中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
3期
180-185
,共6页
李凤秋%杨孜%张爱青%王伽略%孙晓乐%孟然
李鳳鞦%楊孜%張愛青%王伽略%孫曉樂%孟然
리봉추%양자%장애청%왕가략%손효악%맹연
先兆子痫%脂肪酸类,非酯化%甘油三酯类%血管舒张
先兆子癇%脂肪痠類,非酯化%甘油三酯類%血管舒張
선조자간%지방산류,비지화%감유삼지류%혈관서장
Pre-eclampsia%Fatty acids,nonesterified%Triglycerides%Vasodilation
目的 分析妊娠中期初母血游离脂肪酸(free fatty acid,FFA)、血脂和子宫动脉切迹在子痫前期的异质性变化. 方法 本研究为前瞻性队列研究.2012年1月1日至5月31日在北京市海淀区妇幼保健院妊娠期建档,并规律进行产前检查的单胎妊娠妇女4 000例,妊娠14～18周行唐氏综合征筛查同时留取血样检测FFA和血脂,妊娠22～24周时行B超探查.其中存在子宫动脉舒张早期切迹者101例纳入有切迹组;无切迹但具有子痫前期高风险因素者172例纳入无切迹组,另外按1:5随机选取无切迹且未发现子痫前期高风险因素者205例纳入无切迹组,无切迹组共377例.采用两独立样本f检验、单因素方差分析、卡方检验(或Fisher精确概率法)和Logistic回归分析进行统计学处理. 结果 有切迹组子痫前期病史和首诊高血压前期的比例高于无切迹组[3.9％(4/101)与0.8％ (3/377),x2=5.52; 42.2％ (43/101)与25.7％ (97/377),x2=10.91;P值均＜0.05].有切迹组中24例(23.8％)发生子痫前期,无切迹组为8例(2.1％)(x2=59.72,P＜0.05).有切迹组血FFA在早发型子痫前期、晚发型子痫前期、妊娠期高血压及健康孕妇亚组间呈逐渐降低趋势[分别为(0.68±0.27)、(0.58±0.21)、(0.57±0.21)和(0.49±0.19) mmol/L,F=2.78,P＜0.05].多因素分析显示,子痫前期病史(OR=6.77,95％CI:1.03～44.56)和首诊高血压前期(OR=3.34,95％CI:1.59～7.01)是发生子痫前期的危险因素.早发型子痫前期的危险因素包括血FFA(OR=135.68,95％CI:3.78～4 873.00)和子痫前期病史(OR=123.25,95％CI:9.27～1 638.00);晚发型子痫前期的危险因素为首诊高血压前期(OR=4.82,95％CI:1.99～11.65);妊娠期高血压的危险因素包括首诊高血压前期(OR=4.69,95％CI:2.08～10.58)和妊娠前体重指数24～28 (OR=3.69,95％CI:1.26～10.83).血压正常伴妊娠期糖尿病的危险因素包括血FFA水平升高(OR=9.08,95％CI:2.49～33.01)和妊娠前BMI≥28(OR=5.08,95％CI:2.16～11.92).结论 妊娠中期初血FFA和甘油三酯水平与子痫前期,尤其是早发型子痫前期存在相关性;妊娠中期有或无子宫动脉舒张早期切迹都有子痫前期发生可能性,存在切迹者更易发生早发型子痫前期,并且甘油三酯水平存在差异及与血FFA存在相关性,血脂的改变早于切迹.
