巨大儿孕妇血脂水平变化及其临床意义
发布时间：2018-08-06 09:08
【摘要】：目的:巨大儿是指出生体重达到或超过4000g的新生儿,是常见的产科并发症之一,严重威胁着母婴健康。近年来,随着生活水平的提高,孕期营养过剩问题日趋增多,巨大儿的发生率也逐年上升。加强对巨大儿预测预防是保障母儿安全的关键措施之一。巨大儿的影响因素众多,除了孕期高血糖因素以外,还包括遗传、孕产次、分娩孕周、孕前体重及孕期增重等。由于正常妊娠期常表现为血脂水平升高,而妊娠期血脂水平与胎儿体重关系报道较少。本研究通过对巨大儿孕妇的一般资料及其孕期血脂水平进行分析,探究孕期脂质代谢对巨大儿发生的影响,提高对巨大儿的预测预防水平,减少围产期并发症。方法:回顾性收集2014年1月1日至2014年12月31日于浙江大学医学院附属妇产科医院定期产检并分娩的孕妇,排除非自然受孕、双胎或多胎、低出生体重儿、高血压、糖尿病等合并症及并发症孕妇,共有7310名正常孕妇纳入本次研究,这些孕妇包括巨大儿413例(实验组),正常体重儿6897例(对照组),比较两组年龄、孕产史、孕前BMI、孕期增重、分娩孕周及中孕期和晚孕期血脂水平。实验组再根据年龄、孕产史、孕前BMI、孕期增重进行分组,分别比较各组间的孕期血脂水平。采用二项Logistic回归分析评价各项因素与巨大儿发生的相关性。结果:1.两组一般资料比较:实验组年龄、孕期增重、分娩孕周均大于对照组,分别为 29.5±3.5 岁与 29.1±3.3 岁,16.63±4.44kg 与 14.65±3.93kg,40±1.6 周与 39±1.3周,差异均有统计学意义(P0.05)。实验组与对照组经产妇分别为110例(26.63%)与 1654 例(23.98%),孕前 BMI 分别为 21.41±3.04kg/m2 与 20.69±27.64kg/m2,差异均无统计学差异(P0.05)。2.两组孕期血脂比较:实验组中、晚孕期TG均高于对照组,分别为2.32±0.85mmol/L 与 2.15±0.84mmol/L,3.85±1.70mmol/L 与 3.32±1.65mmol/L;而实验组中、晚孕期HDL均低于对照组,分别为2.29±0.48mmol/L与2.41± 0.66mmol/L,1.94±0.46mmol/L 与 2.15±0.59mmol/L,差异均有统计学意义(P0.05)。两组间中、晚孕期TC与LDL的差异均无统计学意义(P0.05)。3.巨大儿孕妇年龄与血脂的关系:实验组按年龄分为25岁组、25-29岁组、30-34岁组和35岁四组,35岁组中孕期TG为2.72±0.83mmol/L,高于25岁组、25-29岁组与30-34岁组;而30-34岁组中孕期TG为2.39±1.00mmol/L,高于25岁组,差异均有统计学意义(P0.05)。35岁组与30-34岁组晚孕期TG分别为 4.06±1.92mmol/L 与 4.49±1.80mmol/L,均高于25 岁组与 25-29 岁组,差异均有统计学意义(P0.05)。4.巨大儿孕妇孕产史与血脂的关系:将实验组分为初产妇和经产妇,经产妇中孕期TG高于初产妇,分别为2.49±0.97mmol/L与2.25±0.79mmol/L,差异有统计学意义(P0.05)。而晚孕期TG差异无统计学意义(P0.05)。5.巨大儿孕妇孕前BMI和孕期增重与血脂的关系:将实验组按孕前BMI水平分为消瘦组、正常组、超重组和肥胖组,比较四组间孕期血脂水平,结果表明差异均无统计学意义(P0.05)。另将实验组按照孕期增重情况分为GWG过少组、GWG适宜组、GWG过多组,比较三组间孕期血脂水平,结果表明也均无统计学差异(P0.05)。6.巨大儿的相关因素分析:经logistic分析表明,年龄(OR=1.072,95%CI 1.040-1.105,P0.05),孕期增重(OR=1.108,95%CI 1.083-1.134,P0.05),分娩孕周(OR=1.676,95%CI 1.521-1.847,P0.05)、晚孕期 TG(OR=1.067,95%CI 1.011-1.127,P0.05)、晚孕期 HDL(OR=0.496,95%CI 0.372-0.660,P0.05)均是巨大儿的独立影响因素。结论:1.随着孕妇年龄、孕期增重、分娩孕周、孕期TG增加,巨大儿发生率增加;2.巨大儿孕妇TG与年龄及孕产次相关,高龄经产妇有较高的TG;3.在正常妊娠中,年龄、孕期增重、分娩孕周及晚孕期TG水平是巨大儿的危险因素,而晚孕期HDL水平是巨大儿的保护因素;4.孕期加强营养管理、控制体重过度增长、降低血脂水平、适时终止妊娠均有利于降低巨大儿的发生率,保障母婴健康。
[Abstract]:Objective: gigantic infant is one of the most common obstetric complications, which is one of the common obstetric complications, which is one of the common obstetric complications. In recent years, with the improvement of the living standard, the problem of excess nutrition in pregnancy is increasing, and the incidence of giant children is increasing year by year. Strengthening the prediction and prevention of giant children is the key to ensure the safety of mother and child. One of the key measures. There are many factors affecting the great children. Besides the pregnancy hyperglycemia factors, it includes heredity, pregnancy, pregnancy, pregnancy weight and weight gain during pregnancy. Due to normal pregnancy, the level of blood lipid is often elevated, but the relationship between the level of blood lipid and fetal weight in pregnancy is less. The general data and the level of blood lipid during pregnancy were analyzed to explore the effect of lipid metabolism on the occurrence of giant infants, to improve the prediction and prevention level of the giant infants and to reduce the perinatal complications. Methods: a retrospective collection of pregnant women from January 1, 2014 to December 31, 2014 at the affiliated gynecologic and obstetrics hospital of the Medical College of Zhejiang University was collected and delivered regularly. Excluding unnatural pregnancy, double or multiple births, low birth weight infants, hypertension, diabetes and other complications and complications, 7310 normal pregnant women were included in this study, including 413 cases of large infants (experimental group), 6897 normal weight