脂代谢和同型半胱氨酸与妊娠期高血压疾病的相关性

Relationship of lipid metabolism and homocysteine with hypertensive disorders in pregnancy

目的探讨脂代谢和同型半胱氨酸与妊娠期高血压疾病（HDIP）的相关性，同时了解其炎症反应和胎盘病理学特征。方法选取2008年8月至2010年3月妊娠期高血压疾病患者74例作为研究组，以同期正常妊娠妇女77例作为对照组，进行前瞻性随机对照研究。分析脂代谢和同型半胱氨酸与HDIP的相关性。结果研究组与对照组比较孕前体质量指数（29．03±4．52与23．99±5．90）、总胆固醇[（6．16±1．48）mmol／L与（5．01±1．05）mmol／L]、低密度脂蛋白胆固醇[（3．46±1．35）mmol／L与（2．26±0．86）mmol／L]和C反应蛋白[（29．04±14．90）mg／L与（15．48±4．57）mg／L]比较，差异有统计学意义（t值分别为5．88、5．52、6．54、7．62，P均〈0．05）；甘油三酯[（3．29±1．03）mmol／L与（3．49±1．37）mmol／L]、高密度脂蛋白胆固醇[（1．84±0．40）mmol／L与（1．88±0．35）mmol／L]、同型半胱氨酸[（8．77±2．65）μmol／L与（8．40±2．03）μmol／L]和新生儿体质量[（3547±519）g与（3431±461）g]差异无统计学意义（P均〉0．05）。胎盘病理学中梗死发生率（54．55％比31．04％）和绒毛发育不良与合体结节形成以及缺氧发生率（65．46％比39．66％）差异均有统计学意义（χ^2值分别为6．39、7．53，P均〈0．05）。结论动态联合检测HDIP患者的血脂浓度、同型半胱氨酸和C反应蛋白的变化，尤其重视孕前肥胖妇女妊娠期管理和胎盘病理研究，对于揭示其发病原因和改善妊娠结局有重要的临床意义。

Objective To explore the association of lipid metabolism and homocysteine with hypertensive disorders in pregnancy and observe the inflammatory reaction and the pathological change of placenta. Methods We conducted a prospective randomized placebo-controlled study. Seventy-four cases with hypertensive disorders in pregnancy were recruited as the experimental group and 77 cases of normal pregnant women were recruited as matched control group from Aug. 2008 to Mar. 2010. The relationship between lipid metabolism and homocysteine was analyzed. Results There was significant difference between the two groups in body-mass index before pregnancy （ 29.03 ± 4. 52 vs. 23.99 ± 5.90, t = 5. 88 ）, cholesterol [ （ 6. 16 ± 1.48 ） mmol/L vs. （5.01 ± 1.05 ） retool/L, t = 5.52 ] , low density lipoprotein [ （ 3.46 ± 1.35 ） mmol/L vs. （ 2. 26 ± 0. 86） mmol/L, t = 6. 54 ] and C-reactive protein [ （ 29.04 ± 14.90 ） mmol/L vs. （ 15.48 ± 4. 57 ） mmol/L, t = 7.62 ] （ P 〈 0. 05 ）. No significant difference was found on triglycerides [ （ 3.29 ± 1.03 ） mmol/L vs. （ 3.49 ± 1. 37 ） mmol/L] ,high density lipoprotein [ （ 1. 84 ± 0. 40 ） mmol/L vs. （ 1. 88 ± 0. 35 ） mmol/L l, homocysteine [ （8. 77 ±2.65） mmol/L vs. （8.40 ±2.03） mmol/L] and neonatal weight [ （3547 ±519）g vs. （3431 ±461）g] （P 〉 0. 05 ） . Significant difference exists in placenta pathology of infarction （ 54.55% vs. 31.04% ）, villi dysplasia,fit nodules form and hypoxia（65.46% vs. 39.66%） （P 〈0.05）.Conclusion We should detect lipid, homoeysteine and C-reactive protein by dynamic combinational ways, pay more attention to women with high BMI before pregnancy, and value placenta pathology research on hypertensive disorders in pregnant women. This has high clinical significance in revealing the etiology of hypertensive disorders in pregnant women and improving pregnant outcomes.