妊娠并发甲减患者血清脂蛋白相关磷脂酶A2水平与母婴预后的相关性分析

目的　探讨血清脂蛋白相关磷脂酶A2（LP-PLA2）水平在妊娠并发甲减患者中的表达，并分析其与母婴预后的关系。方法　选取2018年7月~2020年7月妊娠并发甲减患者105例作为研究对象，其中妊娠并发临床甲减46例作为临床甲减组，妊娠并发亚临床甲减59例作为亚临床甲减组，另选取同期产检健康者50例作为对照组。采用酶联免疫吸附法检测血清LP-PLA2水平，采用全自动生化分析仪检测血清三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平，并记录母婴结局。采用Pearson检验分析妊娠并发甲减患者血清LP-PLA2与血脂水平的相关性；采用ROC曲线分析血清LP-PLA2及血脂水平对妊娠并发甲减患者母婴不良结局的预测价值。结果　三组患者血清LP-PLA2，TG，TC和LDL-C和HDL-C水平比较，差异均有统计学意义（F=31.177，97.170，18.242，25.286和9.423，均P＜0.05）；血清LP-PLA2，TG，TC，LDL-C水平由高到低为临床甲减组、亚临床甲减组、对照组，血清HDL-C水平由高到低为对照组、亚临床甲减组、临床甲减组，两两比较差异均有统计学意义（均P＜0.05）。妊娠并发甲减患者血清LP-PLA2与TG，TC，LDL-C水平均呈正相关（r=0.504，0.481和0.552，均P＜0.05），与HDL-C水平呈负相关（r=-0.433，P＜0.05）。亚临床甲减组和临床甲减组患者总母婴不良结局发生率分别为69.49%和78.26%，均明显高于对照组（32.00%）,差异有统计学意义（均P＜0.05）。母婴不良结局组患者血清LP-PLA2，TG，TC和LDL-C水平均明显高于母婴正常结局组（t=4.389，4.072，2.662，3.099，均P＜0.05），血清HDL-C水平明显低于母婴正常结局组（t=3.131，P＜0.05）。血清LP-PLA2水平预测妊娠并发甲减患者母婴不良结局的价值（曲线下面积0.942，敏感度和特异度分别为85.50%和96.40%）高于血脂指标。结论　妊娠并发甲减患者血清LP-PLA2水平升高，可作为评估母婴不良结局的血清指标。

Correlation between Serum Lipoprotein Associated Phospholipase A2 Level and Maternal and Infant Prognosis in Pregnant Women with Hypothyroidism

Objective　To investigate the expression of serum lipoprotein associated phospholipase A2 (Lp-PLA2) in pregnant women with hypothyroidism and analyze its relationship with the prognosis of mother and infant. Methods　A total of 105 cases of pregnant women with hypothyroidism from July 2018 to July 2020 were selected as the research objects, including 46 cases of pregnant women with hypothyroidism as the clinical hypothyroidism group, 59 cases of pregnant women with subclinical hypothyroidism as the subclinical hypothyroidism group, and 50 healthy persons in the same period were selected as the control group. The level of serum Lp-PLA2 were detected by enzyme-linked immunosorbent assay. The levels of serum triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were detected by automatic biochemical analyzer. Pearson test was used to analyze the correlation between serum Lp-PLA2 and blood lipid levels in patients with Pregnancy complicated with hypothyroidism. ROC curve was used to analyze the predictive value of serum Lp-PLA2 and blood lipid levels in the adverse outcomes of pregnant women ard infants with hypothyroidism. Results　There were significant differences in serum Lp-PLA2, TG, TC, LDL-C and HDL-C levels among the three groups (F = 31.177, 97.170, 18.242, 25.286 and 9.423, all P < 0.05). Serum Lp-PLA2, TG, TC, LDL-C levels from high to low were in clinical hypothyroidism group, subclinical hypothyroidism group and control group, while serum HDL-C level from high to low was in control group, subclinical hypothyroidism group and clinical hypothyroidism group, with statistical significance (P < 0.05). Serum Lp-PLA2 was positively correlated with TG, TC, LDL-C levels ( r = 0.504, 0.481 and 0.552, all P < 0.05), and negatively correlated with HDL-C level in pregnant women with hypothyroidism ( r = -0.433, P < 0.05). The incidence of adverse maternal and infant outcomes in subclinical hypothyroidism group and clinical hypothyroidism group were 69.49% and 78.26%, respectively, which were significantly higher than that in the control group,the differences were stafisti significant-cally(P < 0.05). The levels of serum Lp-PLA2, TG, TC and LDL-C in the group with adverse maternal and infant outcomes were significantly higher than those in the group with normal maternal and infant outcomes ( t = 4.389, 4.072, 2.662, 3.099, all P< 0.05), and the level of serum HDL-C was significantly lower than that in the group with normal maternal and infant outcomes (t = 3.131, P < 0.05). The value of serum Lp-PLA2 level in predicting adverse maternal and neonatal outcomes of pregnant women with hypothyroidism (area under curve: 0.942, sensitivity and specificity were 85.50%, 96.40%,respectively) was higher than that of blood lipid index. Conclusion　The serum Lp-PLA2 level in pregnant women with hypothyroidism was increased, which can be used as a serum index to evaluate the adverse outcomes of mother and infant.