推荐早孕期和中孕期血清脂质的参考值范围：来自中国的回顾性研究。
Recommended reference values for serum lipids during early and middle pregnancy: a retrospective study from China.
机构信息
Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China.
Teaching and Researching office of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China.
出版信息
Lipids Health Dis. 2018 Oct 31;17(1):246. doi: 10.1186/s12944-018-0885-3.
BACKGROUND
Disturbances in maternal lipid metabolism have been shown to increase the risk of adverse pregnancy outcomes. However, there is no consensus as to what constitutes normal maternal lipid values during pregnancy. Thus, the aim of this study was to establish serum lipid reference ranges during early and middle pregnancy.
METHODS
We conducted a retrospective survey in Beijing from 2013 to 2014. A total of 17,610 singleton pregnancies with lipid data from early and middle pregnancy were included. First, after excluding women with adverse pregnancy outcomes, we performed a descriptive analysis of total cholesterol (TC), triglycerides (TG), high-density lipid cholesterol (HDL-C) and low-density lipid cholesterol (LDL-C) levels using means and standard deviations to determine appropriate percentiles. Second, in the total population, we examined the lipid levels in different trimesters with the risk of adverse pregnancy outcomes using categorical analyses and logistic regression models. Third, we determined the lipid reference range in early and middle pregnancy based on the first two results. Finally, based on the reference ranges we determined, we assessed whether the number of abnormal lipid values affected the risk of adverse pregnancy outcomes.
RESULTS
(1) Serum levels of TC, TG, LDL-C and HDL-C all increased significantly from early to middle pregnancy, with the greatest increase in TG. (2) A trend towards an increasing incidence of adverse pregnancy outcomes was observed with increasing levels of TC, TG, and LDL-C and decreasing levels of HDL-C in both early and middle pregnancy. (3) We recommend that serum TC, TG and LDL-C reference values in early and middle pregnancy should be less than the 95th percentiles, whereas that of HDL-C should be greater than the 5th percentile, i.e., in early pregnancy, TC < 5.64 mmol/L, TG < 1.95 mmol/L, HDL-C > 1.23 mmol/L, and LDL-C < 3.27 mmol/L, and in middle pregnancy, TC < 7.50 mmol/L, TG < 3.56 mmol/L, HDL-C > 1.41 mmol/L, and LDL-C < 4.83 mmol/L. (4) Higher numbers out-of-range lipids during early and middle pregnancy were correlated with a higher risk of adverse pregnancy outcomes.
CONCLUSIONS
The reference ranges recommended in this paper can identify pregnant women with unfavourable lipid values.
背景
已证实，母体脂质代谢紊乱会增加不良妊娠结局的风险。然而，目前对于妊娠期间母体脂质的正常值尚无共识。因此，本研究旨在建立早、中期妊娠时的血清脂质参考范围。
方法
我们在北京进行了一项回顾性调查，纳入了 2013 年至 2014 年期间有脂质数据的 17610 例单胎妊娠。首先，排除不良妊娠结局的女性后，我们使用均值和标准差对总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平进行描述性分析，以确定合适的百分位数。其次，在全人群中，我们使用分类分析和逻辑回归模型检查不同孕期的血脂水平与不良妊娠结局的风险。再次，基于前两项结果，确定早、中期妊娠的脂质参考范围。最后，基于我们确定的参考范围，评估异常血脂值的数量是否会影响不良妊娠结局的风险。
结果
（1）TC、TG、LDL-C 和 HDL-C 的血清水平均从早孕期到中孕期显著升高，其中 TG 升高最明显。（2）早、中孕期 TC、TG 和 LDL-C 水平升高和 HDL-C 水平降低与不良妊娠结局发生率呈上升趋势。（3）我们建议早、中期妊娠时 TC、TG 和 LDL-C 的血清参考值应小于第 95 百分位数，而 HDL-C 的参考值应大于第 5 百分位数，即早孕期 TC < 5.64 mmol/L、TG < 1.95 mmol/L、HDL-C > 1.23 mmol/L 和 LDL-C < 3.27 mmol/L，中孕期 TC < 7.50 mmol/L、TG < 3.56 mmol/L、HDL-C > 1.41 mmol/L 和 LDL-C < 4.83 mmol/L。（4）早、中孕期血脂异常的数量越多，不良妊娠结局的风险越高。
结论
本文推荐的参考范围可以识别血脂值不良的孕妇。
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