非高密度脂蛋白在妊娠期高血压和子痫前期的变化及预测价值

The change and clinical significance of non-high density lipoprotein level of pregnant women with gestational hypertension or preeclampsia

目的:研究非高密度脂蛋白(non-HDL-C)在妊娠高血压及子痫前期的变化及其临床意义。方法:本院2016年-2017年分娩孕妇,正常组218例、妊娠期高血压组99例、轻度子痫前期69例、早发型重度子痫前期52例、晚发型重度子痫前期148例。收集孕妇资料及血脂指标,计算non-HDL-C,分析总胆固醇(TC)、甘油三酯(TG)、non-HDL-C、低密度酯蛋白(LDL-C)、酯蛋白a(LPa)、载酯蛋白A(APOA)及载酯蛋白B(APOB)与收缩压及舒张的相关性,妊娠期高血压及子痫前期相关因素。采用ROC曲线分析法判断non-HDL-C对妊娠期高血压及子痫前期的适宜切点。结果:5组间TC、TG、non-HDL-C、LDL-C、LPa及APOB水平有差异(P<0.05)。多元回归分析,non-HDL-C与收缩压呈正相关,TG、TC、non-HDL-C与舒张压呈正相关(均P<0.05),non-HDL-C是妊娠期高血压及子痫前期的高危因素。ROC曲线non-HDL-C对妊娠期高血压及子痫前期的适宜切点值为4.89mmol/L。结论:non-HDL-C是妊娠期高血压及子痫前期发生的独立危险因素,当>4.89mmol/L时应警惕妊娠高血压及子痫前期的发生,提前干预改善妊娠结局。

Objective:To study the change and clinical significance of non-high density lipoprotein-cholesterol(non-HDL-C)level of pregnant women with gestational hypertension or preeclampsia.Methods:From 2016 to 2017,218 normol pregnant women were selected in group A,99 pregnant women with gestational hypertension were included in group B,69 pregnant women with mild preeclampsia were included in group C,52 pregnant women with late onset severe preeclampsia were included in group D,and 148 pregnant women with early onset severe preeclampsia were included in group E.The general information and blood lipids index of women in the five groups were collected.The value of total cholesterol–high densitylipoprotein was calculated.And the correlation between the levels of TC,TG,LDL-C,non-HDL-C,LPa,APOA and APOB,and the value of systolic blood pressure and diastolic blood pressure were anlyzed.The related factors of gestational hypertension and preeclampsia were analyzed.ROC curve analysis was used to determine the appropriate pointcut of non-HDL-C for predicting gestational hypertension and preeclampsia.Results:There were significant difference in the levels of TG,TC,non-HDL-C,LDL-C,LPa APOA and APOB of women among the five groups(P<0.05).Multiple regression analysis showed that non-HDL-C level was positively correlated with value of systolic blood pressure,and the levels of TG and TC were positively correlated with value of diastolic blood pressure(all P<0.05).The non-HDL-C level was a high risk factor of gestational hypertension or preeclampsia.ROC curve analysis showed that the appropriate cut-off value of non-HDL-C level for predicting gestational hypertension or preeclampsia by ROC curve was 4.89mmol/L.Conclusion:Non-HDL-C is an independent risk factor of gestational hypertension and preeclampsia occurence.When the level of non-HDL-C of women exceed 4.89mmol/L,it should be alert to the occurrence of gestational hypertension or preeclampsia,so intervention should be done in advance for improving pregnancy outcomes of pregnant women with gestational hypertension or preeclampsia.