妊娠期女性血脂变化特点

The change characteristics of lipids in normal pregnancy women

目的 探讨正常妊娠女性血脂的动态变化特点。方法回顾性分析2015年1月1日至12月31日本院收治的771例正常妊娠孕妇的临床资料,同时选取同期本院妇科住院患者100例作为对照。收集产妇的年龄、身高、非孕期体重、孕晚期体重,孕早期(12^(+6)周前)、孕中期(13～27^(+6)周)、孕晚期(≥28周)的血脂(总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、载脂蛋白A、载脂蛋白B、脂蛋白a)测定结果。对血脂与体重、体重指数(body mass index,BMI)等因素的关系进行分析。结果①与正常非孕期女性相比,妊娠女性的血脂在孕早期即发生明显改变,表现为总胆固醇、低密度脂蛋白、载脂蛋白B下降(P均<0.05),甘油三脂、高密度脂蛋白、载脂蛋白A明显升高(P均<0.05),而脂蛋白a无明显变化(P>0.05)。②正常妊娠女性孕早、中、晚期血脂指标除脂蛋白a外(P=0.1399),其余均明显升高(各组指标经方差分析比较,P均<0.001),其中甘油三酯增加最为明显,孕晚期甘油三酯较孕早期增加3倍,而具有保护作用的载脂蛋白A/载脂蛋白B在孕晚期明显下降。③在孕早期,总胆固醇、甘油三酯、低密度脂蛋白、载脂蛋白B均与体重、体重指数及孕周呈正性相关(P<0.01),而除甘油三酯与年龄相关外,其余血脂指标与年龄、身高无相关性。在孕晚期,血脂仍受非孕期体重、BMI以及孕周影响,且大多数血脂增长程度(除高密度脂蛋白与载脂蛋白A)与早孕期体重、BMI均呈负性相关。体重增长的程度对血脂变化影响不大。结论正常妊娠女性自孕早期出现明显血脂变化,随孕周增加血脂呈不同程度上升,其中以甘油三酯升高最为明显。血脂受非孕期体重、BMI、孕周影响较大,但其增长与孕期体重增长无明显相关。

Objective With increasing of pregnancy weeks, there is a significant change in metabolism, especially of the lipids. To find the lipids profile change characteristics of the normal women in different pregnancy weeks. Method Collected 771 normal pregnancy cases with normal delivery by virginal or Cesarean section in our hospital from 2015.1.1 to 2015.12.31. And collected the lipid profiles of 100 patients in gynecological department without complications as a control group.Tested the blood lipid profiles（cholesterol, triglyceride,high density lipoprotein, low density lipoprotein, Apo A, Apo B, and Lpa） of pregnancy women in early（before 12＋6 weeks）, mid（13～27＋6 weeks）, and late（after 28 weeks） pregnancy. Result ①Compared with non-pregnancy women, there were significant changes from early pregnancy, which indicated that triglyceride, low density lipoprotein（LDL） and Apo B decreased（P〈0.05）, and total cholesterol,high density lipoprotein（HDL） and Apo A increased significantly（P〈0.05）, while no significant change in Lpa（P〈0.05）. ②There was a significant raise of all blood lipids excepted Lpa（P=0.1399） from early to late pregnancy weeks（variance analysis of each index P0.001）, and triglycerides with 2,3 folds increased obviously. However, it was found that the protective effect of Apo A/Apo B decreased significantly during the third trimester of pregnancy. ③In first trimester, cholesterol, triglyceride, LDL and Apo B have positive relationship with weight of pregnancy, BMI and pregnant weeks. In addition to triglycerides, all the rest lipids have no relationship with age and height of pregnancy. In third trimester, the lipids are still affected by weight of early pregnancy, BMI and pregnant weeks, and which of them have negative relationship with the lipids growth（except HDL and Apo A）. There is no affection of lipids in third trimester and growth of lipids by gestational weight gain. Conclusion There is a significant change of blood lipids in normal pregnant women from early pregnancy, and the blood lipids are rising in different degree with the increase of gestational age, in which the raise of triglyceride is the most obvious. The blood lipids are affected by early gestational weight, BMI and pregnant weeks remarkably, but have no relationship with the gestational weight gain.