妊娠期高血压疾病与血脂、ApoA1及Hcy水平的相关性分析

Correlation analysis of HDCP and blood lipid,ApoA1 and Hcy levels

目的分析不同严重程度妊娠期高血压疾病(HDCP)孕妇血脂、载脂蛋白A1(ApoA1)及同型半胱氨酸(Hcy)水平变化。方法选择2017年1月至2017年6月杭州市余杭区第一人民医院收治的73例HDCP孕妇为病例组,根据其病情的严重程度分为轻度组(34例),重度组(39例)。另同期选取该院50例健康孕妇为对照组,比较各组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、Hcy及ApoA1的水平,并分析上述指标与HDCP疾病严重程度的相关性。结果病例组TC、LDL-C、HDL-C及ApoA1与对照组比较,均无显著性差异(t值分别为1.21、0.73、0.71、0.20,均P>0.05),而病例组TG和Hcy水平较对照组均显著升高(t值分别为4.73、5.32,均P<0.05)。轻度组TG、TC、LDL-C、HDL-C、ApoA1及Hcy水平与对照组比较均无显著性差异(t值分别为0.97、0.13、0.58、0.17、0.20、0.26,均P>0.05)。重度组TC、LDL-C及Hcy水平较轻度组、对照组均显著升高(t值分别为3.15、3.65、10.54、2.78、2.56、9.89,均P<0.05)。经Pearson相关性分析结果发现,HDCP患者TC(r值分别为:0.36、0.39)、LDL-C(r值分别为:0.41、0.48)和Hcy(r值分别为0.39、0.33)水平与其疾病的严重程度均存在显著关系(均P<0.05)。经Logistic回归分析结果发现,TC水平与妊娠期高血压(OR=1.24,95%CI:1.09~3.34)、子痫前期(OR=1.19,95%CI:1.11~6.57)、分娩巨大儿(新生儿出生体重≥4 000g)(OR=2.01,95%CI:1.56~8.79)均密切相关(均P<0.05);TG水平与子痫前期(OR=1.54,95%CI:1.14~3.05)、分娩低出生体重儿(新生儿出生体重≤2 500g)(OR=1.42,95%CI:1.12~6.09)均密切相关(均P<0.05);LDL-C水平与妊娠期高血压(OR=2.43,95%CI:1.05~9.89)、新生儿窒息(新生儿出生后1分钟Apgar评分≤7分)(OR=0.49,95%CI:0.25~0.98)均密切相关(均P<0.05);HDL-C与子痫前期(OR=0.13,95%CI:0.05~0.79)、分娩低出生体重儿(OR=0.65,95%CI:0.35~0.94)均密切相关(均P<0.05)。结论 HDCP尤其是重度患者TC、LDL-C和Hcy水平显著上升,其与疾病的严重程度均呈现密切联系,故在评估HDCP患者疾病严重程度上具有较高的预测价值,因此在临床上应密切检测妊娠期血脂及Hcy等指标的情况。

Objective To analyze the changes of serum lipids, apolipoprotein A1 （ApoA1） and homocysteine （Hcy） levels in pregnant women with different severity of hypertensive disorder complicating pregnancy （HDCP）. Methods A total of 73 pregnant women with HDCP in the First People＇s Hospital of Yuhang District in Hangzhou City from January to June 2017 were selected as case group. According to the severity of disease, these cases were divided into mild group （34 cases） and severe group （39 cases）. At the same period 50 cases of healthy pregnant women were selected as control group. The triglyceride （TG）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDLC）, Hcy and ApoA1 levels were compared among those groups, and the correlation between those indexes and the severity of HDCP was analyzed. Results There were no significant differences in TC, LDL-C, HDLC and ApoA1 between the case group and the control group （t value was 1.21, 0.73, 0.71 and 0.20, respectively, all P〉0.05）, while the levels of TG and Hey in the case group were significantly higher than those in the control group （t value was 4.73 and 5.32, respectively, both P〈0.05）. The levels of TG, TC, LDL-C, HDL-C, ApoA1 and Hcy in the mild group showed no significant difference in comparison of the control group （t value was 0.97, 0.13, 0.58, 0.17, 0.20 and 0.26, respectively, all P〉0.05）. The levels of TC, LDL-C and Hcy in the severe group were significantly higher than those in the mild group and in the control group （t value was 3.15, 3.65, 10.54, 2.78, 2.56 and 9.89, respectively, all P〈0.05）. The results of Pearson correlation analysis showed that the levels of TC （r value was 0.36 and 0.39, respectively）, LDL-C （r value was 0.41 and 0.48, respectively） and Hcy （r value was 0.39 and 0.33, respectively） in patients with HDCP were significantly correlated with the severity of the disease （all P〈0.05）. The results of Logistic regression analysis found that the level of TC was closely correlated with the gestational hypertension （OR=1.24, 95%CI： 1.09 3.34）, preeclampsia （OR=1.19, 95%CI ： 1.11-6.57）, fetal macrosomia （neonatal birth weight ≥ 4 000 g） （OR 2.01, 95%CI.. 1.56-8.79） （all P〈0.05）, and that the level of TG was closely correlated with preeclampsia （OR = 1.54, 95 %CI ： 1.14 - 3.05） and low birth weight infants （neonatal birth weight 〈 2 500g） （OR=1.42, 95%CI： 1.12-6.09） （both P〈0.05）. The level of LDL-C was closely correlated with the pregnancy induced hypertension （OR =2.43, 95%CI ： 1.05-9.89） and neonatal asphyxia （Apgar score of ≤ 7 points at 1 minute after birth） （0R=0.49, 95%CI： 0.25-0.98） （both P%0.05）, and HDLC level was closely correlated with preeclampsia （OR=0.13, 95%CI： 0.05-0.79） and low birth weight infants （OR-0.65, 95%CI： 0.35-0.94） （both P〈0.05）. Conclusion The TC, LDL-C and Hcy levels significantly increase in pregnant women with HDCP, especially severe patients, and they are closely correlated with the severity of the disease, which has higher predictive value in severity assessment for patients with HDCP, so blood lipids, Hcy and other indexes should be closely monitored during pregnancy in clinics.