收稿日期: 2018-05-14
网络出版日期: 2019-02-26
基金资助
国家自然科学青年基金资助项目(81300513);上海市科委中西医引导类课题项目(15411964200)
Correlation between blood lipid levels in early pregnancy and preeclampsia
Received date: 2018-05-14
Online published: 2019-02-26
[目的] 探讨孕早期血脂水平与子痫前期发生的相关性.[方法] 选取 2015 年 1 月 1 日至 2015 年 12 月 31 日在上海交通大学医学院附属国际和平 妇幼保健院建卡分娩的子痫前期孕妇 272 例作为研究组, 同时选取同期分娩的健康妊娠孕妇 300 例作为对照组. 检测 2 组孕妇孕 (11+3) 周~(13+6) 周血清总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、高密度脂蛋白(high density lipoprotein, HDL)、低密度脂蛋白(low density lipoprotein, LDL)、载脂蛋白 A(apolipoprotein A, ApoA)、载脂蛋白 B(apolipoprotein B, ApoB)及脂蛋白 a(lipoprotein a, LPa), 计算动脉粥样硬化指数(atherosclerosis index, AI), TC/HDL, TG/HDL, LDL/HDL 及 ApoB/ApoA 并进行比较. 利用受试者工作特征(receiver operating characteristic, ROC)曲线进行检测指标预测子痫前期评价.[结果] 子痫前期组 TG, LDL, ApoB, AI, TC/HDL, TG/HDL, LDL/HDL 及 ApoB/ApoA 均明显高于正常妊娠组($P\!<\!0.05$). 2 组 TC, LPa, HDL 及 ApoA 无统计学差异($P\!>\!0.05$). ROC曲线确定 TG/HDL 对子痫前期有预测价值($P\!<\!0.05$), 曲线下面积(area under the curve, AUC)为0.843, 最佳临界值为1.49, 灵敏度为 67.7%, 特异度为 91.7%.[结论] 子痫前期患者孕早期存在高血脂异常代谢, TG/HDL对子痫前期发生有预测价值.
林楠, 顾玮, 华人意, 侯燕燕 . 孕早期血脂水平与子痫前期的相关性[J]. 上海大学学报(自然科学版), 2019 , 25(1) : 18 -23 . DOI: 10.12066/j.issn.1007-2861.2045
[Objective] To explore the connection between blood lipid levels in early pregnancy and the risk of preeclampsia. [Methods] To analyze 272 cases with preeclampsia who received routine examination and gave birth in International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January to December in 2015. Controls were 300 healthy pregnant women at the same stage of delivery. The levels of serum total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB) and lipoprotein a (LPa) were detected in early pregnancy ((11+3)~(13+6) weeks), and atherosclerosis index (AI), TC/HDL, TG/HDL, LDL/HDL and ApoB/ApoA were calculated. The receiver operating characteristic (ROC) curve was used to predict preeclampsia. [Results] The levels of TG, LDL, ApoB, AI, TC/HDL, TG/HDL, LDL/HDL and ApoB/ApoA of the preeclampsia group were significantly higher than those of the control group ($P\!<\!0.05$). There were no significant differences in the levels of TC, LPa, HDL and ApoA between the two groups ($P\!>\!0.05$). The ROC curve indicated that TG/HDL had predictive value for preeclampsia ($P\!<\!0.05$). Area under the curve (AUC) was 0.843, the critical value was 1.49, sensitivity 67.7%, specificity 91.7%. [Conclusion] Patients with preeclampsia had significant abnormal hyperlipidemia metabolism in early pregnancy. TG/HDL may be a reference predictor of the risk of preeclampsia.
