妊娠中期初血游离脂肪酸、血脂水平和子宫动脉切迹与子痫前期的关系  

Correlation of free fatty acid and blood lipids in early second trimester and uterine artery notch in pre-eclampsia

作　　者：李凤秋[1] 杨孜[2] 张爱青[3] 王伽略[2] 孙晓乐[2] 孟然[2] 

机构地区：[1]北京市海淀区妇幼保健院妇产科 [2]北京大学第三医院妇产科,100191 [3]北京市海淀区妇幼保健院超声科

出　　处：《中华围产医学杂志》2014年第3期180-185,共6页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金（81370723）;北京市自然科学基金（7132215）

摘　　要：目的 分析妊娠中期初母血游离脂肪酸（free fatty acid,FFA）、血脂和子宫动脉切迹在子痫前期的异质性变化. 方法 本研究为前瞻性队列研究.2012年1月1日至5月31日在北京市海淀区妇幼保健院妊娠期建档,并规律进行产前检查的单胎妊娠妇女4 000例,妊娠14～18周行唐氏综合征筛查同时留取血样检测FFA和血脂,妊娠22～24周时行B超探查.其中存在子宫动脉舒张早期切迹者101例纳入有切迹组;无切迹但具有子痫前期高风险因素者172例纳入无切迹组,另外按1：5随机选取无切迹且未发现子痫前期高风险因素者205例纳入无切迹组,无切迹组共377例.采用两独立样本f检验、单因素方差分析、卡方检验（或Fisher精确概率法）和Logistic回归分析进行统计学处理. 结果 有切迹组子痫前期病史和首诊高血压前期的比例高于无切迹组[3.9％（4/101）与0.8％ （3/377）,x2=5.52; 42.2％ （43/101）与25.7％ （97/377）,x2=10.91;P值均＜0.05].有切迹组中24例（23.8％）发生子痫前期,无切迹组为8例（2.1％）（x2=59.72,P＜0.05）.有切迹组血FFA在早发型子痫前期、晚发型子痫前期、妊娠期高血压及健康孕妇亚组间呈逐渐降低趋势[分别为（0.68±0.27）、（0.58±0.21）、（0.57±0.21）和（0.49±0.19） mmol/L,F=2.78,P＜0.05].多因素分析显示,子痫前期病史（OR=6.77,95％CI：1.03～44.56）和首诊高血压前期（OR=3.34,95％CI：1.59～7.01）是发生子痫前期的危险因素.早发型子痫前期的危险因素包括血FFA（OR=135.68,95％CI：3.78～4 873.00）和子痫前期病史（OR=123.25,95％CI：9.27～1 638.00）;晚发型子痫前期的危险因素为首诊高血压前期（OR=4.82,95％CI：1.99～11.65）;妊娠期高血压的危险因素包括首诊高血压前期（OR=4.69,95％CI：2.08～10.58）和妊娠前体重指数24～28 （OR=3.69,95％CI：1.26～10.83）.血压正常伴妊娠期糖尿病的危险因素包括血FFA水平升高�Objective To analyze the heterogeneous variation of serum free fatty acid （FFA） and lipids during early second trimester in women with or without uterine artery notch in pre-eclampsia （PE）.Methods This is a prospective cohort study of 4 000 women with singleton pregnancies registered in early pregnancy and in whom regular check-ups were performed in Haidian Maternal ＆ Child Health Hospital.Blood specimens were collected at gestational age 14-18 weeks at the same time of screening for Down＇s syndrome.One hundred and one cases with early diastolic notch of the uterine artery were included in the N＋ group,and 172 cases without notch but at high risk of PE were included in the N-group at 22-24 weeks.In addition,205 women who were selected randomly at a ratio of 1 ∶ 5,without notch or PE high-risk factors,were also included in the N group.Both groups were subgrouped according to the outcomes of pregnancy complications：early-onset PE group EPE,late-onset PE （LPE）,gestational hypertension （GH） group,gestational diabetes mellitus （GDM） group with normal blood pressure,and no complications （NC） group.The variation in FFA and other lipid metabolism indicators in the PE subgroups were compared and analyzed by two independent-sample t-test,one-factor analysis of variance,Chi-square test （or Fisher＇s exact） and Logistic regression.Results History of PE and pre-hypertension at first visit differed significantly between the N＋ and N-groups [3.9％ （4/101） vs.0.8％ （3/377）,x2=5.52,P＜0.05; pre-hypertension at first visit,42.2％ （43/101） vs.25.7％ （97/377）,x2=10.91,P＜0.05].In the N＋ group,23.8％ （n=24） of women had PE,of which 37.5％ （n=8） were early onset.In the N group,2.1％ （n=8） had PE,and all were late onset.The incidence of PE differed significantly between the N＋ and N-groups （x2=59.72,P＜0.05）.In the N＋ group,FFA gradually decreased among the ePE,IPE,GH and NC groups [（0.68±0.27）,（0.58±0.21）,（0.57±0.21） and （0.49±0.

关 键 词：先兆子痫 脂肪酸类 非酯化 甘油三酯类 血管舒张 

分 类 号：R714.244[医药卫生—妇产科学]