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JAMA:筛查先兆子痫的益处多多!一项来自美国预防服务工作组的建议

2017-04-30 MedSci MedSci原创

先兆子痫影响着约4%的美国孕妇,其这是全世界导致孕产妇死亡的第二大原因,可能会导致严重的母体并发症,包括中风、子痫和器官功能衰竭。胎儿和新生儿的围产期不良结局包括子宫内生长受限,低出生体重儿和死胎。与先兆子痫相关的许多并发症导致早期诱发剖宫产和随后的早产。非裔美国妇女中发生先兆子痫的概率比白人妇女更为普遍,流行率的差异部分可能是由于非裔美国妇女受到不成比例的先兆子痫危险因素的影响。非裔美国妇女的病

先兆子痫影响着约4%的美国孕妇,其这是全世界导致孕产妇死亡的第二大原因,可能会导致严重的母体并发症,包括中风、子痫和器官功能衰竭。胎儿和新生儿的围产期不良结局包括子宫内生长受限,低出生体重儿和死胎。与先兆子痫相关的许多并发症导致早期诱发剖宫产和随后的早产。


非裔美国妇女中发生先兆子痫的概率比白人妇女更为普遍,流行率的差异部分可能是由于非裔美国妇女受到不成比例的先兆子痫危险因素的影响。非裔美国妇女的病例死亡率与先兆子痫相关,高于白人妇女的3倍。在获得产前保健方面的不平等可能会导致非裔美国妇女与先兆子痫相关的不良后果。

近期,一篇发表在权威杂志JAMA上的文章更新了1996年美国预防服务工作组(USPSTF)关于先兆子痫筛查的建议。

USPSTF审查了关于先兆子痫筛查和诊断测试准确性的证据,筛查先兆子痫的潜在好处和危害,风险预测工具的有效性以及治疗筛查出的先兆子痫的好处和危害。

鉴于治疗可以减少孕产妇和围产期的发病率和死亡率,以及血压测量准确性的确切证据,USPSTF发现,有足够的证据表明筛查先兆子痫可以为母亲和婴儿带来实质性的益处。此外,有足够的证据可以将筛查和治疗先兆子痫的危害十分微小。因此,USPSTF以中度的确定性得出结论,孕妇筛查先兆子痫有很大的净收益。

USPSTF建议在怀孕期间对孕妇进行血压测量筛查先兆子痫(B推荐)。

原始出处:
US Preventive Services Task Force, Bibbins-Domingo K, et al. Screening for Preeclampsia: US Preventive Services Task Force Recommendation Statement. JAMA. 2017 Apr 25;317(16):1661-1667. doi: 10.1001/jama.2017.3439.

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    2017-05-02 Drhzm308

    学习了,可做参考

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=192738, encodeId=46b9192e38f3, content=学习了,可做参考, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Tue May 02 06:43:29 CST 2017, time=2017-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192411, encodeId=8adf19241188, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Mon May 01 07:25:37 CST 2017, time=2017-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192332, encodeId=6f2a1923321d, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Mon May 01 00:43:29 CST 2017, time=2017-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192220, encodeId=9add192220db, content=这个没有新意, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Sun Apr 30 16:13:13 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192217, encodeId=13c919221ed3, content=学习了分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 30 16:04:58 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192193, encodeId=fb3d19219386, content=血压筛查非常有价值,因为先兆之前有可能和先心有关系, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Apr 30 13:34:58 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-05-01 三生有幸9135

    学习一下谢谢分享

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=192738, encodeId=46b9192e38f3, content=学习了,可做参考, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Tue May 02 06:43:29 CST 2017, time=2017-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192411, encodeId=8adf19241188, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Mon May 01 07:25:37 CST 2017, time=2017-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192332, encodeId=6f2a1923321d, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Mon May 01 00:43:29 CST 2017, time=2017-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192220, encodeId=9add192220db, content=这个没有新意, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Sun Apr 30 16:13:13 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192217, encodeId=13c919221ed3, content=学习了分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 30 16:04:58 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192193, encodeId=fb3d19219386, content=血压筛查非常有价值,因为先兆之前有可能和先心有关系, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Apr 30 13:34:58 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-05-01 tanxingdoctor

    学习了谢谢分享

    0

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    2017-04-30 Dr.jerry

    这个没有新意

    0

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    2017-04-30 dhzzm

    学习了分享了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=192738, encodeId=46b9192e38f3, content=学习了,可做参考, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Tue May 02 06:43:29 CST 2017, time=2017-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192411, encodeId=8adf19241188, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Mon May 01 07:25:37 CST 2017, time=2017-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192332, encodeId=6f2a1923321d, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Mon May 01 00:43:29 CST 2017, time=2017-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192220, encodeId=9add192220db, content=这个没有新意, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Sun Apr 30 16:13:13 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192217, encodeId=13c919221ed3, content=学习了分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Sun Apr 30 16:04:58 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=192193, encodeId=fb3d19219386, content=血压筛查非常有价值,因为先兆之前有可能和先心有关系, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Sun Apr 30 13:34:58 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-04-30 lovetcm

    血压筛查非常有价值,因为先兆之前有可能和先心有关系

    0

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先兆子痫和终末期肾病之间存在相当大的相关性,然而,肥胖是之前未被发现的混杂因素,预先存在的肾脏疾病是常见的。

Hypertension:PPI对先兆子痫的影响!

PPIs可以降低sFlt-1和可溶性内皮因子的分泌,减轻血管内皮功能障碍,血管扩张,降低血压,并具有抗氧化和抗炎的特性。他们对于先兆子痫等其他内皮功能障碍参与的疾病具有潜在的治疗价值。

Hypertension:低分子量肝素可改善先兆子痫高风险孕妇的血管内皮功能

由此可见,低分子量肝素可改善先兆子痫高风险的孕妇血管内皮功能,并可能通过增加胎盘生长因子的生物利用度所介导。

存在肾损伤史,痊愈了仍会增加女性妊娠期各种并发症的发生!

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Diabetes Care:FABP4可能是1型糖尿病女性患者先兆子痫新的预测指标

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Neurology:先兆子痫患者的长期脑白质和灰质有何变化?

由此可见,先兆子痫的病史与年轻女性的颞叶白质改变和皮质体积减少有关,这与她们经典的心血管风险曲线不成比例。改变的严重程度与妊娠时间成正比,这与妊娠后持续的损伤累积是一致的。

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