妊娠和高危妊娠期应用吸入类固醇激素导致高血压的巢式病例对照研究
2007/03/12
研究目的是采用巢式病例对照研究妊娠期患有哮喘的妇女应用吸入类固醇激素是否提高妊娠高血压综合症及妊娠子痫的发病率。病例来自魁北克的三个健康数据库，为1990和2000年间4593例妊娠妇女，3505例哮喘患者。主要观察指标妊娠导致的高血压和子痫。结果共发现302例妊娠高血压综合症及165妊娠子痫。从怀孕初期到分娩应用吸入类固醇激素与妊娠高血压综合症和子痫无明显相关性（与妊娠高血压调整后胜算比1.02，95%可信区间为0.77至1.34，与子痫调整后胜算比1.06，95%可信区间为0.74至1.53）。未观察到吸入类固醇激素与妊娠高血压综合症和子痫存在明显的剂量依赖关系（与妊娠高血压调整后胜算比1.57，95%可信区间为1.02至2。41，与子痫调整后胜算比1.72，95%可信区间为0.98至3.02）。口服类固醇激素明显提高妊娠高血压综合症患病率，趋向于提高子痫患病率但未达统计学差异。
结论为孕期应用吸入类固醇激素与妊娠高血压综合症和子痫无明显的相关性，然而，重症或未经控制的哮喘患者合并妊娠高血压综合症及子痫的风险高。
结论为孕期应用吸入类固醇激素与妊娠高血压综合症和子痫无明显的相关性，然而，重症或未经控制的哮喘患者合并妊娠高血压综合症及子痫的风险高。
（韩福军 广州呼吸疾病研究所 510120 摘译）
(BMJ. 2005 ;29;330(7485):230. Epub 2005;19)
Martel MJ, Rey E, Beauchesne MF, Perreault S, Lefebvre G, Forget A, Blais L.
Use of inhaled corticosteroids during pregnancy and risk of pregnancy induced hypertension: nested case-control study.
BMJ. 2005 Jan 29;330(7485):230. Epub 2005 Jan 19.
OBJECTIVE: To determine whether the use of inhaled corticosteroids during pregnancy increases the risk of pregnancy induced hypertension and pre-eclampsia among asthmatic women.
DESIGN: Nested case-control study.
SETTING: Three administrative health databases from Quebec: RAMQ, MED-ECHO, and Fichier des evenements demographiques.
PARTICIPANTS: 3505 women with asthma, totalling 4593 pregnancies, between 1990 and 2000.
MAIN OUTCOME MEASURES: Pregnancy induced hypertension and pre-eclampsia.
RESULTS: 302 cases of pregnancy induced hypertension and 165 cases of pre-eclampsia were identified. Use of inhaled corticosteroids from conception until date of outcome was not associated with an increased risk of pregnancy induced hypertension (adjusted odds ratio 1.02, 95% confidence interval 0.77 to 1.34) or pre-eclampsia (1.06, 0.74 to 1.53). No significant dose-response relation was observed between inhaled corticosteroids and pregnancy induced hypertension or pre-eclampsia. Oral corticosteroids were significantly associated with the risk of pregnancy induced hypertension (adjusted odds ratio 1.57, 1.02 to 2.41), and a trend was seen for pre-eclampsia (1.72, 0.98 to 3.02).
CONCLUSION: No significant increase of the risk of pregnancy induced hypertension or pre-eclampsia was detected among users of inhaled corticosteroids during pregnancy, while markers of uncontrolled and severe asthma were found to significantly increase the risks of pregnancy induced hypertension and pre-eclampsia.
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吸烟哮喘患者对糖皮质激素的全身敏感性
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