infants (control group), two groups of age, pregnancy history, pre pregnancy BMI, weight gain during pregnancy, pregnancy week and pregnancy. The level of blood lipid in the middle pregnancy and the late pregnancy. The experimental group was divided into groups according to age, pregnancy history, pre pregnancy BMI and pregnancy weight gain. The blood lipid levels in pregnancy were compared respectively. Two Logistic regression analysis was used to evaluate the correlation between the factors and the occurrence of gigantic infants. Results: the general data of the 1. two groups were compared: the age of the experimental group, the weight gain during pregnancy and childbirth. The gestational weeks were 29.5 + 3.5 years old and 29.1 + 3.3 years old, 16.63 + 4.44kg and 14.65 3.93kg, 40 + 1.6 weeks and 39 + 1.3 weeks, the difference was statistically significant (P0.05). The experimental group and the control group were 110 (26.63%) and 1654 cases (23.98%) respectively. The difference between pre pregnancy and pre pregnancy was 3.04kg/m2 and 27.64kg/m2, respectively. No statistical difference (P0.05).2. two groups during pregnancy blood lipid comparison: in the experimental group, the late pregnancy TG was higher than the control group, 2.32 + 0.85mmol/L and 2.15 + 0.84mmol/L, 3.85 + 1.70mmol/L and 3.32 + 1.65mmol/L, while in the experimental group, the late pregnancy HDL was lower than the control group, 2.29 + 0.48mmol/L and 2.41 + 0.66mmol/L, 1.94 + 0.46mmol/L and 2, respectively. .15 + 0.59mmol/L, the difference was statistically significant (P0.05). There was no significant difference between TC and LDL during the late pregnancy (P0.05) the relationship between age and blood lipid in pregnant.3. giant infants: the experimental group was divided into 25 year old group, 25-29 year old group, 30-34 year old group and 35 year old four group, and 35 year old group during pregnancy TG was 2.72 + 0.83mmol/L, higher than the 25 year old group, 25-29 years old group. In the 30-34 year old group, the TG in the 30-34 year old group was 2.39 + 1.00mmol/L, which was higher than that in the 25 year old group. The difference was statistically significant (P0.05) and TG was 4.06 + 1.92mmol/L and 4.49 + 1.80mmol/L in the late pregnancy of the 30-34 year old group. The difference was statistically significant (P0.05) the maternal history and blood lipid of the pregnant women of.4. gigantic infants. Relationship: the experimental group was divided into primipara and parturients. The TG in pregnant women was 2.49 + 0.97mmol/L and 2.25 + 0.79mmol/L during pregnancy, and the difference was statistically significant (P0.05). There was no statistical significance (P0.05) the relationship between pre pregnancy BMI and gestational weight gain of pregnant women with.5. in pregnant women (P0.05) in the late pregnancy (P0.05): the experimental group was divided according to the level of pre pregnancy BMI. For the thinner group, the normal group, the super recombination and the obese group, the blood lipid levels were compared between the four groups. The results showed that the difference was not statistically significant (P0.05). In addition, the experimental group was divided into GWG group according to the weight gain of pregnancy, GWG suitable group and GWG group, and compared the level of blood lipid in pregnancy between the three groups, the results showed no statistical difference (P0.05).6. giant. Analysis of related factors: logistic analysis showed that age (OR=1.072,95%CI 1.040-1.105, P0.05), pregnancy weight gain (OR=1.108,95%CI 1.083-1.134, P0.05), birth gestational week (OR=1.676,95%CI 