25羟维生素D与妊娠期高血压疾病的相关性研究

发布时间：2018-07-21 20:04

【摘要】：目的:1.探讨孕早期、孕晚期血清25羟维生素D水平与妊娠期高血压、子痫前期、重度子痫前期发病的关系,为其预测、预防和治疗提供依据。2.分析孕早期至孕晚期血清25羟维生素D水平变化及该变化与妊娠期高血压疾病发病的关系,以指导孕期合理补充维生素D。方法:选取2015年7月1日至2016年3月1日期间于沈阳市妇婴医院定期产检的孕早期单胎初产孕妇,采集基本信息,排除慢性合并症及内分泌代谢性疾病患者,最终2008人纳入研究。孕周根据孕早期超声核实。分别于8~13+6周、32~36周期间一次产检时留取空腹静脉血3ml,分离出血清后置于-80℃条件下冻存。患者定期产检,根据产检手册以及入院分娩病例等追踪其妊娠结局,随访时间截止到2016年10月31日。根据结局分为妊娠期高血压组(A组)、子痫前期组(B组)、重度子痫前期组(C组)、正常妊娠组(D组)。D组是从结局未患妊娠期高血压疾病的孕妇中随机抽签选取200名组成。四组所有血液样本统一进行血清25羟维生素D水平检测。采用SPSS 21.0软件进行统计分析,应用ANOVA比较多组间差异,采用配对t检验进行组内前后结果比较,采用Logistic回归分析评估25羟维生素D水平预测妊娠期高血压疾病发病的OR值及95%可信区间,P0.05为差异有统计学意义。结果:中途因失访、流产、早产、引产等原因退出或无法追踪妊娠结局者206人,共1802人完成孕早期及孕晚期血样采集。最终妊娠期高血压78人、子痫前期46人、重度子痫前期37人、正常妊娠1641人、子痫0人。最终A组78人、B组46人、C组37人、D组200人。各组研究对象在年龄、孕前BMI、孕次、孕早期采血孕周、孕晚期采血孕周均无明显差异(P0.05)。孕早期血清25羟维生素D水平A、B、C、D组各为17.47±6.41ng/ml、14.33±5.60ng/ml、11.26±4.54ng/ml、18.21±6.73ng/ml。孕晚期血清25羟维生素D水平A、B、C、D组各为20.66±7.06ng/ml、16.54±6.51ng/ml、13.03±5.79ng/ml、21.04±7.63ng/ml。B组、C组分别与D组相比,孕早期、孕晚期血清25羟维生素D水平均显著降低,差异有统计学意义(P0.05)。A组与D组相比,无明显差异(P0.05)。两两比较后发现,A、B、C组孕早期或孕晚期血清25羟维生素D水平均依次递减(P0.05)。各组组内孕早期与孕晚期血清25羟维生素D水平相比,孕晚期均较孕早期升高(P0.05)。当血清25羟维生素D在孕早期或孕晚期处于缺乏(20ng/ml)状态时,C组所占比例最大(89.19%、81.08%),B组、A组次之,D组所占比例最小(66.50%、60.50%);维生素D水平正常者(30~100ng/ml),孕早期或孕晚期所占比例均为最小(7.20%、12.19%)。孕早期血清25羟维生素D水平20ng/ml与≥20ng/ml相比,B、C组发病风险均显著增高(OR值6.84,95%CI1.91-24.53;OR值5.19,95%CI 1.28-21.09)。当孕期血清25羟维生素D水平升高≥5ng/ml时,与升高5ng/ml相比,C组发病风险明显降低,有统计学意义(OR值0.17,95%CI 0.05-0.60)。结论:1.孕早期或孕晚期血清25羟维生素D水平降低均与子痫前期的发病相关,而与妊娠期高血压发病无关。孕早期血清25羟维生素D水平可作为子痫前期发病的一项风险预测指标。2.孕早期血清25羟维生素D水平20ng/ml,是子痫前期发病的独立危险因素。孕早期维生素D缺乏者应当及时补充维生素D。3.血清25羟维生素D水平与妊娠期高血压疾病严重程度呈负相关。4.孕晚期维生素D水平高于孕早期,进行维生素D补充时,孕晚期剂量应当适当调整。5.无论孕早期维生素D水平如何,当孕期血清25羟维生素D水平升高5ng/ml以上时,重度子痫前期发病风险降低。
[Abstract]:Objective: 1. to explore the relationship between the level of serum 25 hydroxyvitamin D in the early pregnancy and the late trimester of pregnancy with pregnancy induced hypertension, preeclampsia and severe preeclampsia, and to provide a basis for the prediction, prevention and treatment of the changes of serum levels of 25 hydroxyvitamin D in the early pregnancy to the late pregnancy and the relationship between this change and the pathogenesis of pregnancy induced hypertension. A reasonable supplement of vitamin D. during pregnancy: a single pregnant early pregnant woman from July 1, 2015 to March 1, 2016 at the maternal and infant hospital of Shenyang city was selected to collect basic information, eliminate chronic complications and the patients with endocrine and metabolic diseases. The final 2008 were included in the study. The gestational weeks were verified by ultrasound at the early stage of pregnancy. Respectively, 8~13+6 Week, 32~36 week, during the period of one time, we left fasting venous blood 3ml, separated the bleeding and put it under the condition of -80 C. The patients were regularly examined, and the pregnancy outcome was traced according to the manual and the hospitalized cases. The outcome was divided into the pregnancy hypertension group (Group A) and the preeclampsia group (group B) according to the outcome. The severe preeclampsia group (group C) and the normal pregnancy group (group D).D were randomly selected 200 women from pregnant women who had no pregnancy induced hypertension. The four groups of all blood samples were unified to test the level of serum 25 hydroxyvitamin D. SPSS 21 software was used for statistical analysis. The difference of multiple