高危妊娠人群妊娠相关急性肾损伤的临床特征和妊娠结局分析

doi:10.3969/j.issn.1674-8115.2026.01.007

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (1): 60-65.doi: 10.3969/j.issn.1674-8115.2026.01.007

高危妊娠人群妊娠相关急性肾损伤的临床特征和妊娠结局分析

应奕雯¹, 李舒¹, 张珍¹, 虞靖然¹, 张宁²(), 牟姗¹()

^1.上海交通大学医学院附属仁济医院肾脏科，上海 200127
^2.上海交通大学医学院附属仁济医院妇产科，上海 200127

收稿日期:2025-07-14 接受日期:2025-12-05 出版日期:2026-01-28 发布日期:2026-01-30
通讯作者: 牟　姗，主任医师，博士；电子信箱：shan_mou@126.com
张　宁，副主任医师，博士；电子信箱：ningning1723@126.com。
作者简介:第一联系人：应奕雯参与了数据整理和分析，李舒参与了数据收集、统计分析和论文撰写，张珍参与了数据整理，虞靖然参与了数据分析，张宁参与了研究设计和论文撰写，牟姗负责研究指导、数据采集和论文修改。所有作者均阅读并同意了最终稿件的提交。
为共同第一作者（*co-first authors）。
基金资助:
“医苑新星”青年医学人才培养资助计划［SHWSRS（2024）_70］;2025年度中医药标准化项目(2025BZ019);2023年上海交通大学“交大之星”计划重大项目(20230101)

Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations

Ying Yiwen¹, Li Shu¹, Zhang Zhen¹, Yu Jingran¹, Zhang Ning²(), Mou Shan¹()

^1.Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Department of Gynecology and Obstetrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2025-07-14 Accepted:2025-12-05 Online:2026-01-28 Published:2026-01-30
Contact: Mou Shan, E-mail: shan_mou@126.com
Zhang Ning, E-mail: ningning1723@126.com.
About author:First author contact:Ying Yiwen contributed to data organization and analysis. Li Shu contributed to data collection, statistical analysis, and manuscript drafting. Zhang Zhen contributed to data organization. Yu Jingran contributed to data analysis. Zhang Ning contributed to study design and manuscript drafting. Mou Shan was responsible for study supervision, data acquisition, and manuscript revision. All authors have read the last version of paper and consented to submission.
Supported by:
Standardized Construction Project of 2025 Traditional Chinese Medicine(2025BZ019);Major Project of 2023 Shanghai Jiao Tong University “Jiaoda Star” (STAR) Program(20230101);“Rising Star in Medicine” Young Medical Talent Training and Support Program [SHWSRS (2024)_70]

摘要/Abstract

摘要：

目的·探讨高危妊娠人群中妊娠相关急性肾损伤（pregnancy-related acute kidney injury，Pr-AKI）的发病率、临床特征及其与不良妊娠结局的相关性。方法·开展回顾性单中心队列研究，纳入2018年1月—2023年12月于上海交通大学医学院附属仁济医院分娩的17 468例单胎妊娠患者。收集患者的一般人口学特征、合并症相关信息、妊娠期并发症、血肌酐数据和妊娠结局等资料。依照全球改善肾脏病预后组织的诊断标准，对患者是否发生Pr-AKI进行分析。以死产、早期早产（出生孕周<34周）、低出生体质量（出生体质量<2 500 g）等不良妊娠结局为主要观察结局。通过单因素和多因素Logistic回归模型分析Pr-AKI对不良妊娠结局的影响。结果·Pr-AKI发病率为0.3%（61/17 468）。相较于非AKI组，AKI组患者合并慢性高血压、慢性肾脏病、自身免疫性疾病的比例更高（均P<0.05），其死产、早期早产、低出生体质量及子痫前期的发生风险也更高（均P<0.001）。多因素Logistic回归分析的结果显示，Pr-AKI是不良妊娠结局的独立危险因素（adjusted OR=5.868，95% CI 3.142—10.957，P<0.001）。结论·高危妊娠人群的Pr-AKI与其不良妊娠结局相关，需加强早期监测与干预。

