孕妇不同孕期血脂指标分布和变化的观察性研究  

An observational study on serum lipid profile and its changes during gestation in pregnant women

作　　者：彭笑菊 戴楠[2] 汪之顼[1] 张爱华[2] 陈丹丹[1] 殷璐[1] 邵莹莹[1] 丁叶[1] 徐济达[1] 

机构地区：[1]南京医科大学公共卫生学院儿少卫生与妇幼保健学系,江苏南京211166 [2]丹阳市人民医院妇产科,江苏镇江212300

出　　处：《南京医科大学学报（自然科学版）》2016年第7期840-845,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏高校优势学科建设工程资助项目;中国营养学会营养健康科研基金(2013)

摘　　要：目的 :了解各孕期孕妇的血脂水平和变化情况,观察妊娠期糖尿病者和娩出巨大儿的孕妇血脂水平变化。方法 :依托"孕期体重增长适宜值多中心队列研究",收集江苏省丹阳市某医院516例单胎孕妇一般状况信息,妊娠早、中、晚期血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)浓度,观察妊娠期并发症发生情况和新生儿出生状况。比较出生巨大儿与出生非巨大儿者、妊娠期糖尿病(gestational diabetes mellitus,GDM)者与正常妊娠者孕期血脂状况。比较不同孕前体重指数(BMI)孕妇之间孕早期和孕晚期血脂水平。结果:随着孕期进展孕妇血脂水平逐渐升高,而HDLC/TC比值不断降低,LDL-C/HDL-C比值不断升高(均为P<0.05)。但是在同一孕期内,巨大儿与非巨大儿母亲血脂状况几乎没有差别(均为P>0.05);与正常妊娠者相比,GDM孕妇在孕早期和孕中期具有明显较高的TG水平(均为P<0.05)。孕前超重肥胖者孕早期血脂偏高,且GDM发病率较高,而不同孕前BMI孕妇孕晚期血脂水平几乎没有差别。结论:孕早、中期高TG水平可能与GDM发生风险增大有关,孕前应使BMI达到正常水平避免孕早期血脂异常升高。Objective：To investigate blood lipid profile and its changes of pregnant women, and to analyze if dyslipidemia occurred in those who suffered from gestational diabetes mellitus （GDM） or delivery of maerosomia. Methods： Based on the multi-center cohort study for reference intervals of gestational weight gain, total 516 singleton pregnant women were recruited from Danyang city, Jiangsu Province into the study for observation on serum lipid profiles during gestation. The general information of the subjects was collected and serum lipid [triglycerides（TG）, total cholesterol（TC）, low density lipoproten-cholesterol（LDLC）, and high density lipoproteirrcholesterol （HDL-C）] concentrations were tested in three trimesters of gestation. The complications during gestation and conditions of newborns were recorded as well. The lipid profiles during gestation were compared between women who delivered maerosomias and who did not, and between women with GDM and normal pregnancies. The lipid profiles were compared according to pregestational body mass index （BMI） levels in the first and third trimesters as well. Results： The serum lipid levels increased, the rate of HDL-C/TC decreased, and the rate of HDL-C/TC increased with progress of gestation in the investigated pregnant women （both P 〈 0.05）. In same stage of pregnancy, there was little difference in lipid profiles between women who delivered macrosomias and who did not （both P 〉 0.05）. The GDM women had higher serum TG level in first and second trimesters than normal pregnancies （both P 〈 0.05）. Women with pregestational BMI≥24 kg/m2 were more likely to suffer from dyslipidemia in early pregnancy, and GDM morbidity of them was also higher than that of women with pregestational BMI〈24 kg/m2. In our study, there was little difference in lipid profiles among different pregestational BMI levels in the third trimester. Conclusion： Hypertriglyceridemia in the first and second trimesters may be associated with higher risk of GDM.

关 键 词：血脂水平 妊娠 血脂异常 妊娠结局 

分 类 号：R714.7[医药卫生—妇产科学]