上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2021 , Vol. 41 >Issue 4: 483 - 488

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.04.011

论著·临床研究

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 ,
  • 王筱金 ,
  • 马珏 ,
  • 何韵婷 ,
  • 何豪 ,
  • 翟晶 ,
  • 郭玉娜 ,
  • 陈焱 ,
  • 王炳顺
展开
  • 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
张方（1983—），女，讲师，硕士生；电子信箱：peggy_zhang@shsmu.edu.cn。

收稿日期: 2020-05-08

  网络出版日期: 2021-05-14

基金资助

国家自然科学基金(81573162)

收起

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

  • Fang ZHANG ,
  • Xiao-jin WANG ,
  • Jue MA ,
  • Yun-ting HE ,
  • Hao HE ,
  • Jing ZHAI ,
  • Yu-na GUO ,
  • Yan CHEN ,
  • Bing-shun WANG
Expand
  • 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 date: 2020-05-08

  Online published: 2021-05-14

Supported by

National Natural Science Foundation of China(81573162)

Fold

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

本文引用格式

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 . DOI: 10.3969/j.issn.1674-8115.2021.04.011

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

参考文献

1 Duley L. The global impact of pre-eclampsia and eclampsia[J]. Semin Perinatol, 2009, 33(3): 130-137.
2 Mol BWJ, Roberts CT, Thangaratinam S, et al. Pre-eclampsia[J]. Lancet, 2016, 387(10022): 999-1011.
3 杨孜. 多因素、多通路、多机制致病解子痫前期综合征制胜真实世界临床实践[J]. 中国实用妇科与产科杂志, 2017, 33(1): 45-51.
4 Correa PJ, Palmeiro Y, Soto MJ, et al. Etiopathogenesis, prediction, and prevention of preeclampsia[J]. Hypertens Pregnancy, 2016, 35(3): 280-294.
5 Townsend R, Khalil A, Premakumar Y, et al. Prediction of pre-eclampsia: review of reviews[J]. Ultrasound Obstet Gynecol, 2019, 54(1): 16-27.
6 Gallos ID, Sivakumar K, Kilby MD, et al. Pre-eclampsia is associated with, and preceded by, hypertriglyceridaemia: a meta-analysis[J]. BJOG, 2013, 120(11): 1321-1332.
7 王广娇, 杨孜. 脂代谢和脂肪酸代谢与子痫前期[J]. 中国实用妇科与产科杂志, 2018, 34(9): 966-970.
8 Kaaja R. Lipid abnormalities in pre-eclampsia: implications for vascular health[J]. Clin Lipidol, 2011, 6(1): 71-78.
9 Robinson NJ, Minchell LJ, Myers JE, et al. A potential role for free fatty acids in the pathogenesis of preeclampsia[J]. J Hypertens, 2009, 27(6): 1293-1302.
10 杨静, 贾瑞喆, 王素敏. 血脂异常与子痫前期相关性的研究进展[J]. 妇产与遗传(电子版), 2018, 8(1): 54-58.
11 王岩. 子痫前期患者孕期血脂的变化[J]. 南通大学学报(医学版), 2015, 35(3): 251-252.
12 Spracklen CN, Smith CJ, Saftlas AF, et al. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis[J]. Am J Epidemiol, 2014, 180(4): 346-358.
13 Sun LJ, Xu GF, Lv M, et al. Predictive value of maternal serum biomarkers for preeclampsia and birth weight: a case-control study in Chinese pregnant women[J]. J Women's Heal2002, 2018, 27(12): 1519-1524.
14 Olalere FDH, Okusanya BO, Oye-Adeniran BA. Maternal serum lipid in women with preeclampsia in Lagos: a case control study[J]. J Matern Fetal Neonatal Med, 2020, 33(5): 794-798.
15 蒋静, 沈孟荣, 辛怀丽, 等. 妊娠晚期血脂水平与不同类型子痫前期相关性分析[J]. 安徽医学, 2018, 39(10): 1236-1238.
16 谢幸, 苟文丽. 妇产科学[M]. 8版. 北京: 人民卫生出版社, 2013.
17 Busso D, Rigotti A. Blood lipids during pregnancy: a progressively appreciated subject in basic and clinical research[J]. Atherosclerosis, 2018, 276: 163-165.
18 El Khouly NI, Sanad ZF, Saleh SA, et al. Value of first-trimester serum lipid profile in early prediction of preeclampsia and its severity: a prospective cohort study[J]. Hypertens Pregnancy, 2016, 35(1): 73-81.
19 陈葵. 脂代谢紊乱及血清尿酸水平对子痫前期预测的意义研究[J]. 黑龙江医学, 2015, 39(10): 1159-1161.
20 Wojcik-Baszko D, Charkiewicz K, Laudanski P. Role of dyslipidemia in preeclampsia: a review of lipidomic analysis of blood, placenta, syncytiotrophoblast microvesicles and umbilical cord artery from women with preeclampsia[J]. Prostaglandins Other Lipid Mediat, 2018, 139: 19-23.
21 Ephraim R, Doe P, Amoah S, et al. Lipid profile and high maternal body mass index is associated with preeclampsia: a case-control study of the cape Coast metropolis[J]. Ann Med Health Sci Res, 2014, 4(5): 746-750.
22 王明蕊, 赖银璇. 早发型及晚发型子痫前期患者血脂代谢的变化及意义[J]. 吉林医学, 2015, 36(13): 2758-2759.
23 Serrano NC, Guio-Mahecha E, Quintero-Lesmes DC, et al. Lipid profile, plasma apolipoproteins, and pre-eclampsia risk in the GenPE case-control study[J]. Atherosclerosis, 2018, 276: 189-194.
24 Jin WY, Lin SL, Hou RL, et al. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China[J]. BMC Pregnancy Childbirth, 2016, 16: 60.
25 Ware-Jauregui S, Sanchez SE, Zhang CL, et al. Plasma lipid concentrations in preeclamptic and normotensive Peruvian women[J]. Int J Gynecol Obstet, 1999, 67(3): 147-155.
26 Enquobahrie DA, Williams MA, Butler CL, et al. Maternal plasma lipid concentrations in early pregnancy and risk of preeclampsia[J]. Am J Hypertens, 2004, 17(7): 574-581.
Options
文章导航

/

〈 〉