Abstract:

Objective ·To investigate the incidence and clinical features of pregnancy-related acute kidney injury (Pr-AKI) in high-risk populations and its correlation with adverse pregnancy outcomes. Methods ·This retrospective single-center cohort study included 17 468 singleton pregnancies delivered at Renji Hospital, Shanghai Jiao Tong University School of Medicine between January 2018 and December 2023. General demographic characteristics, comorbidities, pregnancy complications, serum creatinine levels, and pregnancy outcomes were collected. Pr-AKI was diagnosed according to Kidney Disease: Improving Global Outcomes criteria. Adverse pregnancy outcomes, including stillbirth, early preterm birth (gestational age < 34 weeks at delivery), and low birth weight (birth weight<2 500 g), were defined as the primary observation endpoints. Univariate and multivariate Logistic regression analyses were used to assess the impact of Pr-AKI on adverse pregnancy outcomes. Results ·The incidence of Pr-AKI was 0.3% (61/17 468). Compared with the non-AKI group, patients in the AKI group had higher rates of chronic hypertension, chronic kidney disease, and autoimmune diseases (P<0.05). Additionally, the risks of stillbirth, early preterm birth, low birth weight, and preeclampsia of the patients in the AKI group were increased (P<0.001). Multivariate Logistic regression analysis confirmed Pr-AKI as an independent risk factor for adverse pregnancy outcomes (adjusted OR=5.868, 95% CI 3.142—10.957, P<0.001). Conclusion ·Pr-AKI significantly contributes to adverse pregnancy outcomes in high-risk pregnant populations, underscoring the need for early monitoring and intervention.

Key words: pregnancy-related acute kidney injury (Pr-AKI), adverse pregnancy outcome, cohort study, preterm birth, low birth weight

中图分类号:

R544.1

应奕雯, 李舒, 张珍, 虞靖然, 张宁, 牟姗. 高危妊娠人群妊娠相关急性肾损伤的临床特征和妊娠结局分析[J]. 上海交通大学学报（医学版）, 2026, 46(1): 60-65.

Ying Yiwen, Li Shu, Zhang Zhen, Yu Jingran, Zhang Ning, Mou Shan. Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 60-65.

图/表 5

参考文献 13

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Characteristic	AKI group (n=61)	Non-AKI group (n=17 407)	P value
Demographic characteristics
Age/year	32.7±4.2	31.8±4.3	0.096
Gravidity/n	1 (0, 2)	1 (0, 2)	0.699
BMI/(kg·m^-2)	26.2±4.2	26.6±4.9	0.468
MAP/mmHg	99.8±13.0	91.3±9.8	<0.001
Age at menarche/year	13.9±1.2	13.5±1.0	0.026
History of preterm birth/n(%)	2 (3.3)	386 (2.2)	0.655
History of miscarriage/n(%)	31 (50.8)	7 028 (40.4)	0.234
Comorbidities/n(%)
PGDM	2 (3.3)	446 (2.6)	0.671
Chronic hypertension	7 (11.5)	846 (4.9)	0.036
Autoimmune disease	12 (19.7)	1 688 (9.7)	0.016
CKD	19 (31.1)	621 (3.6)	<0.001
Cardiac dysfunction	6 (9.8)	416 (2.4)	<0.001
Obesity	7 (11.5)	1 532 (8.8)	0.610
Pregnancy complications/n(%)
GDM	15 (24.6)	3 512 (20.2)	0.485
Gestational hypertension	8 (13.1)	548 (3.1)	<0.001

