评价孕妇肺动脉高压风险和结局的荟萃分析

IF 2.9 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health Pub Date : 2025-07-31 DOI:10.1016/j.preghy.2025.101241

Yangting Li , Xiaolei Yang , Maoni Zeng , Tao Luo , Xiaoyuan Lian , Jiali Liu , Qiaolin Liu , Fei Xiao

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引用次数: 0

摘要

目的传统上认为，妊娠期肺动脉高压（PH）与母亲和胎儿出现不良结局的可能性较高有关。方法为了全面调查孕妇PH相关的危险和最终结果，本研究在多个数据库中进行了广泛的检索。主要包括PubMed、Web of Science、EMBASE、Cochrane Library等国内外权威数据库。两位作者使用预定义的筛选标准独立筛选检索到的文章，并使用“RevMan5.3偏倚风险评估工具”评估纳入研究的质量。结果通过检索EMBASE，共有10项研究被认为是合适的，并被纳入随后的meta分析。在所有纳入的研究中，有10项试验报告了不良妊娠结局的发生率。同质性检验(P <；0.01, I2 = 64%)表明存在异质性，采用随机效应模型进行分析。meta分析结果显示，轻度至中度PH孕妇与重度PH孕妇的不良妊娠结局发生率有显著差异(RR = 0.67, 95% CI 0.60 ~ 0.75, P <；0.01)。在纳入的研究中，有5项试验报告了不良妊娠结局的发生率。齐性检验（P = 0.05, I2 = 58%）表明存在异质性，采用随机效应模型进行统计分析。meta分析结果显示，轻中度肺动脉高压患者与心功能III级至IV级严重疾病孕妇的比例存在显著差异(RR = 0.48, 95% CI 0.39 ~ 0.58, P <；0.01)。使用区域和样本量作为亚组分类，大样本(n >；100, n >；70)和小样本（n≤100,n≤70），非中国患者的异质性较低（I2 = 0%）；同时，n >；100, n >；70高于n100和n70的研究，说明异质性随着样本量的减少而降低。在进行荟萃分析后，发现pH的严重程度与母胎结局密切相关。在后续的分析中，我们将进一步探讨不同的治疗和护理方法对PH患者母婴结果的影响。

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Meta-analysis evaluating the risks and outcomes of pulmonary hypertension in pregnant women

Objectives

Pulmonary hypertension (PH) in pregnancy has traditionally been linked to a higher likelihood of negative outcomes for both the mother and the fetus. A systematic analysis of published papers in recent decades regarding outcomes of pregnancy in patients with PH.

Methods

To comprehensively investigate the dangers and final results associated with PH in pregnant women, this study conducted an extensive search across multiple databases. It mainly includes authoritative databases both domestically and internationally, such as PubMed, Web of Science, EMBASE, Cochrane Library, etc. Two authors screened the retrieved articles independently using predefined screening criteria, and assessed the quality of the included studies using the “RevMan5.3 Risk of Bias Assessment Tool”.

Results

By searching EMBASE, a total of 10 studies were deemed appropriate and brought into the subsequent meta-analysis. Among all the included studies, 10 trials reported the incidence of adverse pregnancy outcomes. The homogeneity test (P < 0.01, I² = 64 %) showed the existence of heterogeneity, and a random effects model was employed for the analysis. The results of the meta-analysis indicate a significant difference in the incidence of adverse pregnancy outcomes between pregnant women with mild to moderate PH and those with severe PH (RR = 0.67, 95 % CI 0.60 ∼ 0.75, P < 0.01). Among the included studies, 5 trials reported the incidence of adverse pregnancy outcomes. The homogeneity test (P = 0.05, I² = 58 %) showed the existence of heterogeneity, and a random effects model was employed for statistical analysis. The meta-analysis results revealed a significant difference in the proportion of patients with mild to moderate pulmonary arterial hypertension compared to pregnant women with severe disease in cardiac function grades III to IV (RR = 0.48, 95 % CI 0.39 ∼ 0.58, P < 0.01). Using region and sample size as subgroup classifications, large samples (n > 100, n > 70) and small sample (n ≤ 100, n ≤ 70), the heterogeneity of non-China patients was lower (I² = 0 %); meanwhile, the heterogeneity of n > 100, n > 70 was higher than that of studies with n 100 and n 70, indicating that the heterogeneity decreased with the decrease in sample size.

Conclusions

After conducting a meta-analysis, it was found that the severity of pH is closely associated with maternal and fetal outcomes. In the subsequent analysis, we will further explore the impact of different treatments and nursing methods on maternal and infant results in patients who have PH.

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来源期刊

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health OBSTETRICS & GYNECOLOGYPERIPHERAL VASCULAR-PERIPHERAL VASCULAR DISEASE

CiteScore

4.90

自引率

0.00%

发文量

127

期刊介绍： Pregnancy Hypertension: An International Journal of Women''s Cardiovascular Health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. We publish articles pertaining to human and animal blood pressure during gestation, hypertension during gestation including physiology of circulatory control, pathophysiology, methodology, therapy or any other material relevant to the relationship between elevated blood pressure and pregnancy. The subtitle reflects the wider aspects of studying hypertension in pregnancy thus we also publish articles on in utero programming, nutrition, long term effects of hypertension in pregnancy on cardiovascular health and other research that helps our understanding of the etiology or consequences of hypertension in pregnancy. Case reports are not published unless of exceptional/outstanding importance to the field.