摘要
目的探讨孕期总胆固醇/高密度脂蛋白胆固醇(TC/HDL-C)比值与妊娠期代谢综合征(GMS)发病的相关性及其与妊娠结局的关联。方法收集南京医科大学附属妇产医院2020年1月一2022年12月收治的孕晚期诊断患有GMS的153例孕产妇(观察组)的临床资料,并随机抽取153例健康孕产妇(对照组)资料进行对照研究。观察两组孕产妇的指标并进行比较,分别通过多元线性回归和限制性立方样条分析孕早期和孕中期TC/HDL-C比值与孕晚期代谢指标和GMS风险的相关性,并根据不同TC/HDL-C比值下CMS孕妇的妊娠结局,分析TC/HDL-C比值与早产亚型间的关联。结果两组年龄、孕周、孕前BMI、孕期增重、孕晚期腹围、是否顺产分娩、早产史、剖宫产史、流产史、新生儿出生体重及新生儿身长比较差异均有统计学意义(均P<0.05)。两组孕中期和孕晚期血压及BMI比较差异均有统计学意义(均P<0.01)。孕早期(孕周<14周),两组空腹血糖(FPG)、HDL-C和TC/HDL-C比值比较差异均有统计学意义(均P<0.05)。孕中期(孕周14~27周)和孕晚期(孕周≥28周),观察组孕妇FPG、空腹胰岛素(FINS)、甘油三酯(TG)、TC、LDL-C、TC/HDL-C比值均高于对照组,HDL-C均低于对照组(均P<0.05)。两组孕妇产后血压异常、BMI异常、糖代谢异常、脂代谢异常情况比较差异有统计学意义(均P<0.05)。在调整年龄、孕周、BMI因素后,孕早期TC/HDL-C比值与孕晚期FPG、收缩压、舒张压、TG、TC、HDL-C相关(均P<0.05),孕中期TC/HDL-C比值与孕晚期FPG、FINS、收缩压、舒张压、TG、TC、HDL-C和低密度脂蛋白胆固醇(LDL-C)相关(均P<0.05),且与孕晚期GMS风险均呈线性关系(P趋势<0.01)。TC/HDL-C比值与早产率呈正相关(RR>1)。结论TC/HDL-C比值升高与GMS发生密切相关,易引发早产,并影响胎儿生长发育。
Objective To explore the correlation between the total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C)ratio during pregnancy and the onset of gestational metabolic syndrome(GMS),as well as its association with pregnancy outcomes.Methods Clinical data of 153 pregnant women diagnosed with GMS in the third trimester admitted to Women's Hospital of Nanjing Medical University from January 2020 to December 2022(observation group)were collected,and data of 153 healthy pregnant women(control group)were randomly selected for a comparative study.Indicators of the two groups were observed and compared.Multiple linear regression and restricted cubic spline analysis were used to analyze the correlation between TC/HDL-C in the first and second trimesters and metabolic indicators in the third trimester and GMS risk,respectively.According to the pregnancy outcomes of CMS pregnant women with different TC/HDL-C ratios,the association between TC/HDL-C ratio and preterm birth subtypes was analyzed.Results There were statistically significant differences between the two groups in age,gestational week,pre-pregnancy body mass index(BMI),weight gain during pregnancy,abdominal circumference in the third trimester,whether to deliver vaginally,history of preterm birth,history of cesarean section,history of abortion,neonatal birth weight,and neonatal length(all P<0.05).There were statistically significant differences in blood pressure and BMI between the two groups in the second and third trimesters(all P<0.01).In the first trimester(gestational week<14 weeks),there were statistically significant differences in fasting plasma glucose(FPC),HDL-C,and TC/HDL-C ratio between the two groups(all P<0.05).In the second trimester(gestational weeks 14-27)and third trimester(gestational week≥28 weeks),the levels of FPG,fasting insulin(FINS),triglyceride(TG),TC,low-density lipoprotein cholesterol(LDL-C),and TC/HDL-C ratio in the observation group were higher than those in the control group,while HDL-C was lower(all P<0.05).There were statistically significant differences between the two groups in postpartum abnormal blood pressure,abnormal BMI,abnormal glucose metabolism,and abnormal lipid metabolism(all P<0.05).After adjusting for age,gestational week,and BMI,first-trimester TC/HDL-C ratio was correlated with third-trimester FPG,systolic blood pressure,diastolic blood pressure,TG,TC,and HDL-C(all P<0.05);second-trimester TC/HDL-C ratio was correlated with third-trimester FPG,FINS,systolic blood pressure,diastolic blood pressure,TG,TC,HDL-C,and LDL-C(all P<O.05),and both were linearly related to third-trimester GMS risk(Plornd<O.O1).The TC/HDL-C ratio was positively correlated with the preterm birth rate(RR>1).ConclusionsAAn increased TC/HDL-C ratio is closely related to the occurrence of GMS,which is prone to cause preterm birth and affect fetal growth and development.
作者
邰雯
吴虹
汤秋勤
王婧
Tai Wen;Wu Hong;Tang Qiuqin;Wang Jing(Department of Obstetrics,Women's Hospital of Nanjing Medical University(Nanjing Women and Children's Healthcare Hospital),Nanjing 210004,China)
出处
《中国医师杂志》
2025年第8期1167-1173,共7页
Journal of Chinese Physician
基金
国家自然科学基金(81971405)。
关键词
总胆固醇
高密度脂蛋白胆固醇
妊娠期代谢综合征
妊娠结局
Total cholesterol
High-density lipoprotein cholesterol
Gestational metabolic syndrome
Pregnancy outcome