1.521-1.847, P0.05), TG (OR=1.067,95%CI), and late pregnancy were both the independence of the giant children. Conclusions: 1. with the age of pregnant women, weight gain during pregnancy, pregnancy week, TG in pregnancy and increased incidence of gigantic infants; 2. pregnant women are related to age and pregnancy and maternal age. The age of pregnant women is higher TG; 3. in normal pregnancy, age, weight gain during pregnancy, pregnancy week and late pregnancy TG level are the risk factors of gigantic infants, and HD in late pregnancy, HD The level of L is the protective factor for the giant infants; in the 4. pregnancy, strengthening the nutrition management, controlling the excessive growth of weight, reducing the level of blood lipid, and ending the pregnancy at the right time are beneficial to reduce the incidence of giant infants and protect the health of mother and child.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.7
，
本文编号：2167234
[Abstract]:Objective: gigantic infant is one of the most common obstetric complications, which is one of the common obstetric complications, which is one of the common obstetric complications. In recent years, with the improvement of the living standard, the problem of excess nutrition in pregnancy is increasing, and the incidence of giant children is increasing year by year. Strengthening the prediction and prevention of giant children is the key to ensure the safety of mother and child. One of the key measures. There are many factors affecting the great children. Besides the pregnancy hyperglycemia factors, it includes heredity, pregnancy, pregnancy, pregnancy weight and weight gain during pregnancy. Due to normal pregnancy, the level of blood lipid is often elevated, but the relationship between the level of blood lipid and fetal weight in pregnancy is less. The general data and the level of blood lipid during pregnancy were analyzed to explore the effect of lipid metabolism on the occurrence of giant infants, to improve the prediction and prevention level of the giant infants and to reduce the perinatal complications. Methods: a retrospective collection of pregnant women from January 1, 2014 to December 31, 2014 at the affiliated gynecologic and obstetrics hospital of the Medical College of Zhejiang University was collected and delivered regularly. Excluding unnatural pregnancy, double or multiple births, low birth weight infants, hypertension, diabetes and other complications and complications, 7310 normal pregnant women were included in this study, including 413 cases of large infants (experimental group), 6897 normal weight infants (control group), two groups of age, pregnancy history, pre pregnancy BMI, weight gain during pregnancy, pregnancy week and pregnancy. The level of blood lipid in the middle pregnancy and the late pregnancy. The experimental group was divided into groups according to age, pregnancy history, pre pregnancy BMI and pregnancy weight gain. The blood lipid levels in pregnancy were compared respectively. Two Logistic regression analysis was used to evaluate the correlation between the factors and the occurrence of gigantic infants. Results: the general data of the 1. two groups were compared: the age of the experimental group, the weight gain during pregnancy and childbirth. The gestational weeks were 29.5 + 3.5 years old and 29.1 + 3.3 years old, 16.63 + 4.44kg and 14.65 3.93kg, 40 + 1.6 weeks and 39 + 1.3 weeks, the difference was statistically significant (P0.05). The experimental group and the control group were 110 (26.63%) and 1654 cases (23.98%) respectively. The difference between pre pregnancy