妊娠早期血脂谱与子痫前期发病风险的关系——基于真实世界数据的研究

doi:10.3969/j.issn.1674-8115.2021.04.011

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (4): 483-488.doi: 10.3969/j.issn.1674-8115.2021.04.011

妊娠早期血脂谱与子痫前期发病风险的关系——基于真实世界数据的研究

张方¹^,²(), 王筱金³, 马珏⁴, 何韵婷¹^,³, 何豪¹^,³, 翟晶¹^,³, 郭玉娜⁴, 陈焱⁴, 王炳顺³()

^1.上海交通大学公共卫生学院，上海 200025
^2.上海交通大学医学院仁济临床医学院，上海 200127
^3.上海交通大学医学院临床研究中心生物统计教研室，上海 200025
^4.上海交通大学医学院附属国际和平妇幼保健院产科，上海 200030

收稿日期:2020-05-08 出版日期:2021-04-28 发布日期:2021-05-14
通讯作者: 王炳顺 E-mail:peggy_zhang@shsmu.edu.cn;wangbingshun@sjtu.edu.cn
作者简介:张方（1983—），女，讲师，硕士生；电子信箱：peggy_zhang@shsmu.edu.cn。
基金资助:
国家自然科学基金(81573162)

Association between blood lipid profile in early pregnancy and risk of preeclampsia: a study based on real world data

Fang ZHANG¹^,²(), Xiao-jin WANG³, Jue MA⁴, Yun-ting HE¹^,³, Hao HE¹^,³, Jing ZHAI¹^,³, Yu-na GUO⁴, Yan CHEN⁴, Bing-shun WANG³()

^1.School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
^2.School of Renji Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^3.Department of Biostatistics, Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^4.Department of Obstetrics, the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

Received:2020-05-08 Online:2021-04-28 Published:2021-05-14
Contact: Bing-shun WANG E-mail:peggy_zhang@shsmu.edu.cn;wangbingshun@sjtu.edu.cn
Supported by:
National Natural Science Foundation of China(81573162)

摘要/Abstract

摘要：

目的·探讨妊娠早期血脂水平与子痫前期（preeclampsia，PE）发病风险的关系。方法·研究对象为2015年1月—2017年12月于上海交通大学医学院附属国际和平妇幼保健院行常规产检并住院分娩的孕妇，经筛选后纳入26 230例，其中发生PE的孕妇（PE组）680例、未发生PE的孕妇（对照组）25 550例。通过电子病历系统获取2组孕妇的一般临床资料和妊娠10~14周的血脂指标。采用多因素Logistic回归分析探讨妊娠早期血脂水平（四分位等级）与PE发病风险的关系。结果·与对照组相比，PE组孕妇妊娠早期的总胆固醇（total cholesterol，TC）、三酰甘油（triacylglycerol，TAG）、低密度脂蛋白（low density lipoprotein，LDL）和载脂蛋白B（apolipoprotein B，ApoB）水平均较高（均P<0.05），而高密度脂蛋白（high density lipoprotein，HDL）水平较低（P=0.000）。多因素Logistic回归分析显示，TAG（>1.45 mmol/L）、LDL（>3.26 mmol/L）和ApoB（>0.86 g/L）是PE发病的独立危险因素（均P<0.05），HDL（>1.99 mmol/L）是PE发病的独立保护因素（P=0.002）。在调整了潜在的混杂因素后，随着TAG、LDL和ApoB水平的升高，PE的发病风险逐渐增加，而HDL反之（均趋势P<0.05）。以最低四分位组为参考，TAG、LDL、ApoB和HDL在最高四分位组的调整OR值及95% CI分别为1.90（1.47~2.45）、1.39（1.08~1.78）、1.51（1.13~2.04）和0.66（0.50~0.86）。结论·妊娠早期的血脂代谢异常预示孕期PE的发病风险增加，及早进行血脂水平的检测有助于PE的早期预测。

关键词: 子痫前期, 妊娠早期, 血脂, 真实世界研究, 电子病历

Abstract:

Objective·To investigate the association between the blood lipid levels in early pregnancy and the risk of preeclampsia (PE).

