[Value of proteinuria in assessing the severity of pre-eclampsia and its maternal and neonatal outcomes].

Objective: To investigate the value of proteinuria in evaluating the severity of pre-eclampsia (PE) and assessing the maternal and neonatal outcomes of PE. Methods: The clinical records of 265 pregnant women who were diagnosed with PE at Peking Union Medical College Hospital from January 2011 to June 2021 were retrospectively analyzed. According to 24-hour urine protein (24-hUPro) results, pregnant women were divided into two groups: the non-proteinuric group (24-hUPro<0.3 g, n=10) and proteinuric group (24-hUPro≥0.3 g, n=255). The proteinuric group was further divided into 3 subgroups based on proteinuria levels: mild group (0.3 g≤24-hUPro<2.0 g, n=119), moderate group (2.0 g≤24-hUPro<5.0 g, n=59), and severe group (24-hUPro≥5.0 g, n=77). The demographic and clinical data, laboratory indicators, pregnancy complications, maternal and neonatal outcomes were compared between different groups. Results: In proteinuric subgroups, increased proteinuria was associated with earlier onset gestations, higher incidence of headache, peripheral tissue edema, serosal effusion, intrauterine growth restriction, and abnormal umbilical cord blood flow (all P<0.05). There were no significant differences in the incidence of placental abruption, eclampsia and maternal mortality among the three subgroups, but there were significant differences in the incidence of neonatal birth weight and multiple neonatal complications (all P<0.05). Compared with the proteinuric group, the non-proteinuric group showed later onset gestation (median:34.7 vs 37.6 weeks) and gestational age of delivery (median:36.0 vs 38.4 weeks), lower proportion of ocular vascular lesions [56.7% (135/238) vs 2/9], higher birth weight (median: 2 325 vs 2 750 g), and lower rate of neonatal intensive care unit occupancy [54.3%(127/234) vs 1/10;all P<0.05]. Conclusions: The proteinuria plays an important role in assessing the severity of PE and maternal and neonatal outcomes, but it is not the only indicator. The non-proteinuric PE pregnant women might still lead to severe maternal and neonatal outcomes.目的： 探讨尿蛋白水平在评估子痫前期（PE）严重程度及母儿结局中的价值。 方法： 回顾性分析2011年1月至2021年6月于北京协和医院治疗的265例PE孕妇的临床资料。根据孕妇分娩前24小时尿蛋白（24-hUPro）定量最高检测值，将265例孕妇分为蛋白尿组（24-hUPro≥0.3 g，255例）和无蛋白尿组（24-hUPro<0.3 g，10例），蛋白尿组进一步分为3个亚组：轻度组（24-hUPro为0.3~<2.0 g，119例）、中度组（24-hUPro为2.0~<5.0 g，59例）、重度组（24-hUPro≥5.0 g，77例）。比较各组孕妇的一般临床特征、实验室检查结果、母儿结局的差异。 结果： 在蛋白尿组PE孕妇的亚组分析中，随尿蛋白水平升高，发病的孕周越早，头痛、外周组织水肿、浆膜腔积液、胎儿生长受限、脐血流异常的发生率均越高（P均<0.05）。蛋白尿组3个亚组间胎盘早剥、子痫、孕产妇死亡的发生率分别比较，差异均无统计学意义（P均>0.05），但新生儿出生体重、新生儿多项并发症的发生率均有统计学差异（P均<0.05）。与蛋白尿组比较，无蛋白尿组PE孕妇的诊断孕周（中位数分别为34.7、37.6周）及分娩孕周（中位数分别为36.0、38.4周）均较晚、眼部血管病变比例低［分别为56.7%（135/238）和2/9］、新生儿出生体重高［中位数分别为2 325和2 750 g］、新生儿重症监护病房入住率低［分别为54.3%（127/234）和1/10］，两组分别比较，差异均有统计学意义（P均<0.05）。 结论： 尿蛋白水平在评估PE病情的严重程度、母儿结局中具有重要意义，但其并非必要性指标，无蛋白尿的PE孕妇仍然可能出现严重的母儿不良结局。.