摘要
目的妊娠期妇女存在生理性高血脂症,可随妊娠过程的结束逐渐下降并恢复至正常水平。本研究探讨妊娠期妇女血脂水平变化特点,分析孕中晚期血脂异常与产妇年龄、文化程度、居住地、产次、孕期体质量指数(BMI)和妊娠并发症的关系以及对母婴结局的影响。方法选择2018-01-11-2019-04-30在天津市东丽区东丽医院产科定期产检并住院分娩的620名产妇为研究对象,收集产妇临床资料及孕早期(≤12周)、孕中期(24~27周)和孕晚期(≥28周)的血脂水平检测资料,包括血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平,并根据孕中晚期血脂水平是否异常分为血脂正常组99名和血脂异常组521例,对两组产妇的年龄、文化程度、居住地、产次、孕期BMI、妊娠并发症和妊娠结局进行分析。结果随着孕期增加,TC(F=11.293,P<0.001)、TG(F=9.421,P=0.002)和LDL-C(F=5.795,P=0.032)水平逐渐升高。单因素分析结果显示,年龄(χ2=4.634,P=0.031)、产次(χ2=34.873,P<0.001)和孕期BMI(χ2=7.284,P=0.026)是孕中晚期血脂异常的影响因素。多因素Logistic回归分析结果显示,年龄≥35岁(OR=3.008,95%CI为1.238~7.312)、初产(OR=2.898,95%CI为1.945~4.329)和孕期BMI≥28kg/m2(OR=2.505,95%CI为1.140~5.501)是孕中晚期血脂异常的危险因素。血脂异常组妊娠期高血压疾病(HDCP)发生率(9.98%)高于血脂正常组(3.03%),χ2=4.971,P=0.026;妊娠糖尿病(GDM)发生率(14.97%)高于血脂正常组(6.06%),χ2=8.661,P=0.003。血脂异常组剖宫产率(χ2=11.734,P=0.001)、早产率(χ2=6.268,P=0.012)、出现胎儿窘迫的比例(χ2=6.948,P=0.008)和巨大儿发生率(χ2=6.016,P=0.014)均高于血脂正常组。结论孕期血脂水平随孕期增长而上升,血脂异常率也随之上升。孕中晚期血脂水平与年龄、产次和孕期BMI存在相关关系,血脂异常会增加妊娠期高血压、妊娠糖尿病和不良妊娠结局的风险。
Objective Pregnant women have physiological hyperlipidemia,which can gradually decrease and return to normal level with the end of pregnancy.The purpose of this study was to explore the characteristics of the changes of serum lipids in pregnant women,and to analyze the relationship between the abnormal blood lipid level in the middle and late period of pregnancy and the age,education level,residence,birth time,body mass index(BMI)during pregnancy,pregnancy complications,as well as the impact on the outcome of mothers and infants.Methods A total of 620 parturients who had undergone regular obstetric checkups and hospitalized delivery in Tianjin Dongli Hospital,Dongli District from2018-01-11-2019-04-30 were selected as the research subjects.Collected the maternal clinical data and the blood lipid level of pregnant women in the early stage(≥12 weeks),the middle stage(24-27 weeks)and the late stage(≥28 weeks),including serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C).According to the abnormal blood lipid level in the middle and late stage of pregnancy,the pregnant women were divided into two groups:normal group 99 and abnormal group 521.The age,education,place of residence,birth time,BMI during pregnancy,pregnancy complications and pregnancy outcome of the two groups were compared.Results With the increase of gestational age,the levels of TC(F=11.293,P<0.001),TG(F=9.421,P=0.002)and LDL-C(F=5.795,P=0.032)during pregnancy also gradually increased.Univariate analysis showed that age(χ2=4.634,P=0.031),parity(χ2=34.873,P<0.001)and pregnancy BMI(χ2=7.284,P=0.026)were the influencing factors of dyslipidemia in the middle and late stages of pregnancy.Multivariate logistic regression analysis showed that age≥35 years old(OR=3.008,95%CI:1.238-7.312),first delivery(OR=2.898,95%CI:1.945-4.329),pregnancy BMI≥28 kg/m2(OR=2.505,95%CI:1.140-5.501)were risk factors for dyslipidemia in the middle and late pregnancy.The incidence of hyperlipidemia during pregnancy(HDCP)in the dyslipidemia group(9.98%)was higher than that of the normal blood lipid group(3.03%),χ2=4.971,P=0.026.The incidence of gestational diabetes(GDM)(14.97%)was higher than the normal blood lipid group(6.06%),χ2=8.661,P=0.003.In the dyslipidemia group,the cesarean section rate(χ2=11.734,P=0.001),the preterm birth rate(χ2=6.268,P=0.012),the rate of fetal distress(χ2=6.948,P=0.008)and the incidence of macrosomia(χ2=6.016,P=0.014)were higher than the normal blood lipid group.Conclusions The level of blood lipid in pregnancy will rise with the increase of gestational age,and the abnormal rate of blood lipid will also rise.The level of blood lipid in the middle and late period of pregnancy is related to age,parity and BMI during pregnancy.Abnormal blood lipid will increase the risk of pregnancy hypertension,gestational diabetes and adverse pregnancy outcome.
作者
王均明
刘淑琴
WANG Jun-ming;LIU Shu-qin(Department of Obstetrics,Dongli Hospital,Dongli District,Tianjin 300300,China)
出处
《社区医学杂志》
CAS
2021年第2期70-73,共4页
Journal Of Community Medicine
关键词
孕期
血脂水平
妊娠并发症
妊娠结局
pregnancy
blood lipid level
pregnancy complications
pregnancy outcome
