妊娠期血脂异常患病率及妊娠早期血脂水平预测价值研究  被引量:1

Prevalence of Dyslipidemia in Pregnancy and Early Predictive Value of Blood Lipid Levels

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作  者:袁仙仙 李静[2] 王佳 张可欣 杨蕊华 郑薇 李光辉[1] YUAN Xianxian;LI Jing;WANG Jia;ZHANG Kexin;YANG Ruihua;ZHENG Wei;LI Guanghui(Division of Endocrinology and Metabolism,Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China;Department of Obstetrics,the Peoples Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区:[1]首都医科大学附属北京妇产医院,北京妇幼保健院围产内分泌代谢科,北京市100026 [2]广西壮族自治区人民医院产科,广西壮族自治区南宁市530021

出  处:《中国全科医学》2024年第6期670-678,共9页Chinese General Practice

基  金:北京市自然科学基金资助项目(青年项目)(7214231);北京市医院管理中心“登峰”人才培养计划(DFL20191402)中国临床试验注册中心注册号:ChiCTR220058395。

摘  要:背景妊娠期血脂异常升高可对母儿健康造成不良影响,不仅增加了子痫前期、妊娠期糖尿病(GDM)、高甘油三酯胰腺炎、晚期流产、早产以及巨大儿的发生风险,亦显著增加了母儿产后心血管疾病的风险。目的分析妊娠早、中、晚期血脂异常的分布特征及其早期血脂水平对妊娠中、晚期血脂异常的预测价值。方法本研究为单中心回顾性研究,纳入2018年1月—2019年6月在首都医科大学附属北京妇产医院产科建档产检至分娩的单胎孕妇,收集临床资料及妊娠早、中、晚期血脂数据[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]。以首都医科大学附属北京妇产医院妊娠期血脂参考范围作为血脂异常诊断标准:包括高总胆固醇血症、高甘油三酯血症、低高密度脂蛋白胆固醇血症和高低密度脂蛋白胆固醇血症。采用二分类Logistic回归分析妊娠早期血脂水平与妊娠中、晚期血脂异常的相关性,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价妊娠早期血脂水平对妊娠中、晚期血脂异常的预测价值,根据灵敏度和特异度确定最佳截断值。结果研究共纳入单胎孕妇8511名,平均年龄为(31.7±3.9)岁,平均孕前BMI为(21.7±3.2)kg/m^(2),其中孕前低体质量988名(11.6%)、正常体质量5568名(65.4%)、超重1271名(14.9%)、肥胖366名(4.3%),GDM孕妇1415名(16.7%),妊娠期高血压疾病(HDP)孕妇650名(7.6%)。妊娠中、晚期TC、TG、LDL-C水平均高于妊娠早期(P<0.05),妊娠晚期HDL-C水平高于妊娠早期,但低于妊娠中期(P<0.05)。妊娠早期血脂异常患病率为23.4%(1990/8511),妊娠中、晚期血脂异常患病率低于妊娠早期(P<0.05)。孕前超重、肥胖孕妇妊娠早期血脂异常患病率高于孕前正常体质量孕妇,但妊娠晚期血脂异常患病率比较,差异无统计学意义(P>0.05);GDM组孕妇妊娠早、中期血脂异常患病Background Elevated dyslipidemia during pregnancy can adversely affect maternal and child health.It not only increases the risk of preeclampsia,gestational diabetes mellitus(GDM),hypertriglyceridemic pancreatitis,late abortion,premature delivery and macrosomia,but also significantly increases the risk of postnatal cardiovascular disease.Objective To analyze the distributional characteristics of dyslipidemia in the first,second and third trimesters of pregnancy and the predictive value of early lipid levels for dyslipidemia in the second and third trimesters of pregnancy.Methods This was a single-center retrospective study,which included singleton pregnant women who were enrolled in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2018 to June 2019 for obstetrics checkups until delivery.Clinical data and lipid data[total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)]were collected in the first,second and third trimesters of pregnancy.The reference range of lipids in department of obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University was used as the diagnostic standard for dyslipidemia,including high total cholesterolemia,high triacylglycerolemia,low HDL-cholesterolemia and high LDL-cholesterolemia.The correlation between lipid levels in the first trimester of pregnancy and dyslipidemia in the second and third trimesters of pregnancy was analyzed by using binary Logistic regression,and the receiver operating characteristics(ROC)curves of the subjects were plotted to obtain the area under ROC curve(AUC),to evaluate the predictive value of the lipid levels in the first trimester of pregnancy for dyslipidemia in the second and third trimesters of pregnancy,and to determine the optimal cut-off value according to the sensitivity and specificity.Results A total of 8511 singleton pregnant women were included in the study,with an average age of(31.7±3.9)years and an average pre-preg

关 键 词:妊娠 孕妇 血脂异常 患病率 妊娠期糖尿病 妊娠期高血压疾病 截断值 

分 类 号:R339.2[医药卫生—人体生理学] R589.2[医药卫生—基础医学]

 

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