妊娠早期胆汁酸代谢产物与超重之间的关联研究

Study of association between bile acid metabolites in early pregnancy and overweight

目的探讨妊娠早期胆汁酸代谢水平与超重之间可能存在的关联。方法2010年至2012年,天津市妇女儿童保健中心面向市城区搜集了22302名孕妇资料,随后选取其中有孕早期血样的妊娠期糖尿病孕妇243例及年龄特征匹配的非妊娠期糖尿病孕妇243名,建立了以妊娠期糖尿病为目标疾病的巢式病例对照研究。借助该研究人群,本课题以超重为研究目标进行分组,获得超重组(体重指数≥24.0 kg/m^(2))166例,非超重组(体重指数<24.0 kg/m^(2))320例;运用logistic回归方法进行胆汁酸代谢水平与超重关联的评价。结果超重组中初级游离型胆汁酸水平高于非超重组,差异有统计学意义。经调整多种混杂因素后,与低水平人群相比,血清胆酸(cholic acid,CA)水平>0.086 nmol/mL时超重的OR值为2.09(95%CI 1.14~3.80,校正后P=0.040);血清鹅脱氧胆酸(chenodeoxycholic acid,CDCA)水平>0.043 nmol/mL时超重的OR值为2.15(95%CI 1.22~3.78,校正后P=0.040),其余胆汁酸水平与超重关联无统计学意义。通过逐步回归对各胆汁酸进行筛选,发现CA可能与超重的发生独立相关;与低水平(CA≤0.086 nmol/mL)人群相比较,当CA>0.086 nmol/mL时,超重的OR值为2.03(95%CI 1.11~3.74,P=0.022)。结论妊娠早期血清CA和CDCA的代谢水平可能与超重发生相关,其中CA与超重的关联可能具有独立性。

Objective This study examined the associations between the levels of bile acids in early pregnancy and the occurrence of overweight.Methods From 2010 to 2012,22302 pregnant women were recruited by Tianjin Women and Children′s Health Center to investigate gestational diabetes.Two hundred and forty-three women with gestational diabetes mellitus provided overnight fasting blood samples in the first trimester,and 243 counterparts without gestational diabetes mellitus matched on age were selected randomly to establish a nested case-control study.The association between bile acids and overweight were evaluated by binary logistic regression with data from 166 overweight pregnant women(body mass index≥24.0 kg/m^(2))and 320 normal weight subjects(body mass index<24.0 kg/m^(2)).Results Compared to non-overweight group,the level of primary unconjugated bile acids in overweight group was significantly higher.After adjustment of confounding factors,the OR of cholic acid(CA)>0.086 nmol/mL for overweight was 2.09(95%CI 1.14-3.80,adjusted P=0.040),and OR of chenodeoxycholic acid(CDCA)>0.043 nmol/mL was 2.15(95%CI 1.22-3.78,adjusted P=0.040)compared with the lower groups.However,the significant associations between the other bile acids and overweight were not detected.Stepwise selection was used to identify significant bile acid species in logistic regression.We found that only CA was independently associated with overweight,and the OR of CA>0.086 nmol/mL vs≤0.086 nmol/mL was 2.03(95%CI 1.11-3.74,P=0.022).Conclusion CA and CDCA in early pregnancy maybe associated with overweight,and CA might be independently associated with overweight.