妊娠期血脂生理性变化趋势及正常参考值研究

Rescarch on normal reference values of blood lipid levels in pregnancy

目的探讨孕期正常孕妇血脂变化趋势,初步建立妊娠期血脂正常参考值范围。方法运用前瞻性研究,选择2013年6月至2014年6月在重庆市涪陵区妇幼保健院产前检查并住院分娩的无合并症及并发症的492例孕妇作为研究对象,选择同期156例非孕健康体检妇女作为对照,建立孕妇血脂正常参考值范围。孕妇血脂采用酶法及免疫比浊法检测,参考值范围采用中位数及双侧限值表示。采用t检验研究其变化趋势。结果 （1）孕妇血脂水平在孕期随妊娠时间逐渐上升,至晚孕期达峰值,孕中期和孕晚期均明显高于早孕妇女和非妊娠妇女,差异有统计学意义（P〈0.05）,早孕与非妊娠妇女比较差异无统计学意义（P〉0.05）;晚孕期妇女胆固醇（TC）是非妊娠妇女的1.5倍,三酰甘油（TG）是非妊娠的4倍。（2）采用中位数及双侧限值表示孕期血脂参考值,其范围TC早孕3.20-6.93mmol/L、中孕3.04-8.83 mmol/L、晚孕3.54-9.83 mmol/L;TG早孕0.12-4.53 mmol/L、中孕0.17-5.30mmol/L、晚孕0.13-6.12mmol/L。结论孕妇血脂水平在孕期随妊娠时间逐渐上升,早、中、晚孕期之间存在明显差异,至晚孕期达峰值。建立正常孕妇早、中、晚孕期的血脂参考值范围有临床意义。

Objective To research the change trend of blood lipids during normal pregnancy for establishing the normal reference value ranges in normal pregnant women .Methods By using the prospective study ,492 normal pregnant women undergoing the prenatal examination and institutional delivery without cocurrent disease and compli‐cations in our hospital from June 2013 to June 2014 were selected and contemporaneous 156 non‐pregnant healthy women were selected as the controls for establishing the normal referencevalue ranges of blood lipids ,including TG , TC ,HDL ,LDL ,apo A ,apo B .The blood lipids of pregnant women were detected by adopting the enzymic method . The reference value range was expressed by median and two‐side limiting value .Its change trend wa sresearched by using t test .Results （1）The blood lipid levels during pregnancy in pregnant women were gradually increased with the gestational duration extending and reached the peak value till late pregnancy ,which in second trimester and late pregnancy were significantly higher than those in the early pregnant women and non‐pregnant women ,the differences were statistically significant （P〈0 .05） ,but there was no statistical difference between the early pregnant women and non‐pregnant women （P〉0 .05）;the cholesterol and triglyceride levels in late pregnant women were 1 .5 times and 4 times of which in non‐pregnant women respectively .（2）Using the median and bilateral limiting value for expressing the blood lipid reference value in pregnancy ,the range of cholesterol（TC）：3 .20 -6 .93 mmol/L in early pregnancy , 3 .04-8 .83 mmol/L in the second trimester of pregnancy and 3 .54 -9 .83 mmol/L in late pregnancy ;triglyceride （TG）：0 .12-4 .53 mmol/L in early pregnancy ,0 .17-5 .30 mmol/L in the second trimester of pregnancy and 0 .13-6 .12 mmol/L in late pregnancy .Conclusion The blood lipid levels during pregnancy pregnancy in pregnant women are gradually increased with the pregancy duration ,demonstrate the significant differences during early ,middle and late pregnancy and reach the peak value till late pregnancy .Establishing the reference value ranges of blood lipids in pregnant women has a clinical significance .