妊娠早期同型半胱氨酸和血脂水平对重度子痫前期的预测价值

目的：探讨妊娠早期血清同型半胱氨酸（Hcy）和血脂水平对重度子痫前期（sPE）的预测价值。方法：采用病例对照研究，选取2016年1月-2016年10月在我院建卡正规产检并最终分娩的孕妇为研究对象，妊娠早期（11～12周）抽取空腹血检查Hcy、叶酸、维生素B12（VB12）和血脂[三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、脂蛋白a（Lip a）、载脂蛋白A1（Apo-A1）和Apo-B]水平，sPE患者74例（sPE组），同期正常妊娠、血压正常、无孕期并发症且足月分娩正常胎儿的75例孕妇作为对照组。比较2组孕妇的Hcy、叶酸、VB12及血脂水平，对差异有统计学意义的标志物进行Logistic回归分析并分析其预测sPE发生的价值。结果：sPE组孕妇年龄、体质量指数（BMI）大于对照组，初产妇比例较对照组多，差异有统计学意义（均P＜0.05），sPE组分娩孕周及新生儿出生体质量小于对照组，差异有统计学意义（均P＜0.05）。sPE组Hcy、TG、Apo-B高于对照组，差异有统计学意义（均P＜0.05），sPE组叶酸水平低于对照组，差异有统计学意义（P＜0.05）。Logistic回归分析发现年龄和Hcy是发生sPE的危险因素（OR分别为1.11和 2.04，P＜0.05）。单独各指标预测sPE发生的ROC曲线下面积（AUC）在0.600～0.693之间，以Hcy的AUC最高（AUC=0.693，P＜0.001，95%CI：0.607～0.779）。采用联合检测的方法（Hcy+TG+Apo-B+叶酸+年龄+BMI）的AUC为0.777（P＜0.001，95%CI：0.704～0.851）。结论：孕妇年龄大及妊娠早期Hcy增高是sPE发生的独立危险因素。妊娠早期联合检测Hcy及TG等多项指标可提高预测sPE发生风险的价值。

Maternal Serum Homocysteine and Lipids in First Trimester for Prediction of Severe Preeclampsia

Objective：To obtain the predictive value of serum homocysteine and lipid concentrations in first trimester for severe preeclampsia. Methods：This was a case-control study, selecting pregnant women underwent regular birth and delivery in our hospital from January 2016 to October 2016 as the research objects，74 severe preeclampsia and 75 uncomplicated singleton pregnancies were enrolled. The maternal serum Hcy, folic acid, VB12, TC, TG, LDL, HDL, Apo-A1, Apo-B and Lip a were tested in first trimester (11th to 12th week). Maternal characteristics and pregnancy outcome were collected for each individual woman. Logistic regression model was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI). Receiver operating curve (ROC) analysis and the area under ROC curve (AUC) was used to indicate the best model for prediction. Results：There was significant differences in maternal age, BMI, gestational weeks and birth weight between two groups (P＜0.05). Women who subsequently developed severe preeclampsia had higher concentrations of Hcy, TG, and Apo-B than control subjects (P＜0.05). The folic acid concentrations were lower in women with severe preeclampsia than that in control subjects (P＜0.05). Logistic regression revealed age and Hcy were risk factors for severe preeclampsia. The OR was 1.11 and 2.04 respectively (P＜0.05). AUC of individual marker is among 0.600~0.693. Hcy was the highest（AUC=0.693, P＜0.001, 95%CI: 0.607~0.779）. AUC of multiple markers (TG+Apo-B+folic acid+Hcy+age+BMI) was 0.777 (P＜0.001, 95%CI: 0.704~0.851). Conclusions：Advanced age and first-trimester high homocysteine are the risk factors for severe preeclampsia. First-trimester Hcy and TG combined with maternal characteristics are promising markers in the risk assessment of severe preeclampsia.