新疆医科大学学报

目的探究孕妇孕中期血脂水平、血液流变学与妊娠结局的相关性。方法纳入2016年2月—2019年7月于江苏省常州市妇幼保健院和江苏省中西医结合医院产科分娩并且产检资料完整的240例孕产妇。根据是否存在妊娠期并发症将患者分为正常组143例、妊娠期高血压疾病(HDCP)组32例、妊娠期糖尿病(GDM)组65例。比较3组研究对象孕中期血脂指标、血液流变学指标的差异以及不同的妊娠结局;分析孕中期血脂或血液流变学指标异常者与正常者的妊娠结局差异。结果GDM组、HDCP组孕中期低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇(TC)水平均高于正常组,高密度脂蛋白胆固醇(HDL-C)水平低于正常组;血浆黏度(PV)、红细胞压积(HCT)、全血高切粘度(HWBV)、全血低切粘度(LWBV)、血沉(ESR)水平高于正常组;GDM组、HDCP组巨大儿、早产儿、窒息、低体重等不良结局的发生率高于正常组,差异有统计学意义(P<0.05)。而GDM组与HDCP组上述指标差异无统计学意义(P>0.05)。孕中期血脂异常者巨大儿、早产、低体重、窒息发生率较相应指标正常者升高,血液流变学异常者胎儿窘迫、巨大儿、早产、低体重、窒息发生率较相应指标正常者升高,差异均有统计学意义(P<0.05)。结论 GDM、HDCP患者在孕中期可能出现明显的血脂代谢异常或血液流变学紊乱,其最终不良结局的发生风险偏大。应加强对此类群体相关指标的监测,并在必要时采取针对性措施,从而有效保障母婴健康。

Objective To explore the correlation between blood lipid level, hemorheology and pregnancy outcome in the second trimester of pregnancy. Methods 240 pregnant women who delivered in Changzhou Maternal and Child Health Hospital of Jiangsu Province and Jiaangsu intergrated traditional Chinese and Western Medicine Hospital from February 2016 to July 2019 with complete antenatal examination data were included. According to the existence of gestational complications, the patients were divided into three groups: normal group(n=143), HDCP group(n= 32) and gestational diabetes mellitus(GDM) group(n= 65). The differences of blood lipid and hemorheology indexes and different pregnancy outcomes in the second trimester of pregnancy were compared among the three groups, and the pregnancy outcomes of patients with abnormal blood lipid or hemorheology indexes in the second trimester of pregnancy were analyzed. Results In the second trimester of pregnancy, the levels of low density lipoprotein cholesterol(LDL-C), triglyceride(TG) and total cholesterol(TC) in GDM group and HDCP group were higher than those in normal group,while the level of high density lipoprotein cholesterol(HDL-C) was lower than that in normal group, and the levels of plasma viscosity(PV), hematocrit(HCT), whole blood high shear viscosity(HWBV), whole blood low shear viscosity(LWBV) and erythrocyte sedimentation rate(ESR) were higher than those in normal group. The incidences of macrosomia, premature infants, asphyxia and low weight in GDM group and HDCP group were significantly higher than those in normal group. There was no significant difference in the above-mentioned indexes between GDM group and HDCP group(P>0.05). The incidences of macrosomia, preterm delivery, low weight and asphyxia in patients with abnormal blood lipids in the second trimester were higher than those with normal corresponding indexes, and the incidences of fetal distress, macrosomia, preterm delivery, low weight and asphyxia in patients with abnormal hemorheology were significantly higher than those with normal hemorheology(P<0.05). The difference was statistically significant(P<0.05).Conclusion Patients with GDM and HDCP may have obvious abnormal blood lipid metabolism or hemorheology disorder in the second trimester of pregnancy, and the risk of final adverse outcome is high. The monitoring of relevant indicators of such groups should be strengthened, and targeted measures should be taken when necessary, so as to effectively protect maternal and infant health.