摘要
目的探讨妊娠不同时期血脂参考值范围,为临床监控妊娠妇女血脂提供参考。方法选取2014年6—12月在本院建档并系统孕检的足月单胎孕妇2336例作为研究对象。将其中的1045例正常孕妇血脂排序,求出相应百分位数。总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)和低密度脂蛋白(low-density lipoprotein,LDL)取单侧上限第95百分位数(P95),高密度脂蛋白(high-density lipoprotein,HDL)取单侧下限第5百分位数(P5)作为异常临界值。将经单因素logistic回归模型分析得出的和孕期血脂具有相关性疾病的病例综合作为研究对象,求出总符合率π。将得出最佳符合率百分位数的具体血脂值作为最佳边缘异常临界值,结合异常临界值,建立妊娠期血脂参考值区间(正常范围、边缘异常范围、异常范围)。结果适合本地区的正常妊娠妇女早中晚期的血脂参考值范围如下。孕早期的TC正常范围、边缘异常范围和异常范围分别为<4.93mmol/L、4.93~5.70mmol/L和>5.70mmol/L;TG的正常范围、边缘异常范围和异常范围分别为<1.68mmol/L、1.68~2.18mmol/L和>2.18mmol/L;HDL的正常范围、边缘异常范围和异常范围分别为>1.55mmol/L、1.28~1.55mmol/L和<1.28mmol/L;LDL的正常范围、边缘异常范围和异常范围分别为<2.96mmol/L、2.96~3.44mmol/L和>3.44mmol/L。孕中期的TC正常范围、边缘异常范围和异常范围分别为<7.17mmol/L、7.17~7.55mmol/L和>7.55mmol/L;TG的正常范围、边缘异常范围和异常范围分别为<2.56mmol/L、2.56~4.20mmol/L和>4.20mmol/L;HDL的正常范围、边缘异常范围和异常范围分别为>1.75mmol/L、1.36~1.75mmol/L和<1.36mmol/L;LDL的正常范围、边缘异常范围和异常范围分别为<4.99mmol/L、4.99mmol/L和>4.99mmol/L。孕晚期的TC正常范围、边缘异常范围和异常范围分别为<7.95mmol/L、7.95mmol/L和>7.95mmol/L;TG的正常范围、边缘异常范围和异常范围分别为<3.64mmol/L、3.64~5.47mmol/L和>5.47mmol/L;HDL的正常范围、边缘异常范围和异常范围分别为>1.65mmol/L、1.31~1.65mmol/L和<1.31mmol/L;LDL的正常范围、边缘异常范围和异常范围分别为<5.17mmol/L、5.17mmol/L和>5.17mmol/L。结论孕期血脂指标多为偏态性分布,宜采用百分位数法确定异常值范围。将相关性疾病作为研究对象,确定医学范畴上的临界值,并建立边缘异常区间,可以提高临床医师对血脂异常可疑者的重视程度,适时给予一定的临床干预。
Objective The purpose is to explore the parameter value of blood lipid in various gestation periods, and to provide reference for clinical monitoring. Method Among 2336 full-term pregnant women with singleton in our hospital from June to December in 2014, the 1045 cases were sequenced in blood lipid level of normal pregnant women, and their corresponding percentiles were determined. The 95th percentiles of distributions for TC, TG, LDL and the 5th percentiles of distributions for HDL were considered as the abnormal critical value. By integrating the correlative cases of pregnancy blood lipids in the analysis of single factor logistic regression, the objects were determined and the corresponding total coincidence rates （π） were respectively calculated. Specific blood lipids in percentile at the optimal coincidence rate was considered as the optimal critical value, thus to establish the normal reference value range of blood lipids. Result The normal range, the margin anomaly range and the anomaly range of the TC in the early pregnancy were 〈4.93mmol/L, 4.93-5.70mmol/L and〉5.70mmol/L; TG, the normal range, the margin anomaly range and the anomaly range were 〈 1.68 mmol/L, 1.68-2.18mmol/L and 〉2.18mmol/L; HDL, the normal range, the margin anomaly range and the anomaly range were〉 1.55mmol/L, 1.28-1.55mmol/L and 〈 1.28mmol/L; LDL, the normal range, the margin anomaly range and the anomaly range were 〈2.96mmol/L, 2.96-3.44mmol/L and〉3.44mmol/L. The normal range, the margin anomaly range and the anomaly range of the TC in the mid-pregnancy were 〈 7.17mmol/L, 7.17-7.55mmol/L and 〉7.55mmol/L; TG, the normal range, the margin anomaly range and the anomaly range were 〈2.56mmol/L, 2.56-4.20mmol/L and 〉4.20mmol/L; HDL, the normal range, the margin anomaly range and the anomaly range were 〉 1.75mmol/L, 1.36-1.75mmol/L and 〈 1.36mmol/L; LDL, the normol range, the margin anomaly range and the anomaly range were 〈4.99mmol/L, 4.99mmol/L and 〉4.99mmol/L. The normal range, the margin anomaly range and the anomaly range of TC in late pregnancy were 〈7.95mmol/L, 7.95mmol/L and 〉7.95mmol/L; TG, the normal range, the margin anomaly range and the anomaly range were 〈3.64mmol/L, 3.64- 5.47mmol/L and 〉5.47mmol/L; HDL were 〉 1.65mmol/L, 1.31-1.65mmol/L and 〈 1.31mmol/L; LDL were 〈5.17mmol/L, 5.17mmol/L and 〉 5.17mmol/L. Conclusion Blood lipid levels in pregnancy are normally characterized by the skewness of distribution, thus percentile method is preferably adopted to determine abnormal range. By considering correlative diseases as research subjects, determining critical values in medical terms and establishing edge anomaly range, the awareness of clinicians towards suspicious patients is raised and medical interference is timely given.
作者
孟彤
孟文颖
王娟
韩娜
周丽
MENG Tong;MENG Wen-ying;WANG Juan;HANNa;ZHOU Li(Department of Obstetric,Tongzhou Maternal ＆ Child Health Hospital of Beij＇ing,Beij＇ing 101101,China)
出处
《中国医刊》
CAS
2018年第9期1009-1014,共6页
Chinese Journal of Medicine
基金
2014年度首都卫生发展科研专项项目基金资助(首发2014-4-7084)
关键词
妊娠
血脂
参考值
Pregnancy
Blood lipid
Parameter value
