载脂蛋白A与子痫前期孕妇糖脂代谢紊乱及妊娠结局的关联性研究

Association of apolipoprotein A with glucose and lipid metabolism disorders and pregnancy outcomes in pregnant women with preeclampsia

摘要

目的 探讨载脂蛋白A(ApoA)与子痫前期(PE)患者糖脂代谢紊乱及妊娠结局的关联。方法 回顾性选择2023年1月至2024年6月河北中石油中心医院收治的230例子痫前期孕妇患者,根据糖脂代谢情况分成糖脂代谢正常组(n=123)和糖脂代谢异常组(n=107),收集两组患者的一般资料.多元线性回归分析ApoA与糖脂代谢指标的关系;Logistic回归分析ApoA与糖脂代谢紊乱的相关性.再根据妊娠结局分成良好妊娠结局组(n=162)和不良妊娠结局组(n=68),多因素Logistic回归分析患者不良妊娠结局的影响因素;构建中介效应模型,分析糖脂代谢紊乱对ApoA与PE患者妊娠结局之间关系的影响;基于限制性立方样条模型分析ApoA与不良妊娠结局发生的剂量-反应关系;Log-binomial回归分析PE患者ApoA与不良妊娠结局及其亚型的关联。结果 随着ApoA水平升高,空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA₁c)升高(β>0,P<0.05),低密度脂蛋白胆固醇(LDL-C)降低(β<0,P<0.05);ApoA与糖脂代谢紊乱密切相关(P趋势<0.05).ApoA、FPG、HDL-C、LDL-C和HbA₁c是患者不良妊娠结局的影响因素(OR值分别为2.875、3.821、3.335、3.289、1.793,P<0.05);糖脂代谢紊乱在ApoA与PE患者妊娠结局之间的中介效应显著(β=0.638,P<0.001).ApoA与不良妊娠结局发生大致呈显著的负相关,特别当ApoA<1.43mg/L时,随着ApoA降低,不良妊娠结局的风险显著上升.PE孕妇不良妊娠结局发生率为29.57%,其中ApoA低水平孕妇占比88.24%,显著高于ApoA高水平孕妇(11.76%),ApoA水平与各不良妊娠结局发生率负相关(RR<1)。结论 ApoA水平的降低与PE孕妇糖脂代谢紊乱的发生密切相关,易增加不良妊娠风险.

Abstract

Objective To investigate the association between apolipoprotein A (ApoA) and glucose and lipid metabolism disorders and pregnancy outcomes in patients with preeclampsia (PE). Methods A total of 230 pregnant women with preeclampsia admitted to Hebei PetroChina Central Hospital from January 2023 to June 2024 were retrospectively selected, and they were divided into normal glucose and lipid metabolism group (n=123) and abnormal glucose and lipid metabolism group (n=107) according to glucose and lipid metabolism, and the general data of the two groups were collected. Multiple linear regression analysis was used to analyze the relationship between ApoA and glycolipid metabolism indexes. Logistic regression analysis analyzed the correlation between ApoA and glucose and lipid metabolism disorders. According to the pregnancy outcomes, patients were divided into good pregnancy outcome group (n=162) and adverse pregnancy outcome group (n=68), and the influencing factors of adverse pregnancy outcomes were analyzed by multivariate logistic regression. A mediating effect model was constructed to analyze the effect of glucose and lipid metabolism disorders on the relationship between ApoA and pregnancy outcomes in PE patients. Based on the limiting cubic spline model, the dose-response relationship between ApoA and adverse pregnancy outcomes was analyzed. Log-biological regression analysis was used to analyze the association of ApoA with adverse pregnancy outcomes and its subtypes in PE patients. Results With the increase of ApoA level, fasting plasma glucose (FPG), fasting insulin (FINS), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and glycosylated hemoglobin (HbA₁c) increased (β>0, P<0.05), and low-density lipoprotein cholesterol (LDL-C) decreased (β<0, P<0.05). ApoA was closely related to glucose and lipid metabolism disorders (P trend<0.05). ApoA, FPG, HDL-C, LDL-C and HbA₁c were the influencing factors of adverse pregnancy outcomes (OR values were 2.875, 3.821, 3.335, 3.289 and 1.793, P<0.05), respectively, and glucose and lipid metabolism disorders had a significant mediating effect on pregnancy outcomes between ApoA and PE patients (β=0.638, P<0.001). ApoA was significantly negatively associated with adverse pregnancy outcomes, especially when ApoA<1.43mg/L, and the risk of adverse pregnancy outcomes increased significantly as ApoA decreased. The incidence of adverse pregnancy outcomes in pregnant women with PE was 29.57%, of which 88.24% were pregnant women with low ApoA level, which was significantly higher than that of pregnant women with high ApoA level (11.76%), and ApoA level was negatively correlated with the incidence of adverse pregnancy outcomes (RR<1). Conclusion The decrease of ApoA level is closely related to the occurrence of glucose and lipid metabolism disorders in pregnant women with PE, which can easily increase the risk of adverse pregnancy.

关键词

载脂蛋白A / 子痫前期 / 糖脂代谢紊乱 / 妊娠结局

Key words

apolipoprotein A / preeclampsia / glucose and lipid metabolism disorder / pregnancy outcome

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