分析肾移植术后妊娠受者34周前分娩危险因素。

回顾性分析2013年1月至2020年12月期间在浙江大学医学院附属第一医院成功分娩的肾移植受者临床资料。共计有57例受者被纳入研究，按照分娩时妊娠时间是否超过34周将受者分为≤34周分娩组和>34周分娩组，分别为21例和36例。观察肾移植受者原发病、移植妊娠间隔时间、妊娠年龄、孕期免疫抑制剂血药浓度、分娩方式、新生儿出生体重百分位数及Apgar评分等。符合正态分布的计量资料采用成组t检验进行比较，计数资料采用χ²检验进行比较，采用logistic回归分析分娩34周前早产危险因素。P<0.05为差异有统计学意义。

57例受者妊娠时平均年龄(31±4)岁(24~42岁)，平均移植妊娠间隔时间为(44±23)个月(14~104个月)。均为剖宫产，平均孕周为(34.2±2.2)周(27.7~37.7周)，新生儿出生时平均1分钟Apgar评分为(8.4±1.9)分(1.0~10.0分)。>34周分娩组新生儿Apgar评分高于≤34周分娩组，分别为(8.9±1.0)、(7.4±2.6)分，差异有统计学意义(t＝3.17，P<0.05)。两组受者妊娠年龄、移植妊娠间隔时间和新生儿出生体重百分位数差异均无统计学意义(t＝-1.28、0.25和-0.68，P均>0.05)。>34周分娩组肾移植受者妊娠年龄<32岁的比例(77.8%)、移植妊娠间隔时间<48个月的比例(66.7%)与≤34周分娩组(81.0%、71.4%)差异均无统计学意义(χ²＝0.08、0.14，P均>0.05)；妊娠期血清肌酐<1.5 mg/dL的比例(94.4%)低于≤34周分娩组(66.7%)，差异有统计学意义(χ²＝7.70，P<0.05)。两组受者妊娠前蛋白尿、妊娠前高血压发生比例差异均无统计学意义(χ²＝0.15、1.13，P均>0.05)，妊娠期高血压和妊娠期糖尿病发生比例差异均有统计学意义(χ²＝4.51、7.54，P均<0.05)。Logistic回归分析结果显示，妊娠期高血压、妊娠期糖尿病和妊娠期血清肌酐≥1.5 mg/dL是肾移植受者分娩34周前早产儿的危险因素(OR＝8.661、12.684和21.562，P均<0.05)。

妊娠期高血压、妊娠期糖尿病和妊娠期血清肌酐升高与肾移植术后妊娠受者34周前分娩有关。

To analyze the risk factors of preterm delivery at less than 34 weeks in renal transplant recipients.

The renal transplant recipients who delivered successfully in the First Affiliated Hospital, Zhejiang University School of Medicine from January 2013 to December 2020 were retrospectively analyzed. A total of 57 recipients were enrolled in the study. According to whether the pregnancy time was more than 34 weeks, the recipients were divided into ≤34 weeks delivery group (n=21) and >34 weeks delivery group (n=36). The indexes including primary disease, the time interval between the transplantation and the pregnancy, gestational age, blood concentration of immunosuppressant during pregnancy, mode of delivery, percentile of neonatal birth weight, and Apgar score were observed. The measurement data conforming to normal distribution were compared by group t test, the counting data were compared by Chi-square test, and the risk factors of preterm delivery at less than 34 weeks were analyzed by logistic regression. A P<0.05 was considered statistically significant.

The average age of 57 recipients at gestation was (31±4) years (24-42 years), and the average interval from renal transplant to pregnancy was (44 ± 23) months (14-104 months). All cases were delivered by cesarean section, the average gestational week was (34.2±2.2) (27.7-37.7), and the average Apgar score at birth was (8.4±1.9) (1.0-10.0). The Apgar score of newborns in the >34 weeks delivery group was higher than that in the ≤ 34 weeks delivery group [(8.9±1.0) vs (7.4±2.6)], and the difference had statistical significance (t=3.17, P<0.05). There were no significant difference in gestational age, the time interval between the transplantation and the pregnancy, percentile of neonatal birth weight between the two groups (t=-1.28, 0.25, and -0.68, all P>0.05). There were no significant difference in the proportion of renal transplant recipients with gestational age <32 years (77.8%) and the interval between transplantation and pregnancy <48 months (66.7%) between the group of >34 weeks and the group of ≤34 weeks (81.0% and 71.4%) (χ²= 0.08, 0.14, all P>0.05). The proportion of serum creatinine <1.5 mg/dL during pregnancy (94.4%) was lower than that in the ≤34 weeks delivery group (66.7%), and the difference was statistically significant (χ²=7.70, P<0.05). There were no significant difference in the proportion of pre-pregnancy proteinuria and pre-gestational hypertension (χ²=0.15, 1.13, all P>0.05). The differences of gestational hypertension and gestational diabetes mellitus between the two groups were statistically significant (χ²=4.51, 7.54, all P<0.05). Logistic regression analysis showed that the gestational hypertension, gestational diabetes mellitus, and gestational gestational serum creatinine >1.5 mg/dL were risk factors for premature infants with delivery ≤34 weeks in renal transplant recipients (OR=8.661, 12.684 and 21.562, all P<0.05).

Gestational hypertension, gestational diabetes mellitus, and gestational serum creatinine increase are associated with premature infants with delivery before 34 weeks in renal transplant recipients.