子痫前期患者维生素D水平与糖脂代谢的关系及在妊娠结局中的相互关系

The relationship between vitamin D levels and glucose and lipid metabolism in patients with preeclampsia and their correlation in pregnancy outcomes

摘要

目的 探究子痫前期(PE)患者维生素D水平与糖脂代谢的关系及在妊娠结局中的相互关系.方法 选择2021年1月至2023年1月长治医学院附属和平医院收治的256例PE孕妇作为研究对象,根据维生素D水平分为维生素D正常组(n=41)、维生素D不足组(n=87)和维生素D缺乏组(n=128).比较所有孕妇的一般资料、糖脂代谢水平、妊娠结局差异;随访孕妇至分娩,观察所有孕妇的妊娠结局并进行评估与统计.利用分层交互检验分析血清维生素D水平与糖脂水平间的关系.采用相加、相乘交互作用模型对危险因素进行分析.结果 维生素D正常组、不足组、缺乏组的PE孕妇孕期增重依次增加,高血压史、糖尿病史、高血脂史占比依次增加,户外活动及每日日晒时长依次减少,差异均有统计学意义(χ²/F值介于12.595~192.598之间,P<0.05);维生素D不足组和维生素D缺乏组的血糖参数糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹血清胰岛素(FINS)、平均血糖(MBG)、血糖标准差(SDBG)、血糖波动频数(NEGE)、稳态模式评估胰岛素抵抗指数(HOMA-IR),以及血脂参数总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、游离脂肪酸(FFA)、载脂蛋白B(ApoB)均高于维生素D水平正常组,维生素D缺乏组的HbA1c、MBG、SDBG、NEGE、FFA、ApoB均高于维生素D不足组,差异具有统计学意义(F值介于2.041~14.967之间,P<0.05);分层交互检验作用分析结果显示血清维生素D与糖脂代谢指标之间的关系稳定存在(P交互<0.05);维生素D正常组、不足组、缺乏组的PE孕妇不良妊娠结局发生率依次增加,差异有统计学意义(χ²=74.395,P<0.001);糖脂代谢异常组的PE孕妇不良妊娠结局发生率高于糖脂代谢正常组,差异有统计学意义(χ²=97.480,P<0.001);相加交互作用模型分析表明,维生素D不足与糖脂代谢异常并存时,PE孕妇出现不良妊娠结局的风险是二者均正常的2.206倍,大于两因素单独存在之和;相乘交互作用模型分析结果显示,不同维生素D水平与不同糖脂代谢情况之间存在相乘交互作用(OR值介于2.323~4.780之间,P<0.01).结论 PE患者的低维生素D水平与糖脂代谢异常具有一定相关性,且二者同时存在时,PE孕妇的不良妊娠结局风险显著增加.

Abstract

Objective To explore the relationship between vitamin D level and glucose and lipid metabolism in patients with preeclampsia (PE) and their relationship in pregnancy outcome. Methods A total of 256 pregnant women with PE admitted to the Heping Hospital Affiliated to Changzhi Medical College from January 2021 to January 2023 were selected as the study subjects, and they were divided into normal vitamin D group (n=41), vitamin D deficiency group (n=87) and vitamin D deficiency group (n=128) according to vitamin D levels. The general data, glucose and lipid metabolism levels, and pregnancy outcomes of all pregnant women were compared. Pregnant women were followed up to delivery, and the pregnancy outcomes of all pregnant women were observed, evaluated and statistically counted. A hierarchical interaction test was used to analyze the relationship between serum vitamin D level and glycolipid level. The additive and multiplicative interaction models were used to analyze the risk factors. Results The weight gain of PE pregnant women in the normal vitamin D group, insufficient group and deficient group increased in pregnancy, the proportion of hypertension, diabetes and hyperlipidemia increased, and the outdoor activities and daily sun exposure duration decreased in turn, and the differences were statistically significant (χ ²/F values ranged from 12.595 to 192.598, P<0.05). The glycemic parameters of vitamin D-deficient group and vitamin D-deficient group were glycosylated hemoglobin (HbA1c), fasting blood glucose (FPG), fasting serum insulin (FINS), mean blood glucose (MBG), standard deviation of blood glucose (SDBG), frequency of blood glucose fluctuations (NEGE), homeostatic mode assessment of insulin resistance index (HOMA-IR), and blood lipid parameters of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), free fatty acids (FFA) and apolipoprotein B (ApoB) were higher than those of the normal vitamin D group, and the HbA1c, MBG, SDBG, NEGE, FFA, and ApoB levels of the vitamin D deficiency group were higher than those of the vitamin D deficiency group, and the difference was statistically significant (F values ranged from 2.041 to 14.967, P<0.05). The results of stratified interaction test showed that the relationship between serum vitamin D and glucose and lipid metabolism indexes was stable (P interaction<0.05). The incidence of adverse pregnancy outcomes in the normal vitamin D group, vitamin D insufficiency group and vitamin D deficiency group increased in sequence, and the difference was statistically significant (χ ²=74.395, P<0.001). The incidence of adverse pregnancy outcomes in PE pregnant women with abnormal glucose and lipid metabolism was higher than that in the normal glucose and lipid metabolism group, and the difference was statistically significant (χ ²=97.480, P<0.001). The results of additive interaction model analysis showed that when vitamin D insufficiency and abnormal glucose and lipid metabolism coexisted, the risk of adverse pregnancy outcomes in pregnant women with PE was 2.206 times higher than that of both normal factors, which was greater than the sum of the two factors alone, and the results of multiplicative interaction model analysis showed that there was a multipliative interaction between different vitamin D levels and different glucose and lipid metabolism (OR values ranged from 2.323 to 4.780, P<0.01). Conclusion Low vitamin D levels in PE patients are associated with abnormal glucose and lipid metabolism, and the risk of adverse pregnancy outcomes in pregnant women with PE is significantly increased when both are present.

关键词

子痫前期 / 维生素D / 糖脂代谢 / 妊娠结局

Key words

preeclampsia / vitamin D / glycolipid metabolism / pregnancy outcome

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