陈冠帅 孔淦霞 姚志妮

【摘要】 目的：探討重度子痫前期合并轻-中度地中海贫血患者的妊娠特征。方法：选取2012年1月-2018年1月在本院住院分娩76例重度子痫前期合并轻-中度地中海贫血患者为第一组、1 696例重度子痫前期患者为第二组、2 139例妊娠合并轻-中度地中海贫血患者为第三组。回顾分析三组的妊娠特征、结局。结果：第一组胎儿引产、胎儿水肿综合征、羊水过多、轻度贫血、血栓前状态、妊娠期糖尿病和器官功能损伤的发生率均高于第二组，胎儿生长受限的发生率低于第二组，差异均有统计学意义（P<0.05）;第一组胎儿引产、早产、死胎、水肿综合征、胎儿窘迫、羊水过多、产后出血、HELLP综合征、中度贫血、妊娠并器官功能损伤、血栓前状态的发生率均高于第三组，差异均有统计意义（P<0.05）;第二组引产、早产、死胎、胎儿窘迫、胎儿生长受限、羊水过少、产后出血、HELLP综合征、中度贫血、妊娠合并感染、血栓前状态、妊娠合并器官功能损伤、肺动脉高压的发生率均高于第三组，妊娠期糖尿病、轻度贫血、胎膜早破的发生率均低于第三组，差异均有统计意义（P<0.05）。结论：重度子痫前期与妊娠合并轻-中度地中海贫血患者相比，重度子痫前期引起更多的母胎不良事件，面临更多的妊娠风险;重度子痫前期对红细胞的损伤程度比轻-中度地中海贫血更为严重;重度子痫前期合并轻-中度地中海贫血患者在胎儿水肿、引产、贫血、母体器官功能受损等方面的发生率明显增高，应加强这类孕妇围产保健。

【关键词】 重度子痫前期; 地中海贫血; 妊娠结局

【Abstract】 Objectives：To investigate the pregnancy characteristics of severe preeclampsia with mild to moderate thalassemia.Method：A total of 76 cases of severe preeclampsia with mild to moderate thalassemia were selected as the first group from January 2012 to January 2018，1 696 cases of severe preeclampsia were the second group，2 139 pregnant women with mild to moderate thalassemia were the third group.The pregnancy characteristics and outcomes of the three groups were analyzed retrospectively.Result：The incidence of fetal induced labor，fetal edema syndrome，polyhydramnios，mild anemia，prethrombotic state，gestational diabetes mellitus and organ damage in first group were higher than those of second group，and the incidence of fetal growth restriction was lower than that of second group，the differences were statistically significant（P<0.05）.The incidences of induced labor，premature delivery，stillbirth，edema syndrome，fetal distress，polyhydramnios，postpartum hemorrhage，HELLP syndrome，moderate anemia，organ dysfunction and prethrombotic state in first group were higher than those of third group，the differences were statistically significant（P<0.05）.The incidence of induced labor，premature delivery，stillbirth，fetal distress，fetal growth restriction，oligohydramnios，postpartum hemorrhage，HELLP syndrome，moderate anemia，pregnancy complicated infection，prethrombotic state，organ dysfunction and pulmonary hypertension in second group were higher than those of third group，the incidence of gestational diabetes mellitus，mild anemia and premature rupture of membranes were lower than those of third group，the differences were statistically significant（P<0.05）.Conclusion：Severe preeclampsia causes more maternal and fetal adverse events and faces more pregnancy risks than those with mild to moderate thalassemia during pregnancy.The erythrocyte damage of severe preeclampsia is more serious than that of mild to moderate thalassemia.The incidence of severe preeclampsia complicated with mild to moderate thalassemia in fetal edema，fetal induced labor，anemia，maternal organ dysfunction and other aspects has increased significantly.Perinatal health care for such pregnant women should be strengthened.

【Key words】 Severe preeclampsia; Thalassemia; Pregnancy outcome

First-authors address：Dongguan Maternal and Child Health Hospital Affiliated to Southern Medical University，Dongguan 523000，China

doi：10.3969/j.issn.1674-4985.2019.16.004

妊娠期高血压疾病（HDP）是一组常见于妊娠的并发症，也是主要导致孕产妇和新生儿发病和死亡的原因[1]。全世界HDP发生率为8%～10%[2]。HDP按严重程度分為轻度、中度和重度，重度HDP又称先兆子痫和子痫，子痫即在高血压基础上有抽搐，其中重度子痫前期占39.96%左右[3]。地中海贫血是一类单基因遗传性、溶血性疾病，妊娠合并地中海贫血可导致胎儿生长受限、早产，甚至胎死宫内等不良妊娠结局，并可能引起血栓栓塞、心脏病变、内分泌功能异常等严重并发症[4]。在中国，该病多见于西南、华南地区，其中以广东、广西、云南等地区最常见[5]。重度子痫前期和地中海贫血虽然发病机制不尽相同，但两者的发病过程却相互影响，国内外单独对两种疾病的研究比较多，但综合两者病情特征加以对比的研究却较少。本文拟选取在本院住院分娩的76例重度子痫前期合并轻-中度地中海贫血患者、1 696例重度子痫前期患者和2 139例妊娠并地中海贫血患者为研究对象，分析疾病的临床特点及妊娠结局。……