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 PDF全文下载地址:
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