妊娠中期血脂异常与妊娠结局的相关性研究

Study on the relationship between hyperlipidemia of in the second trimester of pregnancy and pregnancy outcome

目的探讨孕中期不同血脂指标异常及异常项数与不良妊娠结局的相关性。方法回顾性分析2018年1月至2019年12月在东部战区总医院妇产科建卡产检和分娩的650例单胎孕妇的临床资料。根据孕中期血脂4项检查结果分为2组:血脂正常组(308例)和血脂异常组(342例,其中242例只有1项血脂指标异常,62例有2项血脂指标异常,38例存在3项及以上血脂指标异常)。比较2组孕妇的基本临床资料、妊娠期糖尿病(GDM)、巨大儿等妊娠期并发症及不良妊娠结局发生情况。采用Logistic回归模型分析确定不良妊娠结局发生的独立危险因素,通过受试者工作曲线分析其预测不良妊娠结局的价值。结果血脂异常组较血脂正常组的年龄[(30.15±4.49)岁vs(29.27±4.07)岁]、孕期BMI增幅[(5.61±1.54)kg/m^2 vs(5.31±1.87)kg/m^2]、不良妊娠结局发生率(48.5%vs 39.61%)均增高(P<0.05)。血脂异常组与血脂正常组GDM和巨大儿的发生率分别为22.22%vs 13.64%、15.21%vs 7.14%,差异均有统计学意义(P<0.05);孕中期总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)异常均增加GDM和巨大儿的发病风险;LDL-C是巨大儿发生的独立危险因素(OR值2.06,95%CI为1.04~4.08,P<0.01),且受试者工作曲线证实LDL-C>3.43 mmol/L可作为孕中期有效预测巨大儿的血清指标(P<0.05)。血脂异常项数越多,GDM、巨大儿、早产及胎膜早破等发病率越高;≥3项血脂指标同时异常是导致不良妊娠结局的独立危险因素,其OR值为4.84,95%CI为1.87~12.50(P<0.01)。结论妊娠中期脂代谢异常会增加不良妊娠结局发生率,且血脂指标异常项数越多,不良妊娠结局的发生风险越高。

Objective To investigate the correlation between the abnormal blood lipid index and the number of abnormal items in the second trimester and the pregnancy outcome.Methods From January 2018 to December 2019,650 pregnant women for antenatal examination and delivery in the gynecology and obstetrics of our hospital were enrolled.Grouped According to the results of 4 tests of middle pregnancy blood lipids,all patients were divided into 2 groups,including normal blood lipid group(308 cases)and dyslipidemia group(342 cases,including 242 cases with only one dyslipidemia index,62 cases with two dyslipidemia indexes,38 cases with three or more dyslipidemia indexes).Gestational diabetes mellitus(GDM),macrosomia and other complications of pregnancy and the occurrence of adverse pregnancy were analyzed in each group.Logistic regression model was used to analyze the independent risk factors of the adverse pregnancy outcome.The value of predicting the adverse pregnancy outcome was analyzed by the ROC curve of the subjects.Results The age of dyslipidemia group[(30.15±4.49)years old vs(29.27±4.07)years old],BMI increase during pregnancy[(5.61±1.54)kg/m^2 vs(5.31±1.87)kg/m^2]and incidence of adverse pregnancy outcomes(48.5%vs 39.61%)were higher than those in normal group.The incidence of GDM and macrosomia(22.22%,13.64%)was significantly higher than that in the normal group(15.21%,7.14%,P<0.05).The abnormal increase of TC,TG and LDL-C during pregnancy were increased the risk of GDM and macrosomia.LDL-C was an independent risk factor for the occurrence of macrosomia(OR=2.06,95%CI 1.04-4.08,P<0.01).The ROC curve of the subjects confirmed that LDL-C>3.43 mmol/L could act as a serum index to effectively predict macrosomia(P<0.05).The higher the number of dyslipidemia items,the higher the incidence of GDM,macrosomia,premature delivery and premature rupture of membranes and≥three indexes of dyslipidemia at the same time were independent risk factors leading to adverse pregnancy outcomes(OR values 4.84,95%CI 1.87-12.50,P<0.01).Conclusion Abnormal lipid metabolism in the middle of pregnancy will increase the incidence of adverse pregnancy outcomes and the more abnormal items of blood lipid indicators,the higher the risk of adverse pregnancy outcomes.