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子痫前期：临床特征和诊断

Authors
Phyllis August, MD, MPH
Baha M Sibai, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
陈颖, 副主任医师

引言

子痫前期是一种多系统疾病，其特征是在妊娠后半期出现新发的高血压，并伴有蛋白尿和/或终末器官功能障碍(表 1)。尽管多数存在子痫前期的妊娠可在足月或接近足月时分娩，且母亲与胎儿的结局均良好，但此类妊娠的母体和/或胎儿死亡或出现严重并发症的风险增加[1,2]。

与妊娠有关的高血压性疾病的定义

与妊娠有关的高血压性疾病主要有4种[3,4]：

●子痫前期–子痫前期指的是既往血压正常的女性在妊娠20周后出现新发高血压，并伴蛋白尿和/或终末器官功能障碍(表 1)。严重高血压和终末器官受损的症状/体征，被认为是子痫前期中严重的疾病(表 2)[4]。2013年，美国妇产科医师学会不再把蛋白尿作为诊断有严重特征的子痫前期的一个必要标准。该学会也不再将大量蛋白尿(5g/24h)和胎儿生长受限作为重度子痫前期的可能特征，因为大量蛋白尿与妊娠结局的相关性较差，且无论是否诊断为子痫前期，胎儿生长受限的处理方法是类似的[4]。也不再将少尿作为重度子痫前期的一个特征。

子痫指的是在不存在引起癫痫的其他神经系统疾病的情况下，在子痫前期女性中发生的癫痫大发作。(参见“子痫”)

HELLP综合征(溶血、肝酶升高、血小板计数低)可能是子痫前期的一种严重形式，但二者之间的关系仍存在争议；HELLP综合征可能是一种独立的疾病。由于多达15%-20%的HELLP综合征患者并未同时发生高血压或蛋白尿，这使某些专家认为HELLP综合征是有别于子痫前期的一种独立疾病。 (参见“HELLP综合征”)

●慢性/之前存在的高血压–慢性/之前存在的高血压指的是收缩压大于等于140mmHg和/或舒张压大于等于90mmHg，并且这些在妊娠前已经存现，或在妊娠20周之前(至少在不同时间进行2次测量)存在，或持续至产后12周以上。它可是原发性的(原发性高血压，之前被称为“特发性高血压”)，也可继发于多种躯体疾病。 (参见“成人高血压的概述”)

●在慢性/之前存在高血压的基础上合并子痫前期–在慢性/之前存在高血压的基础上合并子痫前期，被定义为慢性/之前存在高血压的女性在妊娠20周后，出现新发的蛋白尿或终末器官功能障碍。对于在妊娠之前或妊娠早期出现蛋白尿的慢性/之前存在高血压的女性患者，合并子痫前期被定义为：在妊娠后半期高血压恶化或顽固性高血压(尤其是急性高血压)，或出现子痫前期严重疾病谱中的症状/体征(表 2)。

                                         

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