Key words： blood lipid; preeclampsia; early pregnancy
| [1] | Killion M . New hypertension in pregnancy guidelines[J]. Mcn Am J Matern Child Nurs, 2015,40(2):128-156. |
| [2] | Mankuta D, Elami-Suzin M, Elhayani A , et al. Lipid profile in consecutive pregnancies[J]. Lipids Health Dis, 2010(9):1-4. |
| [3] | 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2015版)[J]. 中华妇产科杂志, 2015,50(10):721-728. |
| [4] | Belo L, Caslake M, Gaffney D , et al. Changes in LDL size and HDL concentrarion in normal and preeclamptic pregnancies[J]. Atherosclerosis, 2002,162(2):425-432. |
| [5] | Jin W Y, Lin S L, Hou R L , et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-base study from China[J]. BMC Pregnancy and Childbirth, 2016,16(1):60-68. |
| [6] | Babita G, Raghuram P, Varshil M . Association of lipid profile in pregnancy with preeclampsia, gestational diabetes mellitus, and preterm delivery[J]. Cureus, 2017, DOI: 10.7759/cureus.1420. |
| [7] | 杨扬, 孟涛 . 血脂干预对子痫前期早期预防作用[J]. 中国实用妇科与产科杂志, 2014,10(10):766-769. |
| [8] | Magnussen E B, Vatten L J, Lundnilsfn T I , et al. Prepregnancy cardiovascular risk factors as predictors of preeclampsia: population based cohort study[J]. BMJ British Medical Journal, 2007,335(7627):978-990. |
| [9] | Kazemian E, Dorosty A R, Sotoudeh G , et al. Nutritional status of women with gestational hypertension compared with normal pregnant women[J]. Hypertens Pregnancy, 2013,32(2):146-156. |
| [10] | Chae J S, Parik J K, Kang L , et al. Mild weight loss reduces inflammatory cytokines, lekocyte count and oxidative stress in overweight and moderately obse participants treated for 3 years with dietary modification[J]. Nutr Res, 2013,33(3):195-203. |
| [11] | Stark J M . Preeclampsia and cytokine induced oxidative stress[J]. Br J Obstet Gynaecol, 1993,100(2):105-109. |
| [12] | Daniel A, Enquobahrie, Michelle A , et al. Maternal plasma lipid concentrarion during pregnancy and risk of preeclampsia[J]. J Am Hypertens, 2004,17(2):574-581. |
| [13] | Magnussen E B, Vatten L J, Lund-Nilsen T L , et al. Prepregnancy cariovascular risk factors as predictors of preeclampsia: population based cohort study[J]. BMJ British Medical Journal, 2007,335(2):978-986. |
| [14] | 杨孜 . 重视脂质代谢与先兆子痫等病理妊娠的发生发展[J]. 中国妇产科临床杂志, 2006,7(6):405-406. |
| [15] | Iris R D, Rimm E B, Hankinson S E , et al. Multivariate assessment of lipid parameters as predictors of coronary heart disease among postmenopausal women: potential implications for clinical guidelines[J]. Circulation, 2004,110(18):2824-2830. |
| [16] | Singh M, Pathak M S, Paul A . Hypertensiopn patisents as compared to normal pregnant women[J]. Ann Med Health Sci Res, 2014,4(4):638-641. |
| [17] | 苏秀梅, 李林娜 . 妊娠晚期血脂水平与不同类型子痫前期相关性分析[J]. 中山大学学报(医学科学版), 2016,37(3):428-432. |
| [18] | Edailna M D, Flávio V M, José W Q . Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population[J]. BMC Pregnancy and Chlidbirth, 2013,13(12):159-167. |
| [19] | 邓松清, 刘斌, 王子莲 . 妊娠期高血压疾病孕妇孕中期血脂代谢研究[J]. 中山大学学报(医学科学版), 2016,37(1):100-104. |
| [20] | Campbell D M, Bhattacharya A, Horgan G , et al. Inter-pregancy weight change and pregnancy hypertension[J]. Pregnancy Hypertens, 2015,5(1):67-78. |
| [21] | Shopen N, Schife E, Koren M , et al. Facters that predict the development of hypertension in women with pregnancy-induced hypertension[J]. Am J Hpertens, 2016,29(1):141-146. |
/
| 〈 |
|
〉 |