目的 分析妊娠中期初母血遊離脂肪痠(free fatty acid,FFA)、血脂和子宮動脈切跡在子癇前期的異質性變化. 方法 本研究為前瞻性隊列研究.2012年1月1日至5月31日在北京市海澱區婦幼保健院妊娠期建檔,併規律進行產前檢查的單胎妊娠婦女4 000例,妊娠14～18週行唐氏綜閤徵篩查同時留取血樣檢測FFA和血脂,妊娠22～24週時行B超探查.其中存在子宮動脈舒張早期切跡者101例納入有切跡組;無切跡但具有子癇前期高風險因素者172例納入無切跡組,另外按1:5隨機選取無切跡且未髮現子癇前期高風險因素者205例納入無切跡組,無切跡組共377例.採用兩獨立樣本f檢驗、單因素方差分析、卡方檢驗(或Fisher精確概率法)和Logistic迴歸分析進行統計學處理. 結果 有切跡組子癇前期病史和首診高血壓前期的比例高于無切跡組[3.9％(4/101)與0.8％ (3/377),x2=5.52; 42.2％ (43/101)與25.7％ (97/377),x2=10.91;P值均＜0.05].有切跡組中24例(23.8％)髮生子癇前期,無切跡組為8例(2.1％)(x2=59.72,P＜0.05).有切跡組血FFA在早髮型子癇前期、晚髮型子癇前期、妊娠期高血壓及健康孕婦亞組間呈逐漸降低趨勢[分彆為(0.68±0.27)、(0.58±0.21)、(0.57±0.21)和(0.49±0.19) mmol/L,F=2.78,P＜0.05].多因素分析顯示,子癇前期病史(OR=6.77,95％CI:1.03～44.56)和首診高血壓前期(OR=3.34,95％CI:1.59～7.01)是髮生子癇前期的危險因素.早髮型子癇前期的危險因素包括血FFA(OR=135.68,95％CI:3.78～4 873.00)和子癇前期病史(OR=123.25,95％CI:9.27～1 638.00);晚髮型子癇前期的危險因素為首診高血壓前期(OR=4.82,95％CI:1.99～11.65);妊娠期高血壓的危險因素包括首診高血壓前期(OR=4.69,95％CI:2.08～10.58)和妊娠前體重指數24～28 (OR=3.69,95％CI:1.26～10.83).血壓正常伴妊娠期糖尿病的危險因素包括血FFA水平升高(OR=9.08,95％CI:2.49～33.01)和妊娠前BMI≥28(OR=5.08,95％CI:2.16～11.92).結論 妊娠中期初血FFA和甘油三酯水平與子癇前期,尤其是早髮型子癇前期存在相關性;妊娠中期有或無子宮動脈舒張早期切跡都有子癇前期髮生可能性,存在切跡者更易髮生早髮型子癇前期,併且甘油三酯水平存在差異及與血FFA存在相關性,血脂的改變早于切跡.
목적 분석임신중기초모혈유리지방산(free fatty acid,FFA)、혈지화자궁동맥절적재자간전기적이질성변화. 방법 본연구위전첨성대렬연구.2012년1월1일지5월31일재북경시해정구부유보건원임신기건당,병규률진행산전검사적단태임신부녀4 000례,임신14～18주행당씨종합정사사동시류취혈양검측FFA화혈지,임신22～24주시행B초탐사.기중존재자궁동맥서장조기절적자101례납입유절적조;무절적단구유자간전기고풍험인소자172례납입무절적조,령외안1:5수궤선취무절적차미발현자간전기고풍험인소자205례납입무절적조,무절적조공377례.채용량독립양본f검험、단인소방차분석、잡방검험(혹Fisher정학개솔법)화Logistic회귀분석진행통계학처리. 결과 유절적조자간전기병사화수진고혈압전기적비례고우무절적조[3.9％(4/101)여0.8％ (3/377),x2=5.52; 42.2％ (43/101)여25.7％ (97/377),x2=10.91;P치균＜0.05].유절적조중24례(23.8％)발생자간전기,무절적조위8례(2.1％)(x2=59.72,P＜0.05).유절적조혈FFA재조발형자간전기、만발형자간전기、임신기고혈압급건강잉부아조간정축점강저추세[분별위(0.68±0.27)、(0.58±0.21)、(0.57±0.21)화(0.49±0.19) mmol/L,F=2.78,P＜0.05].다인소분석현시,자간전기병사(OR=6.77,95％CI:1.03～44.56)화수진고혈압전기(OR=3.34,95％CI:1.59～7.01)시발생자간전기적위험인소.조발형자간전기적위험인소포괄혈FFA(OR=135.68,95％CI:3.78～4 873.00)화자간전기병사(OR=123.25,95％CI:9.27～1 638.00);만발형자간전기적위험인소위수진고혈압전기(OR=4.82,95％CI:1.99～11.65);임신기고혈압적위험인소포괄수진고혈압전기(OR=4.69,95％CI:2.08～10.58)화임신전체중지수24～28 (OR=3.69,95％CI:1.26～10.83).혈압정상반임신기당뇨병적위험인소포괄혈FFA수평승고(OR=9.08,95％CI:2.49～33.01)화임신전BMI≥28(OR=5.08,95％CI:2.16～11.92).결론 임신중기초혈FFA화감유삼지수평여자간전기,우기시조발형자간전기존재상관성;임신중기유혹무자궁동맥서장조기절적도유자간전기발생가능성,존재절적자경역발생조발형자간전기,병차감유삼지수평존재차이급여혈FFA존재상관성,혈지적개변조우절적.
