高海拔地区藏族孕产妇妊娠晚期脂代谢特点及其与妊娠结局相关性

Lipid metabolism in late pregnancy and its correlation with adverse perinatal outcome among Tibetan pregnant women in high altitudes

目的探讨高海拔地区藏族孕产妇妊娠晚期脂代谢水平及其与妊娠结局的相关性。方法回顾性分析2021年1月至2022年4月在西藏自治区昌都市察雅县人民医院住院分娩的523例藏族单胎妊娠孕产妇临床和实验室检查资料。根据研究对象长期居住地的海拔高度分为<3500 m组(161例)、3500~4000 m组(203例)和≥4000 m组(159例),比较3组的一般特征、脂代谢水平及妊娠结局等;并根据甘油三酯(triglycerides,TG)水平分为高TG组(TG≥3.23 mmol/L,80例)和对照组(TG<3.23 mmol/L,443例),比较2组的一般特征及妊娠结局。采用Mann-Whitney U检验、Kruskal-Wallis H检验、LSD法、χ^(2)检验或Fisher精确概率法对数据进行组间比较,多因素logistic回归分析高TG血症与不良围产结局的相关性。结果高海拔地区中不同海拔高度藏族孕产妇的年龄、孕产次、分娩前体重指数、入院时血压、总胆固醇(total cholesterol,TC)、TG、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、TG/HDL-C、LDL-C/HDL-C及不良妊娠结局差异均无统计学意义(P值均>0.05);血红蛋白(hemoglobin,Hb)水平随着海拔升高呈上升趋势(P<0.05),其中≥4000 m组孕妇的Hb水平高于<3500 m组及3500~4000 m组[121.0 g/L(108.0~132.0 g/L)与115.0 g/L(103.5~128.0 g/L)和117.0 g/L(101.0~127.0 g/L),H值分别为2.37和1.97,P值均<0.05]。按照TG≥3.23 mmol/L的标准,高海拔地区藏族孕产妇妊娠晚期高TG血症的发生率为15.3%(80/523);高TG组与对照组的HDL-C、Hb水平差异无统计学意义[1.7 mmol/L(1.5~2.0 mmol/L)与1.8 mmol/L(1.5~2.1 mmol/L),Z=-1.51;123.5 g/L(110.0~131.8 g/L)与117.0 g/L(104.0~128.0 g/L),Z=1.69;P值均>0.05];高TG组的剖宫产率[13.8%(11/80)与6.6%(29/443),χ^(2)=4.98]及妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)[16.3%(13/80)与7.5%(33/443),χ^(2)=6.54]、子痫前期[8.8%(7/80)与1.6%(7/443),χ^(2)=13.37]、妊娠期高血糖[11.3%(9/80)与3.6%(16/443),χ^(2)=8.69]、早产[7.5%(6/80)与2.0%(9/443),χ^(2)=7.27]、巨大儿[5.0%(4/80)与0.9%(4/443),Fisher精确概率法]、新生儿窒息[8.8%(7/80)与2.5%(11/443),χ^(2)=8.01]的发生率均高于正常组(P值均<0.05)。按海拔高度分组后进行比较,仅≥4000 m组TG与Hb水平呈负相关(r=-0.17,P=0.037)。多因素logistic回归分析显示,妊娠晚期TG≥3.23 mmol/L发生HDP(OR=2.42,95%CI:1.17~5.00)、子痫前期(OR=5.25,95%CI:1.73~16.00)、妊娠期高血糖(OR=3.77,95%CI:1.56~9.09)、早产(OR=4.33,95%CI:1.42~13.22)、巨大儿(OR=6.05,95%CI:1.46~25.15)、新生儿窒息(OR=3.45,95%CI:1.27~9.35)、胎儿宫内死亡(OR=4.94,95%CI:1.01~24.21)的风险均升高(P值均<0.05)。结论高海拔地区中不同海拔高度的藏族孕产妇妊娠晚期脂代谢水平及妊娠结局未见差异;高海拔地区藏族孕产妇妊娠晚期高TG血症与妊娠期高血压、子痫前期、妊娠期高血糖、早产、巨大儿、新生儿窒息、胎儿宫内死亡密切相关。