Methods·Pregnant women who underwent routine prenatal examination and delivered in the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2015 to December 2017 were recruited as the study participants. After screening, 26 230 pregnant women were selected, including 680 pregnant women with PE (PE group) and 25 550 pregnant women without PE (control group). The general clinical data and the blood lipid index during 10?14 weeks of pregnancy were obtained from the electronic medical record system. Multivariate Logistic regression analysis was used to explore the relationship between blood lipid levels at different categorical (by quartile) in early pregnancy and the risk of PE.

Results·Compared with the control group, the levels of total cholesterol (TC), triacylglycerol (TAG), low density lipoprotein (LDL) and lipoprotein B (ApoB) in the early pregnancy of the PE group were higher (all P<0.05), while the level of high density lipoprotein (HDL) was lower (P=0.000). Multivariate Logistic regression analysis showed that TAG (>1.45 mmol/L), LDL (>3.26 mmol/L) and ApoB (>0.86 g/L) were the independent risk factors for PE (all P<0.05), and HDL (>1.99 mmol/L) was the independent protective factor for PE (P=0.002). After adjusting for potential confounding factors, the risk of PE increased successively with the increase of the TAG, LDL and ApoB levels, HDL did the opposite (all P for trend<0.05). With the lowest quartile as a reference, the adjusted OR values and 95% CIs for the highest quartiles of TAG, LDL, ApoB and HDL were 1.90 (1.47?2.45), 1.39 (1.08?1.78), 1.51 (1.13?2.04) and 0.66 (0.50?0.86), respectively.

Conclusion·Dyslipidemia in early pregnancy indicates an increased risk of PE during pregnancy. Examination of blood lipid level during early pregnancy is helpful for early prediction of PE.

Key words: preeclampsia (PE), early pregnancy, blood lipid, real world study, electronic medical record

中图分类号:

R714.252

张方, 王筱金, 马珏, 何韵婷, 何豪, 翟晶, 郭玉娜, 陈焱, 王炳顺. 妊娠早期血脂谱与子痫前期发病风险的关系——基于真实世界数据的研究[J]. 上海交通大学学报(医学版), 2021, 41(4): 483-488.

Fang ZHANG, Xiao-jin WANG, Jue MA, Yun-ting HE, Hao HE, Jing ZHAI, Yu-na GUO, Yan CHEN, Bing-shun WANG. Association between blood lipid profile in early pregnancy and risk of preeclampsia: a study based on real world data[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(4): 483-488.

图/表 3

参考文献 26

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Item	Total (n=26 230)	Control group (n=25 550)	PE group (n=680)	P value^①
Maternal age/year	29.49±3.31	29.48±3.30	29.95±3.52	0.001
Gestational age at delivery/week	39.25±1.27	39.27±1.26	38.58±1.57	0.000
Age of marriage/year	27.33±2.92	27.32±2.91	27.72±3.11	0.002
Age of first pregnancy/year	28.21±3.55	28.21±3.54	28.23±3.87	0.911
Menarche age/year	13.70±1.41	13.70±1.41	13.65±1.41	0.399
Menstrual interval/d	31.02±6.29	31.02±6.31	30.99±5.35	0.883
Menstrual duration/d	5.84±1.16	5.84±1.16	5.74±1.13	0.027
Height/cm	162.28±4.86	162.29±4.85	162.05±5.00	0.205
Weight before pregnancy/kg	54.62±7.54	54.50±7.44	59.00±9.85	0.000
Pre-pregnancy BMI/(kg·m^-2)	20.73±2.57	20.68±2.53	22.44±3.39	0.000
Basic SBP/n (%)				0.024
≤89 mmHg	221 (0.84)	219 (0.86)	2 (0.30)
90?139 mmHg	25 961 (99.02)	25 290 (99.02)	671 (99.26)
≥140 mmHg	35 (0.13)	32 (0.13)	3 (0.44)
Basic DBP/n (%)				0.000
≤59 mmHg	556 (2.12)	550 (2.15)	6 (0.88)
60?89 mmHg	25 629 (97.74)	24 962 (97.73)	667 (98.38)
≥90 mmHg	36 (0.14)	31 (0.12)	5 (0.74)
Gravida/n (%)				0.000
1	18 623 (71.00)	18 175 (71.14)	448 (65.88)
2	5 706 (21.75)	55 53 (21.73)	153 (22.50)
≥3	1 900 (7.24)	1 821 (7.13)	79 (11.62)
Conception method/n (%)				0.000
Nature conceived	20 009 (92.92)	19 530 (93.08)	479 (86.93)
Unnatural conceived	1 525 (7.08)	1 453 (6.92)	72 (13.07)

