华西医学

华西医学

妊娠伴肾衰竭患者接受血液净化治疗的预后研究

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目的 观察妊娠或产后接受血液净化治疗的肾衰竭患者的预后情况。 方法 选择 2009 年 1 月—2017 年 2 月存在妊娠相关状况、肾衰竭并接受血液净化的患者,回顾性地收集患者的临床资料和妊娠结局,并进行分析。 结果 纳入患者 42 例。急性、慢性急性加重和慢性肾衰竭分别为 38、3 和 1 例。妊娠前慢性肾脏病(chronic kidney disease,CKD)5 例(11.9%),伴系统性红斑狼疮 3 例(7.2%),伴高血压 24 例(54.8%),伴急性胰腺炎 5 例(11.9%),伴肝衰竭 7 例(14.3%)。7 例患者(16.7%)在围产期死亡,死亡的基础疾病为急性胰腺炎 2 例,狼疮性肾炎 1 例,急性肝衰竭 3 例,爆发性肺结核 1 例。双胎妊娠 5 例,单胎妊娠 37 例。活产率为 82.1%(23/28),双胎活产率为 50%(5/10)。电话随访的 27 例患者中,进入终末期肾脏病(end stage of renal disease,ESRD) 10 例,与高血压相关(P=0.001);进入 CKD 1~4 期 3 例;余肾功能恢复 14 例。新发 CKD 8 例,未发现相关因素。 结论 妊娠伴肾衰竭需要血液净化患者死亡风险较高,胎儿夭折率较高。病程中伴高血压和既往存在 CKD 患者,进展为 ESRD 的风险增高。部分患者急性肾衰竭未完全恢复,转为 CKD。

Objective To observe the prognosis of pregnant patients with renal failure who underwent blood purification. Methods Pregnant patients with renal failure undergoing blood purification (hemodialysis or hemofiltration) from January 2009 to February 2017 were included in this study. Clinical data and pregnancy outcome were collected retrospectively. Results A total of 42 patients were enrolled in this study, including 38 with acute renal failure, 3 with chronic progressed renal failure, and 1 with chronic renal failure. There were 5 patients (11.9%) with chronic kidney disease (CKD) before pregnancy, 3 (7.2%) with systemic lupus erythematosus, 24 (54.8%) with hypertension, 5 (11.9%) with acute pancreatitis, and 7 (14.3%) with acute liver failure. In perinatal period, 7 patients (16.7%) died, whose underlying diseases were acute pancreatitis in 2, lupus nephritis in 1, acute hepatic failure in 3, and pulmonary tuberculosis breakout in 1. There were 5 patients with twin pregnancy, and 37 patients with single pregnancy. In the 28 patients with natural pregnancy ending, the live birth rate was 82.1% (23/28), and the live birth rate of twin pregnancy was only 50% (5/10). Twenty-seven patients were followed up, in whom 10 were in end stage of renal disease (ESRD), which was correlated with hypertension (P=0.001), and 3 patients were in CKD 1–4. Renal diseases were completely recovered in 14 patients. New CKD were diagnosed in 8 patients, without any correlated factor. Conclusions For pregnant patients with renal failure undergoing hemodialysis or hemofiltration, the death risk and the dead birth rate are high. Patients with hypertension or pre-existed renal failure have higher risk for ESRD. Some patients are not completely recovered from acute renal failure, with CKD left.

关键词: 妊娠; 慢性肾脏病; 血液净化; 预后

Key words: Pregnancy; Chronic kidney disease; Blood purification; Prognosis

引用本文: 李娟, 韦赟博, 周莉. 妊娠伴肾衰竭患者接受血液净化治疗的预后研究. 华西医学, 2018, 33(7): 877-880. doi: 10.7507/1002-0179.201806115 复制