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张昱 三甲
张昱 主任医师
中国中医科学院西苑医院 肾病科

IgA肾病的妊娠

摘要  本研究选取1970到1988年期间受孕过168次的118名IgA肾病妇女,以评估IgA肾病与妊娠之间的相互关系。自然流产、正常分娩、婴儿安全出生、围产期死亡的比率分别为9%、66%、87%、4%。孕前肌酐清除率小于70ml/min的妇女妊娠后与大于70ml/min的妇女相比围产期胎儿死亡率要高(14% vs3%, P < 0.001)。如果孕前妇女的血压持续高于140/90mmHg,那么这些妊娠妇女围产期胎儿死亡率也要高于血压低于140/90mmHg的妊娠妇女(33% vs1%, P < 0.001)。这些数据均采集与1970到1988年,但是分层数据显示,大部分的不良结果均出现在70年代,数据显示70年代围产期胎儿死亡率为9%,但80年代为0%。对其中的85名妊娠妇女持续随访三年或以上后,发现发生肾小球滤过率下降、血压升高、蛋白尿增加的比率分别为19, 11 and 7%。大部分的IgA肾病妇女妊娠后疾病的自然发展过程与未受孕的IgA肾病妇女的病情发展是相似的,但是有5例IgA肾病妇女妊娠后加速了肾脏功能的恶化,最终快速发展为终末期肾病或逼近终末期肾病。如果IgA肾病妇女血压正常并且孕前肌酐清除率率大于70ml/min,那么她们可以不用担心受孕后带来的问题,因为在血压正常并且肌酐清除率大于70ml/min的情况下进行妊娠并不会对妊娠患者病情的发展产生太大的影响。国际肾脏病杂志1991,40,1098-1102             中国中医科学院西苑医院肾病科张昱

(翻译研究生于子凯,校对张昱)

Kidney International (1991) 40, 1098–1102

Pregnancy in IgA nephropathy

Shinichi Abe1

1Department of Internal Medicine, Keio University School of Medicine, Tokyo, JapanTopof page

Abstract

The impacts of IgA nephropathy and pregnancy on each other were evaluated in 118 women who conceived 168 times between 1970 and 1988. Rates of spontaneous abortion, normal delivery, live birth and perinatal death Were 9, 66, 87 and 4%, respectively. Infants born to women with glomerular filtration rates (GFR) lower than 70 ml/min prior to conception had a higher perinatal mortality rate (14% vs. 3%, P < 0.001). This was also true if prepregnancy blood pressures were consistently higher than 140/90 mm Hg (33% vs. 1%, P < 0.001). These were the figures for the whole 18 year period, but stratification of the data revealed that most adverse results occurred in the 1970's, during which the perinatal death rate was 9%, while it was 0% in the 1980's. Eighty-five women were followed for three years or more. At final follow-up, the rates of decrease in GFR, and increases in blood pressure and proteinuria were 19, 11 and 7%, respectively. In most patients the natural history of IgA nephropathy was similar to that of women who had not experienced pregnancy, but there were five instances where gestation seemed to accelerate functional loss, with rapid development of end-stage or near end-stage renal failure. Most women with IgA nephropathy should anticipate few problems with pregnancy, if they are normotensive and their preconception GFR exceeds 70 ml/min. The gestation in such instances should have little influence on the natural history of their nephropathy.

张昱
张昱 主任医师
中国中医科学院西苑医院 肾病科
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