Item	Total (n=26 230)	Control group (n=25 550)	PE group (n=680)	P value^①
Maternal age/year	29.49±3.31	29.48±3.30	29.95±3.52	0.001
Gestational age at delivery/week	39.25±1.27	39.27±1.26	38.58±1.57	0.000
Age of marriage/year	27.33±2.92	27.32±2.91	27.72±3.11	0.002
Age of first pregnancy/year	28.21±3.55	28.21±3.54	28.23±3.87	0.911
Menarche age/year	13.70±1.41	13.70±1.41	13.65±1.41	0.399
Menstrual interval/d	31.02±6.29	31.02±6.31	30.99±5.35	0.883
Menstrual duration/d	5.84±1.16	5.84±1.16	5.74±1.13	0.027
Height/cm	162.28±4.86	162.29±4.85	162.05±5.00	0.205
Weight before pregnancy/kg	54.62±7.54	54.50±7.44	59.00±9.85	0.000
Pre-pregnancy BMI/(kg·m^-2)	20.73±2.57	20.68±2.53	22.44±3.39	0.000
Basic SBP/n (%)				0.024
≤89 mmHg	221 (0.84)	219 (0.86)	2 (0.30)
90?139 mmHg	25 961 (99.02)	25 290 (99.02)	671 (99.26)
≥140 mmHg	35 (0.13)	32 (0.13)	3 (0.44)
Basic DBP/n (%)				0.000
≤59 mmHg	556 (2.12)	550 (2.15)	6 (0.88)
60?89 mmHg	25 629 (97.74)	24 962 (97.73)	667 (98.38)
≥90 mmHg	36 (0.14)	31 (0.12)	5 (0.74)
Gravida/n (%)				0.000
1	18 623 (71.00)	18 175 (71.14)	448 (65.88)
2	5 706 (21.75)	55 53 (21.73)	153 (22.50)
≥3	1 900 (7.24)	1 821 (7.13)	79 (11.62)
Conception method/n (%)				0.000
Nature conceived	20 009 (92.92)	19 530 (93.08)	479 (86.93)
Unnatural conceived	1 525 (7.08)	1 453 (6.92)	72 (13.07)

Index	Control group (n=25 550)	PE group (n=680)	t value	P value
TC/(mmol·L^-1)	4.69±0.76	4.79±0.82	-3.11	0.002
TAG/(mmol·L^-1)	1.23±0.48	1.46±0.70	-8.39	0.000
HDL/(mmol·L^-1)	1.76±0.37	1.64±0.35	7.68	0.000
LDL/(mmol·L^-1)	2.84±0.70	3.02±0.75	-6.32	0.000
ApoA/(g·L^-1)	1.84±0.26	1.82±0.29	1.77	0.078
ApoB/(g·L^-1)	0.77±0.16	0.81±0.17	-6.29	0.000
LPa/(mg·L^-1)	192.82±205.01	196.61±246.51	-0.35	0.724

Index	Control group (n=25 550)	PE group (n=680)	t value	P value
TC/(mmol·L^-1)	4.69±0.76	4.79±0.82	-3.11	0.002
TAG/(mmol·L^-1)	1.23±0.48	1.46±0.70	-8.39	0.000
HDL/(mmol·L^-1)	1.76±0.37	1.64±0.35	7.68	0.000
LDL/(mmol·L^-1)	2.84±0.70	3.02±0.75	-6.32	0.000
ApoA/(g·L^-1)	1.84±0.26	1.82±0.29	1.77	0.078
ApoB/(g·L^-1)	0.77±0.16	0.81±0.17	-6.29	0.000
LPa/(mg·L^-1)	192.82±205.01	196.61±246.51	-0.35	0.724