groups was compared with ANOVA, and the paired t examination was used. Logistic regression analysis was used to evaluate the OR value and 95% confidence interval of 25 hydroxyvitamin D in predicting the incidence of pregnancy induced hypertension. The difference was statistically significant. Results: 206 people were withdrawn from or unable to track the outcome of pregnancy due to loss of visits, abortion, premature delivery, induction of labor and other reasons. A total of 1802 people completed pregnancy. At the early stage and the late pregnancy blood samples, 78 patients with hypertension, 46 preeclampsia, 37 severe preeclampsia, 1641 normal pregnancy and 0 eclampsia, 78 in group A, 46 in group B, 37 in group C and 200 in group D. There were no significant differences in age, BMI before pregnancy, pregnancy, and early pregnancy, and in the early pregnancy. There was no significant difference between pregnancy and pregnancy (P0.05). The level of serum 25 hydroxyvitamin D in early stage A, B, C, D group were 17.47 + 6.41ng/ml, 14.33 + 5.60ng/ml, 11.26 + 4.54ng/ml, and 25 hydroxyvitamin D level A in the late stage of 18.21 + 6.73ng/ml., 20.66 +, 16.54, 13.03 +, 21.04 + The average D water decreased significantly (P0.05), there was no significant difference between the.A group and the D group (P0.05). 22 compared with the A, B, C group, and the early pregnancy or late pregnancy, the average level of serum 25 hydroxyvitamin D decreased (P0.05). Compared with the serum 25 hydroxyvitamin D levels in the early pregnancy and late pregnancy, the late pregnancy was higher than that in the early pregnancy. High (P0.05). When serum 25 hydroxyvitamin D was in the early stage of pregnancy or late pregnancy (20ng/ml), the proportion of C group was the largest (89.19%, 81.08%), B group, A group, the proportion of D group was the smallest (66.50%, 60.50%); vitamin D level was normal (30~100ng/ml), the proportion of early pregnancy or late pregnancy was the smallest (7.20%, 12.19%). The early pregnancy serum 25 was the lowest (12.19%). The risk of 20ng/ml was significantly higher in B and C group (OR value 6.84,95%CI1.91-24.53; OR value 5.19,95%CI 1.28-21.09) than in C group (OR value 6.84,95%CI1.91-24.53; OR value 5.19,95%CI 1.28-21.09). The risk of 25 hydroxyvitamin D in pregnancy was higher than 5ng/ml. The decrease of serum 25 hydroxyvitamin D levels in early or late pregnancy is associated with preeclampsia and is not related to the onset of pregnancy induced hypertension. The level of serum 25 hydroxyvitamin D in the early pregnancy can be used as a risk predictor of preeclampsia, the level of serum 25 hydroxyvitamin D 20ng/ml at the early stage of pregnancy, which is an independent risk factor for preeclampsia. Vitamin D deficiency in the early pregnancy should supplement vitamin D.3. serum 25 hydroxyvitamin D in time with the severity of pregnancy induced hypertension and the level of vitamin D in late.4. pregnancy is higher than that of early pregnancy. When vitamin D supplementation is supplemented, the late pregnancy dose should be properly adjusted to the level of vitamin D at the early stage of pregnancy and when pregnant blood is in pregnancy. The risk of severe preeclampsia decreased when the level of hydroxyvitamin D 25 increased by more than 5ng/ml.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.246

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