Objective To analyze the heterogeneous variation of serum free fatty acid (FFA) and lipids during early second trimester in women with or without uterine artery notch in pre-eclampsia (PE).Methods This is a prospective cohort study of 4 000 women with singleton pregnancies registered in early pregnancy and in whom regular check-ups were performed in Haidian Maternal & Child Health Hospital.Blood specimens were collected at gestational age 14-18 weeks at the same time of screening for Down's syndrome.One hundred and one cases with early diastolic notch of the uterine artery were included in the N+ group,and 172 cases without notch but at high risk of PE were included in the N-group at 22-24 weeks.In addition,205 women who were selected randomly at a ratio of 1 ∶ 5,without notch or PE high-risk factors,were also included in the N group.Both groups were subgrouped according to the outcomes of pregnancy complications:early-onset PE group EPE,late-onset PE (LPE),gestational hypertension (GH) group,gestational diabetes mellitus (GDM) group with normal blood pressure,and no complications (NC) group.The variation in FFA and other lipid metabolism indicators in the PE subgroups were compared and analyzed by two independent-sample t-test,one-factor analysis of variance,Chi-square test (or Fisher's exact) and Logistic regression.Results History of PE and pre-hypertension at first visit differed significantly between the N+ and N-groups [3.9％ (4/101) vs.0.8％ (3/377),x2=5.52,P＜0.05; pre-hypertension at first visit,42.2％ (43/101) vs.25.7％ (97/377),x2=10.91,P＜0.05].In the N+ group,23.8％ (n=24) of women had PE,of which 37.5％ (n=8) were early onset.In the N group,2.1％ (n=8) had PE,and all were late onset.The incidence of PE differed significantly between the N+ and N-groups (x2=59.72,P＜0.05).In the N+ group,FFA gradually decreased among the ePE,IPE,GH and NC groups [(0.68±0.27),(0.58±0.21),(0.57±0.21) and (0.49±0.19) mmol/L,F=2.78,P＜0.05]; Multivariate regression analysis showed that FFA (OR=135.68,95％CI:3.78-4 873.00) and PE history (OR=123.25,95％CI:9.27-i 638.00) were risk factors of ePE.Pre-hypertension at registration (OR=4.69,95％CI:2.08-10.58) and pre-pregnancy body mass index (BMI) 24-28 (OR=3.69,95％CI:1.26-10.83) were risk factors ofGH.FFA (OR=9.08,95％CI:2.49-33.01) and pre-pregnancy BMI ≥ 28 (OR=5.08,95％CI:2.16-11.92) were risk factors for GDM.Conclusions Serum FFA and TG levels in early second trimester are correlated with PE,especially the early-onset PE.The onset of PE is heterogeneous and affected by many factors,and occurs in patients with or without early diastolic notch of the uterine artery in the second trimester.Patients with notch are more likely to have early-onset PE,which is correlated with blood FFA and TG levels.