Variable	Control group/n	PE group/n	Univariate Logistic regression analysis		Multivariate Logistic regression analysis
Variable	Control group/n	PE group/n	cOR (95% CI)	P value	aOR (95% CI)	P value
TC/(mmol·L^-1)
≤4.17	6 457	150	Ref		Ref
>4.17 and ≤4.63	6 409	149	1.00 (0.80?1.26)	0.995	0.96 (0.74?1.24)	0.731
>4.63 and ≤5.15	6 325	182	1.24 (1.00?1.54)	0.055	1.22 (0.96?1.55)	0.111
>5.15	6 359	199	1.35 (1.09?1.67)	0.007	1.18 (0.93?1.51)	0.182
P for trend				0.001		0.061
TAG/(mmol·L^-1)
≤0.92	6 633	111	Ref		Ref
>0.92 and ≤1.15	6 394	123	1.15 (0.89?1.49)	0.291	1.05 (0.79?1.40)	0.736
>1.15 and ≤1.45	6 215	155	1.49 (1.17?1.91)	0.002	1.28 (0.97?1.68)	0.077
>1.45	6 308	291	2.76 (2.21?3.44)	0.000	1.90 (1.47?2.45)	0.000
P for trend				0.000		0.000
HDL/(mmol·L^-1)
≤1.49	6 533	239	Ref		Ref
>1.49 and ≤1.73	6 420	190	0.81 (0.67?0.98)	0.032	0.91 (0.73?1.14)	0.427
>1.73 and ≤1.99	6 342	149	0.64 (0.52?0.79)	0.000	0.85 (0.67?1.07)	0.166
>1.99	6 255	102	0.45 (0.35?0.56)	0.000	0.66 (0.50?0.86)	0.002
P for trend				0.000		0.002
LDL/(mmol·L^-1)
≤2.36	6 496	126	Ref		Ref
>2.36 and ≤2.80	6 385	142	1.15 (0.90?1.46)	0.269	1.07 (0.83?1.38)	0.623
>2.80 and ≤3.26	6 340	175	1.42 (1.13?1.79)	0.003	1.13 (0.88?1.46)	0.351
>3.26	6 329	237	1.93 (1.55?2.40)	0.000	1.39 (1.08?1.78)	0.010
P for trend				0.000		0.008
ApoA/(g·L^-1)
≤1.68	5 132	170	Ref		Ref
>1.68 and ≤1.86	4 864	121	0.75 (0.59?0.95)	0.018	0.82 (0.62?1.08)	0.154
>1.86 and ≤2.02	5 121	130	0.77 (0.61?0.97)	0.024	0.91 (0.69?1.18)	0.464
>2.02	4 671	118	0.76 (0.60?0.97)	0.026	0.97 (0.73?1.28)	0.806
P for trend				0.027		0.863
ApoB/(g·L^-1)
≤0.66	5 168	98	Ref		Ref
>0.66 and ≤0.76	5 072	128	1.33 (1.02?1.74)	0.035	1.27 (0.93?1.74)	0.128
>0.76 and ≤0.86	4 670	128	1.45 (1.11?1.89)	0.007	1.24 (0.91?1.70)	0.175
>0.86	4 879	185	2.00 (1.56?2.56)	0.000	1.51 (1.13?2.04)	0.006
P for trend				0.000		0.009
LPa/(mg·L^-1)
≤64.2	4 950	136	Ref		Ref
>64.2 and ≤119.0	4 946	128	0.94 (0.74?1.20)	0.632	0.95 (0.72?1.26)	0.720
>119.0 and ≤242.8	4 944	151	1.11 (0.88?1.41)	0.377	1.06 (0.81?1.39)	0.673
>242.8	4 942	123	0.91 (0.71?1.16)	0.433	0.85 (0.64?1.13)	0.254
P for trend				0.771		0.414

妊娠早期血脂谱与子痫前期发病风险的关系——基于真实世界数据的研究

Association between blood lipid profile in early pregnancy and risk of preeclampsia: a study based on real world data

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