母孕期血脂水平变化与子代先天性心脏病之间的关系

Relationship Between Changes in Maternal Blood Lipid Levels During Pregnancy and Congenital Heart Disease in Offspring

目的探讨母孕期血脂水平变化与子代先天性心脏病(congenital heart disease,CHD)之间的关系,为儿童CHD的防治提供依据。方法选取2021年5月至2022年5月在内蒙古自治区妇幼保健院进行产检及分娩的孕妇77例,其中病例组为胎儿CHD的孕母,共34例;对照组为胎儿健康的孕母,共43例。检测两组孕母血液生化指标,包括总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、载脂蛋白A1(apolipoprotein-A1,Apo-A1)、载脂蛋白B(apolipoprotein-B,Apo-B)以及空腹血糖(fasting plasma glucose,FPG)。采用二元Logistic回归分析孕母血脂水平与子代CHD之间的相关性。结果与对照组相比,病例组孕母HDL-C和Apo-A1水平显著降低,Apo-B/A1升高,差异有统计学意义(P<0.05)。校正潜在的混杂因素后,HDL-C(OR=0.180,95%CI=0.034~0.947,P=0.043)和Apo-A1(OR=0.957,95%CI=0.934~0.981,P=0.001)水平与CHD发生呈负相关,Apo-B/A1(OR=1.033,95%CI=1.004~1.062,P=0.024)与CHD发生呈正相关。结论母孕期低水平HDL-C和Apo-A1会增加子代CHD的发生风险,血脂代谢水平异常与后代先天性心脏病有一定的相关性。维持孕前和孕期适宜的血脂水平,对于预防CHD等儿童出生缺陷疾病具有重要意义。

Objective To investigate the relationship between changes in maternal lipid levels during pregnancy and congenital heart disease(CHD)in the offspring,and to provide a basis for the prevention and treatment of CHD in children.Methods A total of 77 pregnant women who underwent obstetric examination and delivered in Inner Mongolia Autonomous Region Maternal and Child Healthcare Hospital from May 2021 to May 2022 were selected,of which 34 cases in the case group were pregnant mothers with fetal CHD,and 43 cases in the normal control group were pregnant mothers with healthy fetuses.Blood biochemical indexes of pregnant mothers in both groups were measured,including total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).density lipoprotein cholesterol(HDL-C),apolipoprotein-A1(Apo-A1),apolipoprotein-B(Apo-B),and fasting plasma glucose(FPG).Binary logistic regression was used to analyze the correlation between maternal lipid levels and CHD in offspring.Results Compared with the control group,the levels of HDL-C and Apo-A1 in mothers of CHD children were significantly decreased,and Apo-B/A1 was increased,with statistical significance(P<0.05).After adjusting for potential confounding factors,HDL-C(OR=0.180,95%CI=0.034-0.947,P=0.043)and Apo-A1(OR=0.957,95%CI=0.934-0.981,P=0.001)levels were negatively correlated with the occurrence of CHD.Apo-B/A1(OR=1.033,95%CI=1.004-1.062,P=0.024)was positively correlated with CHD.Conclusion Low levels of HDL-C and Apo-A1 during pregnancy increase the risk of CHD in offspring,and abnormal levels of lipid metabolism are associated with congenital heart disease in offspring.Maintaining appropriate blood lipid levels before and during pregnancy is of great significance for the prevention of CHD and other child birth defects.