Objective To analyze the lipid levels,adverse perinatal outcome and their correlation in Tibetan pregnant women in high altitudes in late pregnancy.Methods Retrospective analysis was performed on clinical and laboratory data of 523 Tibetan singleton pregnant women who delivered after 28 weeks at the Department of Obstetrics and Gynecology,Chaya People's Hospital,Changdu City.The subjects were divided into three groups according to the altitude of their long-term residence,including altitude<3500 m(Group A,n=161),altitude≥3500 m and<4000 m(Group B,n=203)and altitude≥4000 m(Group C,n=159).In addition,the subjects were also grouped into high TG group(TG≥3.23 mmol/L,n=80)and control group(TG<3.23 mmol/L,n=443).The baseline information,levels of lipid and perinatal outcome were compared among Group A,B and C,and also between the high TG and control group,respectively,using Mann-whitney U test,Kruskal-Wallis H test,LSD-t,Chi-square test,or Fisher exact test.Multivariate logistic regression analysis was also applied to analyze the correlation between hypertriglyceridemia and adverse perinatal outcome.Results The maternal age,gravidity and parity,body mess index,blood pressure on admission and total cholesterol(TC),TG,high density lipoprotein-cholesterol(HDL-C),low density lipoprotein-cholesterol(LDL-C),TG/HDL-C ratio and LDL-C/HDL-C ratio in late pregnancy and the occurrence of adverse perinatal outcome did not show any significant differences among Group A,B and C(all P>0.05).However,the hemoglobin(Hb)level increased with the elevation of altitude as expected,and that in Group C was higher than that in Group A and B[121.0 g/L(108.0-132.0 g/L)vs 115.0 g/L(103.5-128.0 g/L)and 117.0 g/L(101.0-127.0 g/L),H=2.37 and 1.97,both P<0.05].The proportion of women with hypertriglyceridemia,the high TG group,in late pregnancy was 15.3%(80/523),and no significant difference was found in HDL-C or Hb levels between the high TG and control group[1.7 mmol/L(1.5-2.0 mmol/L)vs 1.8 mmol/L(1.5-2.1 mmol/L),Z=-1.51;123.5 g/L(110.0-131.8 g/L)vs 117.0 g/L(104.0-128.0 g/L),Z=1.69;both P>0.05].Higher rates of cesarean section[13.8%(11/80)vs 6.6%(29/443),χ^(2)=4.98],hypertensive disorders of pregnancy(HDP)[16.3%(13/80)vs 7.5%(33/443),χ^(2)=6.54],preeclampsia(PE)[8.8%(7/80)vs 1.6%(7/443),χ^(2)=13.37],hyperglycemia during pregnancy[11.3%(9/80)vs 3.6%(16/443),χ^(2)=8.69],preterm birth(PB)[7.5%(6/80)vs 2.0%(9/443),χ^(2)=7.27],microsomia[5.0%(4/80)vs 0.9%(4/443),Fisher exact test]and neonatal asphyxia[8.8%(7/80)vs 2.5%(11/443),χ^(2)=8.01]were observed in the high TG group than in the control group(all P<0.05).Regarding the pregnant women at different altitude,TG was negatively correlated with Hb(r=-0.17,P=0.037)only in Group C.Multivariate logistic regression analysis revealed higher risk of HDP(OR=2.42,95%CI:1.17-5.00),PE(OR=5.25,95%CI:1.73-16.00),hyperglycemia during pregnancy(OR=3.77,95%CI:1.56-9.09),PB(OR=4.33,95%CI:1.42-13.22),microsomia(OR=4.33,95%CI:1.42-13.22),neonatal asphyxia(OR=3.45,95%CI:1.27-9.35)and fetal demise(OR=4.94,95%CI:1.01-24.21)in women with high TG level in late pregnancy(all P<0.05).Conclusions There were no differences in adverse perinatal outcomes or serum lipid levels in late pregnancy among women living at different high altitudes.However,hypertriglyceridemia at the third trimester is closely associated with the incidence of HDP,PE,hyperglycemia during pregnancy,PB,microsomia,neonatal asphyxia and fetal demise in this group of women.