孕早期子宫动脉阻力指数联合血脂水平对妊娠期高血压疾病的预测价值

Value of uterine artery resistance index combined with blood lipid level in early pregnancy in predicting hypertensive disorders of pregnancy

目的探讨孕早期血清中的血脂水平联合B超测定子宫动脉阻力指数(UtA-RI)对妊娠期高血压疾病(HDP)发生的预测价值。方法选取2019年1月至2022年1月在江西省妇幼保健院建档分娩的320名孕早期孕妇为研究对象。根据孕妇是否发生HDP分为研究组(发生HDP,160例)和对照组(未发生HDP,160名)。检测两组孕妇孕11~13^(+6)周血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)及脂蛋白a(LPa),计算动脉粥样硬化指数等血脂比,同时应用彩色多普勒超声测定相应孕周的双侧UtA-RI,取平均值。比较两组孕妇血脂指标、血脂比值比及UtA-RI的差异。采用多因素logistic回归分析探讨孕早期HDP的影响因素,并结合ROC曲线的AUC对血脂水平联合UtA-RI预测HDP的效能进行评价。结果研究组孕妇的孕前BMI及剖宫产率高于对照组,终止妊娠孕龄短于对照组,新生儿出生体重低于对照组,差异有统计学意义(P<0.05)。在血脂水平方面,两组的TC和LPa水平比较,差异无统计学意义(P>0.05);研究组的TG、LDL、ApoA、ApoB水平高于对照组,HDL水平低于对照组,差异有统计学意义(P<0.05)。研究组的AI、TC/HDL、LDL/HDL、UtA-RI高于对照组,ApoB/ApoA低于对照组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,孕前BMI、HDL、LDL、ApoA、ApoB、AI、TC/HDL及UtA-RI是孕妇发生HDP的独立影响因素(OR>1,P<0.05)。ROC曲线结果显示,LDL、ApoA、AI、TC/HDL、LDL/HDL及UtA-RI对HDP具有较好的预测价值,其AUC值分别为0.876、1.000、0.840、0.840、0.773、0.596,血脂水平联合UtA-RI预测HDP的AUC为0.945,渐近95%CI为0.920~0.971。结论孕妇在孕早期行血清血脂水平联合超声UtA-RI检测,有助于及时发现HDP,对提高围生期质量、改善母儿结局意义重大。

Objective To investigate the predictive value of serum lipid level combined with uterine artery resistance index(UtA-RI)in pregnancy with hypertensive disorders of pregnancy(HDP).Methods A total of 320 pregnant women in the first trimester treated in Jiangxi Maternal and Child Health Care Hospital from January 2019 to January 2022 were selected as the study subjects.According to whether pregnant women developed HDP,they were divided into study group(HDP,160 cases)and control group(non-HDP,160 cases).Serum total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),apolipoprotein A(ApoA),apolipoprotein B(ApoB)and lipoprotein A(LPa)of pregnant women in the two groups were detected at weeks of pregnancy 11~13^(+6),and the atherosclerosis index and other lipid ratios were calculated.Meanwhile,bilateral UtA-RI of corresponding gestational weeks were measured by color Doppler ultrasound,and the average value was taken.The difference of blood lipid index,blood lipid ratio and UTA-RI was compared between the two groups.Multivariate logistic regression analysis was used to explore the influencing factors of HDP in the first trimester,and AUC of ROC curve was used to evaluate the prediction efficacy of HDP by lipid level combined with UtA-RI.Results The pre-pregnancy BMI and cesarean section rate of pregnant women in the study group were higher than those in the control group,the gestational age of termination of pregnancy was shorter than that in the control group,and the birth weight of newborns was lower than that in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the levels of TC and LPa between the two groups(P>0.05).The levels of TG,LDL,ApoA and ApoB in the study group were higher than those in the control group,and the level of HDL was lower than that in the control group,and the differences were statistically significant(P<0.05).AI,TC/HDL,LDL/HDL,UtA-RI in the study group were higher than those in the control group,and ApoB/ApoA was lower than that in the control group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that pre-pregnancy BMI,HDL,LDL,ApoA,ApoB,AI,TC/HDL and UtA-RI were independent influencing factors of HDP in pregnant women(OR>1,P<0.05).The results of ROC curve showed that LDL,ApoA,AI,TC/HDL,LDL/HDL and UTA-RI had good predictive value for HDP,and their AUC values were 0.876,1.000,0.840,0.840,0.773 and 0.596,respectively.Serum lipid levels combined with UtA-RI predicted an AUC of 0.945 for HDP,with an asymptotic 95%CI 0.920-0.971.Conclusion The detection of serum lipid level in pregnant women combined with ultrasound UtA-RI in the early stage of pregnancy is helpful for the timely detection of HDP,which is of great significance to improve the peripartum quality and maternal and infant outcomes.