre-eclampsia or gestational hypertension) the risk of adverse maternal outcome (OR 2.0; 95% CI 1.6-2.4) and adverse fetal outcome (OR 1.8; 95% CI 1.5-2.1) increased with increasing concentration of uric acid. Hyperuricaemia corrected for gestation provided additional strength to these associations. Haemoglobin and haematocrit were not associated with adverse pregnancy outcome.Conclusions Hyperuricaemia in hypertensive pregnancy remains an important finding because it identifies women at increased risk of adverse maternal and particularly fetal outcome; the latter, even in women with gestational hypertension without any other feature of pre-eclampsia.