Lippi Giuseppe, Albiero Alessandro, Montagnana Martina, Salvagno Gian Luca, Scevarolli Silvia, Franchi Massimo, Guidi Gian Cesare
Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università di Verona, Italy.
Clin Lab. 2007;53(3-4):173-7.
Physiologic pregnancy is associated with a broad series of metabolic adaptations which may also influence the metabolism of lipids and lipoproteins. Although the modification of serum lipids and lipoproteins has been exhaustively investigated during and after pregnancy, the relative changes recorded vary widely among the different studies. A comprehensive lipid and lipoprotein profile was evaluated in 57 women with uncomplicated pregnancies at different gestational ages (20 in the first, 20 in the second, and 17 in the third trimester of pregnancy) and compared to that of 21 non-pregnant women. Conventional lipid parameters, including total cholesterol, high-density lipoprotein cholesterol and triglycerides, were evaluated on the Modular System P. Low-density lipoprotein cholesterol was quantified by the formula of Friedewald, the atherogenic index of plasma was quantified by the formula log (triglycerides/high-density lipoprotein cholesterol), whereas lipoprotein(a) was assayed on the BN II nephelometric analyzer. We observed that all the lipid parameters tested were significantly modified by the gestational age; in particular, women in the second and third trimester displayed significantly increased total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total to high-density lipoprotein cholesterol ratio, lipoprotein(a) and atherogenic index of plasma (third trimester only) when compared to either the control population or the subgroup of women in the first trimester of pregnancy. The value distributions and the relative percentage of women with undesirable or abnormal values according to the current NCEP or AHA/ACC goals were comparable between controls and women in the first trimester. However, when compared with either controls or women in the first trimester, advanced pregnancy was associated with an increased prevalence of undesirable or abnormal values for total cholesterol, low-density lipoprotein cholesterol and triglycerides in the second trimester, and total cholesterol, low-density lipoprotein cholesterol, triglycerides, total to high-density lipoprotein cholesterol ratio and lipoprotein(a) (only from non-pregnant women) in the third trimester. The results of this case-control study demonstrate that physiological pregnancy is associated with a substantial modification of the lipid and lipoprotein metabolism from the second trimester, providing reference ranges for traditional and emerging cardiovascular risk predictors throughout the gestational period.
生理妊娠与一系列广泛的代谢适应相关，这些适应也可能影响脂质和脂蛋白的代谢。尽管在妊娠期间及产后对血清脂质和脂蛋白的改变进行了详尽研究，但不同研究记录的相对变化差异很大。对57例不同孕周（妊娠早期20例、中期20例、晚期17例）无并发症妊娠的妇女进行了全面的脂质和脂蛋白谱评估，并与21例非妊娠妇女进行比较。在Modular System P上评估常规脂质参数，包括总胆固醇、高密度脂蛋白胆固醇和甘油三酯。低密度脂蛋白胆固醇通过Friedewald公式定量，血浆致动脉粥样硬化指数通过公式log（甘油三酯/高密度脂蛋白胆固醇）定量，而脂蛋白(a)在BN II散射比浊分析仪上检测。我们观察到所有检测的脂质参数都随孕周有显著改变；特别是，与对照组或妊娠早期妇女亚组相比，妊娠中期和晚期妇女的总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、总胆固醇与高密度脂蛋白胆固醇比值、脂蛋白(a)以及血浆致动脉粥样硬化指数（仅晚期）显著升高。根据当前美国国家胆固醇教育计划（NCEP）或美国心脏协会/美国心脏病学会（AHA/ACC）目标，对照组和妊娠早期妇女中具有不良或异常值的妇女的数值分布及相对百分比相当。然而，与对照组或妊娠早期妇女相比，妊娠晚期时，妊娠中期总胆固醇、低密度脂蛋白胆固醇和甘油三酯出现不良或异常值的患病率增加，妊娠晚期总胆固醇、低密度脂蛋白胆固醇、甘油三酯、总胆固醇与高密度脂蛋白胆固醇比值以及脂蛋白(a)（仅非妊娠妇女）出现不良或异常值的患病率增加。这项病例对照研究结果表明，从妊娠中期开始，生理妊娠与脂质和脂蛋白代谢的显著改变相关，为整个孕期传统和新出现的心血管风险预测指标提供了参考范围。
