子痫前期孕妇孕中期血脂水平及其临床意义

Serum lipid level in the second trimester of pregnancy in pregnant women with preeclampsia and its clinical significance

目的分析子痫前期孕妇孕中期血脂水平的变化及其临床意义。方法选取2018年4月至2020年2月在浙江大学医学院附属妇产科医院建卡分娩的子痫前期孕妇148例为试验组,同时选取健康妊娠孕妇148名为对照组。回顾性分析所有研究对象的血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,并计算血脂比值TC/HDL-C、TG/HDL-C及LDL-C/HDL-C进行比较分析。利用受试者工作特征曲线(ROC)预测子痫前期,并分析不同血脂水平与研究对象的妊娠结局相关性。结果试验组TG和TG/HDL-C均显著高于对照组[TG:(2.66±1.03)mmol/L与(2.24±0.79)mmol/L,t=3.995,P<0.001;TG/HDL-C:(1.59±0.85)与(1.24±0.57),t=4.236,P<0.001],而HDL-C显著低于对照组[(1.80±0.37)mmol/L与(1.91±0.37)mmol/L,t=-2.669,P=0.008]。根据ROC曲线分析结果显示,在孕中期,TG、HDL-C以及TG/HDL-C对子痫前期的预测曲线下面积分别为0.601、0.631、0.636,灵敏度分别为47.3%、60.1%、48.7%,特异度分别为73.7%、64.2%、74.3%。经过统计分析,发现TC与胎膜早破存在关联性(χ^(2)=4.727,P<0.05);此外,HDL-C与胎儿生长发育迟缓(χ^(2)=7.868,P<0.01)以及新生儿窒息(χ^(2)=3.944,P<0.05)有关联性。同时,TC/HDL-C和LDL-C/HDL-C比值与早产风险增加存在关联性(TC/HDL-C:χ^(2)=5.535,P<0.05;LDL-C/HDL-C:χ^(2)=8.244,P<0.01),并且也与新生儿窒息存在关联性(TC/HDL-C:χ^(2)=4.635,P<0.05;LDL-C/HDL-C:χ^(2)=4.765,P<0.05)。此外,HDL-C、TC/HDL-C和LDL-C/HDL-C与新生儿Apgar评分存在关联性(HDL-C:χ^(2)=-2.924,P<0.01;TC/HDL-C:χ^(2)=2.250,P<0.05;LDL-C/HDL-C:χ^(2)=2.070,P<0.05)。结论子痫前期患者孕中期存在血脂代谢异常,TG、HDL-C及TG/HDL-c对子痫前期的发生具有预测价值,而TC、HDL-C、TC/HDL-C、LDL-C/HDL-C与妊娠结局相关。

Objective To analyze the changes in serum lipid levels and their clinical significance in pregnant women with preeclampsia during the second trimester of pregnancy.Methods A total of 148 pregnant women with preeclampsia who gave birth at the Women′s Hospital,School of Medicine,Zhejiang University from April 2018 to February 2020 were selected as the experimental group,while 148 healthy pregnant women were selected as the control group.The serum levels of total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),and the ratios(TC/HDL-C,TG/HDL-C,and LDL-C/HDL-C)were calculated and compared.The receiver operating characteristic(ROC)curve was used to predict preeclampsia,and the correlation between different serum lipid levels and pregnancy outcomes was analyzed.Results TG and TG/HDL-C in the experimental group were significantly higher than those in the control group[TG:(2.66±1.03)mmol/L vs(2.24±0.79)mmol/L,t=3.995,P<0.001;TG/HDL-C:1.59±0.85 vs 1.24±0.57,t=4.236,P<0.001],while HDL-C was significantly lower than that of the control group[(1.80±0.37)mmol/L vs(1.91±0.37)mmol/L,t=-2.669,P=0.008].ROC curve analysis results showed that in the second trimester,the area under the curve of TG,HDL-C and TG/HDL-C for preeclampsia was 0.601,0.631 and 0.636,respectively,and the sensitivity was 47.3%,60.1%and 48.7%,respectively.The specificity was 73.7%,64.2%and 74.3%,respectively.Statistical analysis showed that TC was correlated with premature rupture of membranes(χ^(2)=4.727,P<0.05).In addition,HDL-C was associated with fetal growth retardation(χ^(2)=7.868,P<0.01)and neonatal asphyxia(χ^(2)=3.944,P<0.05).At the same time,the ratio of TC/HDL-C and LDL-C/HDL-C was significantly correlated with the increased risk of preterm birth(TC/HDL-C:χ^(2)=5.535,P<0.05;LDL-C/HDL-C:χ^(2)=8.244,P<0.01),and was also associated with neonatal asphyxia(TC/HDL-C:χ^(2)=4.635,P<0.05;LDL-C/HDL-C:χ^(2)=4.765,P<0.05).In addition,HDL-C,TC/HDL-C and LDL-C/HDL-C were significantly correlated with neonatal Apgar score(HDL-C:χ^(2)=-2.924,P<0.01;TC/HDL-C:χ^(2)=2.250,P<0.05;LDL-C/HDL-C:χ^(2)=2.070,P<0.05).Conclusion Patients with preeclampsia have abnormal serum lipid metabolism in the second trimester of pregnancy.TG,HDL-C,and TG/HDL-C have predictive value for the occurrence of preeclampsia,while TC,HDL-C,TC/HDL-C,and LDL-C/HDL-C are related to pregnancy outcomes.