妊娠中、晚期孕妇血脂水平的检测及其正常参考值区间的建立

Analysis of serum lipids levels and the establishment of reference intervals for serum lipids in middle and late pregnancy

目的通过检测健康孕妇在妊娠中、晚期时的血脂水平，建立妊娠中、晚期孕妇的血脂水平正常参考值区间。方法收集2014年1月-2015年2月复旦大学附属妇产科医院产科分娩的3200例健康孕妇为健康妊娠组，同时收集3200例健康育龄期妇女作为健康对照组。采用日立7180型全自动生化分析仪检测两组妇女血清中甘油三酯（TG）、总胆固醇（TCH）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白A（APO．A）和载脂蛋白B（APO—B）水平；其中健康妊娠组孕妇分别在孕14—20周、24—28周、37—40周进行检测。将检测结果按全国临床和实验室标准化研究院制定的C28．A3标准，计算并确定妊娠中、晚期孕妇血脂水平正常参考值区间，即百分数范围为2．5％-97．5％时的血脂水平。结果（1）血脂水平：健康对照组妇女血清TG、TCH、HDL、LDL、APO．A和APO．B水平的中位数分别为0．8、4．2、1．0、2,7mmol／L和1．1、0．8g／L，健康妊娠组孕妇不同孕周TG、TCH、HDL、LDL、APO．A和APO．B水平均高于健康对照组，两组比较，差异均有统计学意义（P〈0．05）。（2）健康妊娠组孕妇血脂水平在孕14—20周、24～28周、37～40周分别与健康对照组比较：TG水平升高1．9、3．8和4．4倍，TCH水平升高1．1、1．5和1．5倍，HDL水平升高1．2、1．6和1．5倍，LDL水平升高1．1、1．4和1．4倍，APO—A水平升高1．3、1．4和1．5倍，APO—B水平升高1．1、1．5和1．5倍。其中TG水平的升高幅度最大，并随孕周进展逐渐升高（P〈0．01）。（3）健康妊娠组孕妇血清LDL／HDL比值的中位数在孕14～20周为2．7、孕24—28周为2．5、孕37～40周为2．6。与健康对照组的2．8比较，健康妊娠组妊娠中、晚期孕妇血清LDL／HDL比值有不同程度的降低，两组比较，差异均有统计学意义（P〈0．05）。（4）健康妊娠组孕妇孕14～20周、24—28周、37—40周的血脂水平正常参考值区间计算结果TG分别为0．7—3．9、1．7—6-3及1．6—8．1mmol／L，TCH分别为3．3～6．9、4．3—8．3及4．3—8．7mmol/L，HDL分别为0．8—1．8、1．0—2．1及1．0—2．1mmol／L，LDL分别为2．1～4．5、2．7～5．1及2．6～5．2mmol／L，APO—A分别为1．1-1．8、1．2、1．9及1．1。2．4g／L，APO．B分别为0．6～1．4、0．9～1．8及0．8～2．1g／L，各指标随妊娠进展出现不同程度的生理性升高；LDL／HDL比值分别为2．3～3．1、2．2～2．9及2．1—3．0，呈逐渐下降的趋势。结论妊娠中、晚期孕妇血脂水平随妊娠进展出现不同程度的生理性升高；针对妊娠中、晚期孕妇血脂水平不同于非孕妇女的特殊性，建立血脂水平正常参考值区间能够为临床准确评估孕妇血脂水平异常提供重要参考依据。

Objective To explore the serum lipids levels in healthy pregnant women, and to establish the reference intervals of serum lipids in middle and late pregnancy. Methods Triglyceride （TG）, total cholesterol （TCH）, high density lipoprotein （HDL）, low density lipoprotein （LDL）, apo-lipoprotein-A （APO-A） and apo-lipoprotein-B （APO-B） were measured in 3 200 pregnant women and 3 200 healthy women of childbearing age（the control group） from January 2014 to Febuary 2015 in Obstetrics and Gynecology Hospital of Fudan University. In the healthy pregnant women, serum lipids were measured at 14-20, 24- 28 and 37-40 gestational weeks, respectively. All the parameters were detected by Hitachi 7180 automatic biochemical analyzer. The test results were calculated and determined by the C28-A3 standard of the National Clinical and Laboratory Standards Institute. And the normal reference intervals of serum lipids in middle and late pregnancy were defined as 2.5%-97.5%. Results （1） The levels of TG, TCH, HDL, LDL, APO-A and APO-B in the control group were 0.8, 4.2, 1.0, 2.7 mmol/L and 1.1, 0.8 g/L, respectively. The levels of TG, TCH, HDL, LDL, APO-A and APO-B in middle and late pregnancy were significantly higher than those in the control group （P〈0.05）. （2） The serum lipids levels at 14-20, 24-28 and 37-40 gestational weeks in healthy pregnant women were compared with the control group as following. The TG levels were 1.9, 3.8 and 4.4 folds of the control group; the TCH levels were 1.1, 1.5 and 1.5 folds of the control group; the HDL levels were 1.2, 1.6 and 1.5 folds of the control group; the LDL levels were 1.1, 1.4 and 1.4 folds of the control group; the APO-A levels were 1.3, 1.4 and 1.5 folds of the control group; and the APO-B levels were 1.1, 1.5 and 1.5 fold of the control group respectively. The TG level was the most increased, and it increased gradually with gestational age （P〈0.01）. （3） The median of LDL to HDL cholesterol ratio in the healthy pregnancy group at 14-20, 24-28 and 37-40 gestational weeks were 2.7, 2.5, 2.6, respectively, which were significantly lower than that of the control group （2.8; P〈0.05）. （4） Reference intervals of serum lipids at 14-20, 24-28 and 37-40 gestational weeks in healthy pregnant women were as following. The TG levels were 0.7-3.9, 1.7-6.3 and 1.6-8.1 mmol/L, respectively; the TCH were 3.3-6.9, 4.3-8.3, 4.3- 8.7 mmol/L, respectively; the HDL were 0.8-1.8, 1.0-2.1 and 1.0-2.1 retool/L, respectively; the LDL were 2.1-4.5, 2.7-5.1 and 2.6-5.2 retool/L, respectively; the APO-A were 1.1-1.8, 1.2-1.9 and 1.1-2.4 g/L, respectively; and the APO-B were 0.6-1.4, 0.9-1.8 and 0.8-2.1 g/L, respectively. The LDL/HDL ratios were 2.3-3.1, 2.2-2.9 and 2.1-3.0, respectively. Conclusions Serum lipids increased physiologically with gestational age in middle and late pregnancy. The establishment of reference intervals for serum lipids in Dreznancv will held to distinguish abnormal serum lipid levels in middle and late pregnancy.