妊娠期糖尿病合并妊娠期高血压疾病孕妇的血脂分布特征分析

Analysis of distribution features of blood lipid levels among pregnant women with gestational diabetes mellitus combined with hypertensive disorders of pregnancy

目的分析妊娠期糖尿病(GDM)合并妊娠期高血压疾病(HDP)的孕妇血脂表达水平及分布特征,探讨其与母婴健康的关联,为管理血脂,控制不良妊娠结局提供科学依据。方法于2014年1月至2016年12月选取在天津市某区妇女儿童保健和计划生育服务中心确诊的GDM合并HDP孕妇95例作为GDM-HDP组,随机选取同期诊断为单纯GDM孕妇95例为GDM组、健康孕妇95例为健康对照组进行研究。收集基本信息,于孕24～28周进行体格检查、口服葡萄糖耐量试验(OGTT)以及血压和血脂水平的测量。采用SPSS 17.0统计软件进行单因素方差分析、χ~2检验和多因素非条件logistic回归分析。结果 GDM-HDP组和GDM组的孕前体质指数(BMI)和孕期体重增加均高于健康对照组;GDMHDP组孕妇的吸烟率最高(8.42%),怀孕次数≥2次、产次≥2次孕妇比例也最高,差异均有统计学意义(P<0.05)。GDMHDP组收缩压、舒张压、甘油三酯(TG)均高于GDM组,高密度脂蛋白胆固醇(HDL-C)水平低于GDM组,差异均有统计学意义(P<0.05);GDM-HDP组和GDM组的OGTT各时间点血糖、收缩压、TG、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均高于健康对照组,HDL-C低于健康对照组,差异均有统计学意义(P<0.05)。3组孕妇发生低出生体重的发生率差异有统计学意义(P<0.05),GDM-HDP组低出生体重发生率最高(9.47%),健康对照组最低(2.11%)。多因素非条件logistic回归分析结果显示,TG水平升高(OR=2.038,95%CI:1.141～3.641)、孕前BMI高(OR=1.645,95%CI:1.046～2.588)与孕妇GDM-HDP并发存在正向关联,是潜在的危险因素;高水平HDL-C(OR=0.463,95%CI:0.258～0.828)与孕妇GDMHDP并发存在负向关联,是孕妇健康的保护因素,均有统计学意义(P<0.05)。结论血脂水平的异常表达与GDM合并HDP存在显著关联,且与不良妊娠结局发生风险增加有关。早中期动态监测孕妇血脂并加强管理,可能是提高母婴健康水平的有效途径,值得临床关注。

Objective To analyze the distribution features of blood lipid levels in pregnant women with gestational diabetes mellitus(GDM)combined with hypertensive disorders of pregnancy(HDP)and to explore the association with maternal and child health.Methods From January of 2014 to December of 2016,95 pregnant women with GDM-HDP and 95 cases simple GDM women were selected from Maternal and Child Care Service Center in Tianjin as GDM-HDP group and GDM group,95 healthy pregnant women were selected as control group.The basic information was collected.The physical examination,OGTT,blood pressure and blood lipid levels were measured in 24-28 weeks of pregnancy.Theχ~2 test,One-way ANOVA and multivariate unconditional logistic regression were used to analyze the data.The used software was SPSS 17.0.Results The body mass index(BMI)and body weight increase of GDM-HDP group and GDM group were significantly higher than those of control group;the smoking rate(8.42%),the proportions of pregnant frequency(≥2 times)and delivery frequency levels(≥2 times)in GDM-HDP group were the highest,P<0.05.The systolic,diastolic blood pressure and TG of GDM-HDP group were significantly higher than those of GDM group,but the HDL-C level of GDM-HDP group was significantly lower than that of GDM group,P<0.05.The OGTT glucose at different time,systolic blood pressure,TG,TC and LDL-C of GDM-HDP group and GDM group were significantly higher than those of control group,but the HDL-C levels of GDM-HDP group and GDM group were significantly lower than that of control group,P<0.05.There were significant differences of low birth weight rate among three groups(P<0.05),the low birth weight rate(9.47%)in GDM-HDP group was the highest,the low birth weight rate(2.11%)in control group was the lowest.The multivariate unconditional logistic regression showed that there was positive correlation between the increased TG level(OR=2.038,95%CI:1.141-3.641)or high BMI(OR=1.654,95%CI:1.046-2.588)and GDM-HDP,which were the risk factors;there was negative correlation between the increased HDL-C level(OR=0.463,95%CI:0.258-0.828)and GDM-HDP,which was the protection factor,P<0.05.Conclusion Abnormal blood lipid level was significantly correlated with GDM complicated HDP,and associated with high risk of abnormal pregnancy outcome.Thus the surveillance of blood lipid level in early and second trimester of pregnancy could be helpful in promoting the health for both mothers and children.