Characteristic	AKI group (n=61)	Non-AKI group (n=17 407)	P value
Demographic characteristics
Age/year	32.7±4.2	31.8±4.3	0.096
Gravidity/n	1 (0, 2)	1 (0, 2)	0.699
BMI/(kg·m^-2)	26.2±4.2	26.6±4.9	0.468
MAP/mmHg	99.8±13.0	91.3±9.8	<0.001
Age at menarche/year	13.9±1.2	13.5±1.0	0.026
History of preterm birth/n(%)	2 (3.3)	386 (2.2)	0.655
History of miscarriage/n(%)	31 (50.8)	7 028 (40.4)	0.234
Comorbidities/n(%)
PGDM	2 (3.3)	446 (2.6)	0.671
Chronic hypertension	7 (11.5)	846 (4.9)	0.036
Autoimmune disease	12 (19.7)	1 688 (9.7)	0.016
CKD	19 (31.1)	621 (3.6)	<0.001
Cardiac dysfunction	6 (9.8)	416 (2.4)	<0.001
Obesity	7 (11.5)	1 532 (8.8)	0.610
Pregnancy complications/n(%)
GDM	15 (24.6)	3 512 (20.2)	0.485
Gestational hypertension	8 (13.1)	548 (3.1)	<0.001

Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	Univariate Logistic regression analysis
Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	OR (95% CI)	P value
Primary outcomes/n(%)
Stillbirth	4 (6.6)	210 (1.2)	<0.001	5.747 (2.066‒15.983)	<0.001
Late preterm birth	22 (38.6)	2 008 (11.7)	<0.001	4.755 (2.784‒8.121)	<0.001
Early preterm birth	11 (19.3)	531 (3.1)	<0.001	7.654 (3.942‒14.862)	<0.001
Low birth weight	20 (35.1)	1 225 (7.1)	<0.001	7.048 (4.078‒12.180)	<0.001
Very low birth weight	9 (15.8)	214 (1.2)	<0.001	14.880 (7.210‒30.711)	<0.001
Secondary outcomes/n(%)
Preeclampsia	19 (31.1)	802 (4.6)	<0.001	9.366 (5.423‒16.178)	<0.001
Cesarean section	47 (82.5)	10 692 (62.2)	0.002	2.859 (1.444‒5.663)	0.001

Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	Univariate Logistic regression analysis
Pregnancy outcome	AKI group (n=61)	Non-AKI group (n=17 407)	P value	OR (95% CI)	P value
Primary outcomes/n(%)
Stillbirth	4 (6.6)	210 (1.2)	<0.001	5.747 (2.066‒15.983)	<0.001
Late preterm birth	22 (38.6)	2 008 (11.7)	<0.001	4.755 (2.784‒8.121)	<0.001
Early preterm birth	11 (19.3)	531 (3.1)	<0.001	7.654 (3.942‒14.862)	<0.001
Low birth weight	20 (35.1)	1 225 (7.1)	<0.001	7.048 (4.078‒12.180)	<0.001
Very low birth weight	9 (15.8)	214 (1.2)	<0.001	14.880 (7.210‒30.711)	<0.001
Secondary outcomes/n(%)
Preeclampsia	19 (31.1)	802 (4.6)	<0.001	9.366 (5.423‒16.178)	<0.001
Cesarean section	47 (82.5)	10 692 (62.2)	0.002	2.859 (1.444‒5.663)	0.001

Characteristic	OR (95% CI)	P value
Age	1.021 (1.005‒1.030)	0.005
Gravidity	1.201 (1.155‒1.246)	<0.001
BMI	0.944 (0.926‒0.957)	<0.001
MAP	1.044 (1.034‒1.044)	<0.001
Age at menarche	1.050 (0.985‒1.110)	0.140
History of preterm birth	3.068 (2.397‒3.935)	<0.001
History of miscarriage	1.446 (1.295‒1.615)	<0.001
PDGM	1.400 (1.038‒1.889)	0.030
Chronic hypertension	2.957 (2.486‒3.535)	<0.001
Autoimmune disease	2.503 (2.174‒2.865)	<0.001
CKD	2.106 (1.702‒2.623)	<0.001
Cardiac dysfunction	2.002 (1.522‒2.639)	<0.001
Obesity	0.886 (0.740‒1.081)	0.250
GDM	1.093 (0.958‒1.238)	0.190
Gestational hypertension	1.251 (0.957‒1.638)	0.100
AKI	8.610 (4.986‒14.877)	<0.001

高危妊娠人群妊娠相关急性肾损伤的临床特征和妊娠结局分析

Analysis of clinical characteristics and pregnancy outcomes of pregnancy-related acute kidney injury among high-risk pregnancy populations

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