内科

目的探讨妊娠高血压患者孕早期心脏自主神经活动是否存在异常，并分析妊娠高血压的影响因素。方法选取2021年9月至2022年1月在广西壮族自治区妇幼保健院顺利分娩的1 243例孕妇作为研究对象，将其中健康足月分娩的1 200例作为健康组，发生妊娠高血压的43例作为妊娠高血压组。比较两组孕妇一般资料和孕早期（孕8周至孕12周）的短程心率变异性（HRV）频域指标，采用多因素logistic回归模型分析妊娠高血压的影响因素。结果妊娠高血压组的受孕次数少于健康组，基础收缩压、基础舒张压、身体质量指数均高于健康组（均P<0.05），妊娠高血压组短程HRV频域指标中的总功率、低频功率、高频功率、高频功率占比均低于健康组（均P<0.05）。多因素logistic回归分析结果显示，受孕次数多、高频功率占比高均为妊娠高血压的独立保护因素，基础收缩压高、身体质量指数高均为妊娠高血压的独立危险因素（均P<0.05）。结论妊娠高血压孕妇孕早期心脏自主神经总体活动存在异常，孕早期迷走神经活动水平异常减弱的孕妇易患妊娠高血压。受孕次数多、高频功率占比高均为妊娠高血压的独立保护因素，基础收缩压高、身体质量指数高均为妊娠高血压的独立危险因素。

Objective To investigate whether there is any abnormal cardiac autonomic nervous activity in patients with gestational hypertension in the first trimester of pregnancy, and to analyze influencing factors of gestational hypertension. Methods A total of 1,243 pregnant women who successfully delivered in the Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region from September 2021 to January 2022 were selected as the study subjects, among which 1,200 healthy cases of term delivery were assigned to the healthy group, and 43 cases of gestational hypertension were selected as the gestational hypertension group. The two groups of pregnant women were compared in the general data and the short-term heart rate variability (HRV) frequency-domain indexes in the first trimester of pregnancy (8-12 weeks pregnant), and influencing factors for gestational hypertension were analyzed by the multivariate logistic regression model. Results The number of conceptions in the gestational hypertension group was less than that in the healthy group, the basal systolic blood pressure, basal diastolic blood pressure, and body mass index were higher than those in the healthy group, and the short-term HRV frequency-domain indexes, including total power, low-frequency power, high-frequency power, and the proportion of high-frequency power in the total power, were lower than those in the healthy group (all P<0.05). The results of multivariate logistic regression analysis showed that many conceptions and a large proportion of high-frequency power in the total power were independent protective factors for gestational hypertension, and a high basal systolic blood pressure and a high body mass index were independent risk factors for gestational hypertension (all P<0.05). Conclusion Pregnant women with gestational hypertension have abnormal cardiac autonomic nervous activities in the first trimester of pregnancy, and pregnant women with abnormally weakened vagus nerve activities in the first trimester of pregnancy are more likely to develop gestational hypertension. Many conceptions and a large proportion of high-frequency power in the total power are independent protective factors for gestational hypertension, and a high basal systolic blood pressure and a high body mass index are independent risk factors for gestational hypertension.