武汉地区妊娠中期孕妇血清生化学指标检测结果分析

Analysis of serum biochemical indexes of the pregnant women during midtrimester of pregnancy in Wuhan

目的了解孕中期孕妇生化指标的变化情况,同时分析孕中期孕妇血清中的生化指标和胎儿生长发育的相关性。方法选取2015年7月1日至2016年12月31日在湖北省中医院做产前检查的1007例正常孕中期孕妇作为研究组,85例非正常孕中期孕妇作为观察组;选取同期至湖北省中医院健康体检中心体检的1053例正常非妊娠育龄期妇女作为健康对照组,调查收集不同孕期人群的临床资料,测定血清中丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、尿素(UREA)、肌酐(CR)、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、高密度脂蛋白胆固醇(LDL-C)。比较研究组与对照组、研究组与观察组孕妇之间各生化指标的差异,并制定相应的参考范围;比较观察组孕妇治疗前后生化指标的差异;同时利用Pearson或Spearman分析孕妇血清中的生化指标与胎儿双顶径之间的相关性。结果研究组与对照组孕妇除了AST、LDL-C(P>0.05)外,其他生化指标组间比较差异均有显著统计学意义(P<0.01);研究组与观察组除ALT、PA(P>0.05)外,其他生化指标间组间比较差异均有统计学意义(P<0.05);研究组孕妇按照孕周的不同分为3组,组间各生化指标比较差异均无统计学意义(P>0.05);研究组孕妇按照年龄的不同分为4组,不同年龄组间的AST、GGT、ALB、PA、TG比较差异均有统计学意义(P<0.05);制定武汉地区孕中期孕妇血清中生化指标的参考范围,ALT、AST、GGT、ALP、TP、ALB、PA、UREA、CR、UA、TC、TG、HDL-C的各项指标的参考范围分别是5~53 U/L、9~42 U/L、5~30 U/L、29~69 U/L、61.1~79.9 g/L、35.2~44.4 g/L、17.3~29.17 mg/dL、1.5~3.9 mmol/L、32~54μmol/L、144~330μmol/L、3.45~6.54 mmol/L、1.01~3.41 mmol/L、1.22~2.62 mmol/L;AST、GGT、ALB、PA、TG指标根据年龄的不同分别建立相应的参考区间;孕中期孕妇血清中TP、ALB、TC、LDL-C与胎儿双顶径相关(P<0.01);观察组应用孕中期生化指标的参考范围后,临床医生及时给予对症治疗,除ALP、HDL-C外,其他指标与治疗前比较均有明显好转,差异均有统计学意义(P<0.05)。结论孕中期孕妇血清中生化指标与非妊娠育龄期妇女比较有显著性差异,不同的年龄段之间也存在差异;应制定相应的参考范围,有利于临床医生给予针对性的孕期健康指导和干预,及时发现并治疗妊娠期发生的合并症,保证母婴的健康和平安。

Objective To understand the changes of biochemical indexes in midtrimester of pregnancy,and analyze the correlation between serum biochemical indexes and fetal growth and development in the midtrimester of pregnancy.Methods From July 1,2015 to December 31,2016,a total of 1007 pregnant women in midtrimester of pregnancy who have prenatal care at Hubei Provincial Hospital of Traditional Chinese Medicine were recruited as the experimental group in our study.For comparison,85 hospitalized abnormal pregnant females during midtrimester of pregnancy were selected as the observation group and 1053 normal non-pregnant females of childbearing age were also recruited as the healthy control group.The demographic data of the different pregnant groups were collected.The alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyltransferase(GGT),alkaline phosphatase(ALP),total protein(TP),albumin(ALB),pre-albumin(PA),urea(UREA),creatinine(CR),uric acid(UA),triglyceride(TG),total cholestrol(TC),high density lipoprotein cholesterol(HDL-C),and low density lipoprotein cholesterol(LDL-C)of the different pregnant groups are detected.The corresponding reference ranges were established for biochemical indexes by comparing the differences between the experimental group and the control group,then the experimental group and the observation group.The biochemical indexes before and after treatment were compared in the observation group,and the correlation between biochemical indexes and biparietal diameter(BPD)was evaluated by Pearson or Spearman correlation analysis.Results The serum biochemical indexes(except LDL-C and AST,P>0.05)of pregnant women during the midtrimester are significantly different from the indexes of non-pregnant women of childbearing age(P<0.01).The biochemical indexes(except ALT and PA,P>0.05)of healthy pregnant women during the midtrimester are significantly different from the indexes of abnormal pregnant women during the midtrimester(P<0.05).There are no significant differences in biochemical indexes among groups in the different gestational period(P>0.05).The AST,GGT,ALB,PA,and TG of the four groups with different age are significantly different(P<0.05).However,there are no statistical differences found in other biochemical indexes.The reference ranges for the serum biochemical indexes of pregnant women during the midtrimester in Wuhan were established:ALT 5-53 U/L,AST 9-42 U/L,GGT 5-30 U/L,ALP 29-69 U/L,TP 61.1-79.9 g/L,ALB 35.2-44.4 g/L,PA 17.3-29.17 mg/dL,UREA 1.5-3.9 mmol/L,CR 32-54μmol/L,UA 144-330μmol/L,TC 3.45-6.54 mmol/L,TG 1.01-3.41 mmol/L,and HDL-C 1.22-2.62 mmol/L.And,the corresponding reference ranges for AST,GGT,ALB,PA and TG are subject to age variations.The fetal biparietal diameter was significantly correlated to TP,ALB,TC,and LDL-C in pregnant women during the midtrimester(P<0.01).Except for ALP and HDL-C,other indexes of abnormal pregnant women during the midtrimester improve better after clinicians’treatments that use above reference ranges.Conclusion There are significant differences in serum biochemical indexes between pregnant women during midtrimester of pregnancy and non-pregnant childbearing age women,and also in different age variations.Therefore,we should establish the corresponding reference ranges for the specific population,which are helpful for clinicians to provide precision health guidance and intervention,identify and treat the complications of pregnancy,and ensure the health and safety of mothers and babies.