Saarelainen Heli, Laitinen Tomi, Raitakari Olli T, Juonala Markus, Heiskanen Nonna, Lyyra-Laitinen Tiina, Viikari Jorma Sa, Vanninen Esko, Heinonen Seppo
Department of Obstetrics and Gynecology, Kuopio University Hospital, University of Kuopio, Finland.
Circ J. 2006 Jun;70(6):768-72. doi: 10.1253/circj.70.768.
The purpose of the present study was to investigate pregnancy-related changes in the maternal serum lipid profile and endothelial function.
As part of the population-based, prospective cohort Cardiovascular Risk in Young Finns study conducted in Finland, 57 pregnant Finnish women and 62 control women matched for age and smoking were examined throughout gestation. Serum triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were determined and concomitantly endothelium-dependent brachial artery flow mediated dilation (FMD) was measured by ultrasound. During pregnancy serum TC, LDL-C, HDL-C, TG and very-low-density lipoprotein cholesterol increased significantly when compared with the non-pregnant state (p<0.001 for each) and towards the end of pregnancy (p<0.001, p<0.001, p=0.007, p<0.001, p<0.001). FMD increased towards the end of pregnancy and there was a statistically significant direct correlation between gestational age and FMD% (r=0.345, p=0.010). Brachial artery diameter at rest and FMD% were negatively correlated in pregnant (r=-0.280, p=0.035) and non-pregnant women (r=-0.360, p<0.004). The univariate correlation analysis showed a direct correlation between maternal serum TC (r=0.333, p=0.012) and TG (r=0.366, p=0.006) and FMD%, whereas a negative non-significant correlation was found in non-pregnant women. In a multivariate model, vessel size (beta=-0.436, p=0.001) and TG (beta=0.502, p<0.001) were the most powerful predictors for FMD% in pregnancy, the influence of other lipids was non-significant.
In healthy pregnant women increased gestational age is associated with improved endothelium-dependent vasodilation responses regardless of concurrently appearing lipid changes.
本研究的目的是调查孕妇血清脂质谱和内皮功能与妊娠相关的变化。
作为在芬兰进行的基于人群的前瞻性队列“年轻芬兰人心血管风险研究”的一部分，对57名怀孕的芬兰妇女和62名年龄及吸烟情况相匹配的对照妇女在整个妊娠期进行了检查。测定血清甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C），并同时通过超声测量内皮依赖性肱动脉血流介导的血管舒张（FMD）。与非妊娠状态相比，孕期血清TC、LDL-C、HDL-C、TG和极低密度脂蛋白胆固醇显著升高（各p<0.001），且在妊娠末期升高更明显（p<0.001、p<0.001、p=0.007、p<0.001、p<0.001）。FMD在妊娠末期升高，且孕周与FMD%之间存在统计学上显著的正相关（r=0.345，p=0.010）。妊娠妇女和非妊娠妇女静息时肱动脉直径与FMD%均呈负相关（妊娠妇女r=-0.280，p=0.035；非妊娠妇女r=-0.360，p<0.004）。单变量相关分析显示，孕妇血清TC（r=0.333，p=0.012）和TG（r=0.366，p=0.006）与FMD%呈正相关，而非妊娠妇女中未发现显著的负相关。在多变量模型中，血管大小（β=-0.436，p=0.001）和TG（β=0.502，p<0.001）是孕期FMD%的最强预测因素，其他脂质的影响不显著。
在健康孕妇中，无论同时出现的脂质变化如何，孕周增加都与内皮依赖性血管舒张反应改善有关。
