Li Juan, Lu Juefei, Wang Mengni, Hu Wen, Jin Neng, Li Xingmiao, Zhao Baihui, Luo Qiong
Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Med (Lausanne). 2021 Dec 1;8:688312. doi: 10.3389/fmed.2021.688312. eCollection 2021.
Maternal lipid profile in second trimester has rarely been investigated in the risk assessment for pre-eclampsia (PE). Since early-onset PE often companied by much worse clinical outcomes, thus, we aimed to evaluate the predictive value of second-trimester maternal lipid profiling for early-onset PE. A prospective cohort study was conducted to measure the second-trimester maternal lipid profile of pregnant women from January to December 2019. The pairwise association between maternal lipid profile and PE onset or pregnancy termination time was quantified. Multiple logistic regression was preformed to define risk factors for early-onset PE, and a nomogram for early-onset PE was developed. The net benefit of our model was evaluated by calibration curve and decision curve analyses. We enrolled 5,908 pregnant women and they were divided into healthy ( = 5,789), late-onset PE ( = 64), and early-onset PE ( = 55) groups. Total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-c) were elevated in patients with PE, while high-density lipoprotein cholesterol (HDL-c) was decreased in patients with PE. TC, TG, and LDL-c were negatively correlated with PE onset time or gestational week at delivery. Receiver operating characteristic curves (ROC) defined the cutoff values of TG and HDL-c, and the final regression model included five statistically significant risk predictors for early-onset PE (maternal age of ≥35 years, multipara, pre-pregnancy body mass index (BMI) ≥25 kg/m, second trimester TG ≥ 2.59 mmol/L and second trimester HDL-c ≤ 2.03 mmol/L. The nomogram had an excellent diagnostic performance (area under the curve = 0.912, sensitivity = 92.7%, and specificity = 76%) and was further validated with good calibration and positive net benefits in a decision curve analysis. An abnormally increased TG concentration and a decreased HDL-c concentration might serve as predictors of early-onset PE. Whether blood lipid-lowering measures can improve severe PE prognosis require further clarification.
孕中期孕妇的血脂水平在子痫前期（PE）风险评估中很少被研究。由于早发型PE往往伴有更差的临床结局，因此，我们旨在评估孕中期孕妇血脂谱对早发型PE的预测价值。进行了一项前瞻性队列研究，以测量2019年1月至12月孕妇的孕中期血脂水平。对孕妇血脂谱与PE发病或妊娠终止时间之间的成对关联进行了量化。进行多因素逻辑回归以确定早发型PE的危险因素，并绘制了早发型PE的列线图。通过校准曲线和决策曲线分析评估了我们模型的净效益。我们纳入了5908名孕妇，她们被分为健康组（n = 5789）、晚发型PE组（n = 64）和早发型PE组（n = 55）。PE患者的总胆固醇（TC）、甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-c）升高，而PE患者的高密度脂蛋白胆固醇（HDL-c）降低。TC、TG和LDL-c与PE发病时间或分娩孕周呈负相关。受试者工作特征曲线（ROC）确定了TG和HDL-c的临界值，最终回归模型包括早发型PE的五个具有统计学意义的风险预测因素（产妇年龄≥35岁、经产妇、孕前体重指数（BMI）≥25 kg/m²、孕中期TG≥2.59 mmol/L和孕中期HDL-c≤2.03 mmol/L）。列线图具有出色的诊断性能（曲线下面积 = 0.912，敏感性 = 92.7%，特异性 = 76%），并在决策曲线分析中通过良好的校准和正净效益得到进一步验证。TG浓度异常升高和HDL-c浓度降低可能是早发型PE的预测指标。血脂降低措施是否能改善重度PE的预后需要进一步阐明。
