子癇 前 症
此為 | |
孕齡20 | |
类型 | |
风险 | |
患病 | 2–8% |
46,900 | |
ICD-11 | JA24 |
OMIM | 609403、609404、609402、189800、614592 |
DiseasesDB | 10494 |
MedlinePlus | 000898 |
eMedicine | 1476919 |
Orphanet | 275555 |
此疾
Eclampsia這個
症狀 與 徵 象
[编辑]病因
[编辑]- 胎座
異常 (胎盤 形成 及發育 異常 ) 免疫 学 因 素 - 孕婦
之 前 的 病 史 或 是正 患有的 疾病 ,若 曾經有 高血壓 、肥 胖 、抗 磷脂综合征 ,或 是 曾有子癇 前 症 ,風 險 較高 飲食 因 素 ,例 如在鈣質攝取 不足 的 地區 補充 鈣質,可 以降 低 子癇 前 症 的 風 險 [4]。環境 因 素 ,例 如空氣 污染[19]。
患有
雖然
19
風 險 因子
[编辑]第 一 胎生 產 糖尿 病 [27]腎 病變 慢性 高 血壓 [27]- 曾有
子癇 前 症 的 病 史 [27] 家族 有 子癇 前 症 的 病 史 - 孕婦
年齡 較大(超過 35歲 ) 肥 胖 [27]抗 磷脂综合征 [27]多 胞胎妊娠 [27]- 曾接受過
腎臟 移植 [28] 罹患 亞 臨床 的 甲狀腺 機能 低下 症 或 甲状腺 抗體 [29][30]胎盤 異常 ,例 如胎盤 缺 氧。
診斷
[编辑]Pre-eclampsia laboratory values | |
---|---|
LDH: 105–333 IU/L Uric Acid: 2.4–6.0 mg/dL AST: 5–40 U/L ALT: 7–56 U/L Plt: 140–450 x 109/L Cr: 0.6–1.2 mg/dL | |
MeSH | D007770 |
LOINC | Codes for pre-eclampsia |
診斷 準則
[编辑]之 前 血壓 正常 ,在 懷 孕二 十 週 後 ,在 間隔 四至六個小時的二次血壓量測,有 出現 收縮 壓 ≥140 mmHg,或 是 舒張壓 ≥90 mmHg的 血壓 值。若 孕婦在 懷 孕二 十週以前就有原發性高血壓,其診斷 準則 為 :收縮 壓 (SBP)上昇 超過 30 mmHg,或 是 舒張壓 (DBP)上昇 超過 15 mmHg。在 24小 時 的 尿 液 樣 本中 ,蛋白 尿 ≥ 0.3克 (300毫克),或 是 SPOT尿 蛋白 和 肌 酐比例 ≥0.3,或 是 尿 液 試 紙 讀數為 1+或 更 高 (只 有 在 其他量 化 量 測 方式 無法 進行 時 才 用 尿 液 試 紙 讀數)[3]。
預 測 測 試
[编辑]儘管
子宮 動脈 都 卜 勒超音波 檢 查以調查胎盤 灌注不足 的 跡 象 。該測試 對 有 子癇 前 症 病 史 的 孕婦有 較高的 陰性 預 測 值(有 助 於排除 診斷 )[21]。有人 會 利用 血清 尿 酸 值的升 高 (高 尿 酸 血 症 )來 預 測 子癇 前 症 [26],儘管它並不 準 確 [21]。高 尿 酸 血 症 可能 是 起因 於腎 功 能 受損導 致尿酸 清 除 率 降 低 。包含 血管 新生 蛋白 如血管 內皮生長 因子 (VEGF)和 胎盤 生長 因子 (PIGF)以及抗 血管 新生 蛋白 可溶性 酪氨酸 激 酶1(sFlt-1),證據 顯示 這些標記 可 望 在 臨床 上 用 來 診斷 子癇 前 症 [26]。一 項 針 對 1014名 因 高 血壓 而住院 的 孕婦的 研究 發現 ,當 sFlt-1與 PIGF的 比 值超過 40時 ,孕婦在 2星 期 內可能 發生 嚴重 子癇 前 症 ;若 比 值小於40則 發生 的 機 率 極 低 。[32]最近 的 研究 顯示 在 尿 液 中 尋 找足 細胞 (腎臟 的 特殊 細胞 )可能 有 助 於預測 子癇 前 症 。在 尿 液 中 發現 的 足 細胞 可能 可 以作為 早期 診斷 標 誌 [33][34][35]。
鑑別 診斷
[编辑]預 防
[编辑]飲食
[编辑]阿 斯匹林
[编辑]運動
[编辑]戒煙
[编辑]免疫 調節
[编辑]治療
[编辑]血壓
[编辑]預 防 子癇
[编辑]流行 病 學
[编辑]相關 條目
[编辑]參考 文獻
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外部 連結
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