and pre pregnancy was 3.04kg/m2 and 27.64kg/m2, respectively. No statistical difference (P0.05).2. two groups during pregnancy blood lipid comparison: in the experimental group, the late pregnancy TG was higher than the control group, 2.32 + 0.85mmol/L and 2.15 + 0.84mmol/L, 3.85 + 1.70mmol/L and 3.32 + 1.65mmol/L, while in the experimental group, the late pregnancy HDL was lower than the control group, 2.29 + 0.48mmol/L and 2.41 + 0.66mmol/L, 1.94 + 0.46mmol/L and 2, respectively. .15 + 0.59mmol/L, the difference was statistically significant (P0.05). There was no significant difference between TC and LDL during the late pregnancy (P0.05) the relationship between age and blood lipid in pregnant.3. giant infants: the experimental group was divided into 25 year old group, 25-29 year old group, 30-34 year old group and 35 year old four group, and 35 year old group during pregnancy TG was 2.72 + 0.83mmol/L, higher than the 25 year old group, 25-29 years old group. In the 30-34 year old group, the TG in the 30-34 year old group was 2.39 + 1.00mmol/L, which was higher than that in the 25 year old group. The difference was statistically significant (P0.05) and TG was 4.06 + 1.92mmol/L and 4.49 + 1.80mmol/L in the late pregnancy of the 30-34 year old group. The difference was statistically significant (P0.05) the maternal history and blood lipid of the pregnant women of.4. gigantic infants. Relationship: the experimental group was divided into primipara and parturients. The TG in pregnant women was 2.49 + 0.97mmol/L and 2.25 + 0.79mmol/L during pregnancy, and the difference was statistically significant (P0.05). There was no statistical significance (P0.05) the relationship between pre pregnancy BMI and gestational weight gain of pregnant women with.5. in pregnant women (P0.05) in the late pregnancy (P0.05): the experimental group was divided according to the level of pre pregnancy BMI. For the thinner group, the normal group, the super recombination and the obese group, the blood lipid levels were compared between the four groups. The results showed that the difference was not statistically significant (P0.05). In addition, the experimental group was divided into GWG group according to the weight gain of pregnancy, GWG suitable group and GWG group, and compared the level of blood lipid in pregnancy between the three groups, the results showed no statistical difference (P0.05).6. giant. Analysis of related factors: logistic analysis showed that age (OR=1.072,95%CI 1.040-1.105, P0.05), pregnancy weight gain (OR=1.108,95%CI 1.083-1.134, P0.05), birth gestational week (OR=1.676,95%CI 1.521-1.847, P0.05), TG (OR=1.067,95%CI), and late pregnancy were both the independence of the giant children. Conclusions: 1. with the age of pregnant women, weight gain during pregnancy, pregnancy week, TG in pregnancy and increased incidence of gigantic infants; 2. pregnant women are related to age and pregnancy and maternal age. The age of pregnant women is higher TG; 3. in normal pregnancy, age, weight gain during pregnancy, pregnancy week and late pregnancy TG level are the risk factors of gigantic infants, and HD in late pregnancy, HD The level of L is the protective factor for the giant infants; in the 4. pregnancy, strengthening the nutrition management, controlling the excessive growth of weight, reducing the level of blood lipid, and ending the pregnancy at the right time are beneficial to reduce the incidence of giant infants and protect the health of mother and child.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.7
，
本文编号：2167234
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