妊娠高血压与胰岛素抵抗、血脂代谢和D-二聚体关系

Relationship between gestational hypertension and insulin resistance,blood lipid metabolism and D-dimer

目的探讨妊娠高血压与胰岛素抵抗、血脂代谢和D-二聚体的关系。方法选取2015年1月至2018年12月安徽医科大学第四附属医院与亳州市人民医院收治的120例妊娠高血压孕妇纳入观察组,并进一步将其分为轻度妊娠高血压组(42例)、子痫前期组(47例)、子痫组(31例)3个亚组;选取同期于安徽医科大学第四附属医院与亳州市人民医院产检的100例健康孕妇纳入对照组,比较两组孕妇和3个亚组孕妇一般临床资料、血脂指标、胰岛素抵抗和D-二聚体水平。采用Pearson相关分析妊娠高血压与血脂、D-二聚体水平及胰岛素抵抗的相关性。结果观察组孕妇收缩压、舒张压、平均动脉压、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、D-二聚体水平、稳态模型评估的胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)指数均显著高于对照组(均P<0.05),高密度脂蛋白(high density lipoprotein,HDL)水平、稳态模型评估的胰岛β细胞功能(homeostasis model assessment-βcell function,HOMA-β)和Matsuda指数均显著低于对照组(均P<0.05);3个亚组孕妇TC、TG、LDL、HDL、D-二聚体水平及HOMA-IR指数、HOMA-β、Matsuda指数比较差异均有统计学意义(均P<0.05)。Pearson相关性分析结果显示,妊娠高血压的严重程度与TC、TG、LDL、D-二聚体水平及HOMA-IR指数均呈正相关(r=0.201、0.257、0.230、0.262、0.257,均P<0.05),与HDL水平、HOMA-β、Matsuda指数均呈负相关(r=-0.242、-0.231、-0.240,均P<0.05)。结论妊娠高血压与血脂代谢紊乱、胰岛素抵抗和D-二聚体水平关系密切,以上指标对评估妊娠高血压严重程度有一定参考意义。

Objective To investigate the relationship between gestational hypertension and insulin resistance,blood lipid metabolism,and D-dimer.Method A total of 120 pregnant women with gestational hypertension admitted to the Fourth Affiliated Hospital of Anhui Medical University and Bozhou People's Hospital from January 2015 to December 2018 were included in observation group,and further divided into mild gestational hypertension group(42 cases),preeclampsia group(47 cases),and eclampsia group(31 cases).A total of 100 healthy pregnant women in the Fourth Affiliated Hospital of Anhui Medical University and Bozhou People's Hospital during the same period were included in control group.The general clinical data,blood lipid indicators,insulin resistance and D-dimer levels of pregnant women in 2 groups and 3 subgroups were compared.The correlation between gestational hypertension and blood lipid indicators,D-dimer level and insulin resistance were analyzed by Pearson method.Result Systolic blood pressure,diastolic blood pressure,mean arterial pressure,total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),D-dimer and homeostasis model assessment of insulin resistance(HOMA-IR)in observation group were significantly higher than those in control group(all P<0.05),high density lipoprotein(HDL),homeostasis model assessment-βcell function(HOMA-β)and Matsuda index were significantly lower than those in control group(all P<0.05).The levels of TC,TG,LDL,HDL,D-dimer and HOMA-IR index,HOMA-βand Matsuda index of pregnant women in 3 subgroups were statistically significant(all P<0.05).Pearson correlation analysis showed that the severity of gestational hypertension was positively correlated with the levels of TC,TG,LDL,D-dimer and HOMA-IR index(r=0.201,0.257,0.230,0.262,0.257,all P<0.05),while negatively correlated with HDL level,HOMA-βand Matsuda index(r=-0.242,-0.231,-0.240,all P<0.05).Conclusion Gestational hypertension is closely related to dyslipidemia,insulin resistance and D-dimer levels.These indicators have certain reference significance for evaluating the severity of gestational hypertension.