25羥維生素D與妊娠期高血壓疾病的相關(guān)性研究
發(fā)布時間：2018-07-21 20:04
【摘要】：目的:1.探討孕早期、孕晚期血清25羥維生素D水平與妊娠期高血壓、子癇前期、重度子癇前期發(fā)病的關(guān)系,為其預(yù)測、預(yù)防和治療提供依據(jù)。2.分析孕早期至孕晚期血清25羥維生素D水平變化及該變化與妊娠期高血壓疾病發(fā)病的關(guān)系,以指導(dǎo)孕期合理補(bǔ)充維生素D。方法:選取2015年7月1日至2016年3月1日期間于沈陽市婦嬰醫(yī)院定期產(chǎn)檢的孕早期單胎初產(chǎn)孕婦,采集基本信息,排除慢性合并癥及內(nèi)分泌代謝性疾病患者,最終2008人納入研究。孕周根據(jù)孕早期超聲核實(shí)。分別于8~13+6周、32~36周期間一次產(chǎn)檢時留取空腹靜脈血3ml,分離出血清后置于-80℃條件下凍存。患者定期產(chǎn)檢,根據(jù)產(chǎn)檢手冊以及入院分娩病例等追蹤其妊娠結(jié)局,隨訪時間截止到2016年10月31日。根據(jù)結(jié)局分為妊娠期高血壓組(A組)、子癇前期組(B組)、重度子癇前期組(C組)、正常妊娠組(D組)。D組是從結(jié)局未患妊娠期高血壓疾病的孕婦中隨機(jī)抽簽選取200名組成。四組所有血液樣本統(tǒng)一進(jìn)行血清25羥維生素D水平檢測。采用SPSS 21.0軟件進(jìn)行統(tǒng)計分析,應(yīng)用ANOVA比較多組間差異,采用配對t檢驗(yàn)進(jìn)行組內(nèi)前后結(jié)果比較,采用Logistic回歸分析評估25羥維生素D水平預(yù)測妊娠期高血壓疾病發(fā)病的OR值及95%可信區(qū)間,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:中途因失訪、流產(chǎn)、早產(chǎn)、引產(chǎn)等原因退出或無法追蹤妊娠結(jié)局者206人,共1802人完成孕早期及孕晚期血樣采集。最終妊娠期高血壓78人、子癇前期46人、重度子癇前期37人、正常妊娠1641人、子癇0人。最終A組78人、B組46人、C組37人、D組200人。各組研究對象在年齡、孕前BMI、孕次、孕早期采血孕周、孕晚期采血孕周均無明顯差異(P0.05)。孕早期血清25羥維生素D水平A、B、C、D組各為17.47±6.41ng/ml、14.33±5.60ng/ml、11.26±4.54ng/ml、18.21±6.73ng/ml。孕晚期血清25羥維生素D水平A、B、C、D組各為20.66±7.06ng/ml、16.54±6.51ng/ml、13.03±5.79ng/ml、21.04±7.63ng/ml。B組、C組分別與D組相比,孕早期、孕晚期血清25羥維生素D水平均顯著降低,差異有統(tǒng)計學(xué)意義(P0.05)。A組與D組相比,無明顯差異(P0.05)。兩兩比較后發(fā)現(xiàn),A、B、C組孕早期或孕晚期血清25羥維生素D水平均依次遞減(P0.05)。各組組內(nèi)孕早期與孕晚期血清25羥維生素D水平相比,孕晚期均較孕早期升高(P0.05)。當(dāng)血清25羥維生素D在孕早期或孕晚期處于缺乏(20ng/ml)狀態(tài)時,C組所占比例最大(89.19%、81.08%),B組、A組次之,D組所占比例最小(66.50%、60.50%);維生素D水平正常者(30~100ng/ml),孕早期或孕晚期所占比例均為最小(7.20%、12.19%)。孕早期血清25羥維生素D水平20ng/ml與≥20ng/ml相比,B、C組發(fā)病風(fēng)險均顯著增高(OR值6.84,95%CI1.91-24.53;OR值5.19,95%CI 1.28-21.09)。當(dāng)孕期血清25羥維生素D水平升高≥5ng/ml時,與升高5ng/ml相比,C組發(fā)病風(fēng)險明顯降低,有統(tǒng)計學(xué)意義(OR值0.17,95%CI 0.05-0.60)。結(jié)論:1.孕早期或孕晚期血清25羥維生素D水平降低均與子癇前期的發(fā)病相關(guān),而與妊娠期高血壓發(fā)病無關(guān)。孕早期血清25羥維生素D水平可作為子癇前期發(fā)病的一項(xiàng)風(fēng)險預(yù)測指標(biāo)。2.孕早期血清25羥維生素D水平20ng/ml,是子癇前期發(fā)病的獨(dú)立危險因素。孕早期維生素D缺乏者應(yīng)當(dāng)及時補(bǔ)充維生素D。3.血清25羥維生素D水平與妊娠期高血壓疾病嚴(yán)重程度呈負(fù)相關(guān)。4.孕晚期維生素D水平高于孕早期,進(jìn)行維生素D補(bǔ)充時,孕晚期劑量應(yīng)當(dāng)適當(dāng)調(diào)整。5.無論孕早期維生素D水平如何,當(dāng)孕期血清25羥維生素D水平升高5ng/ml以上時,重度子癇前期發(fā)病風(fēng)險降低。
[Abstract]:Objective: 1. to explore the relationship between the level of serum 25 hydroxyvitamin D in the early pregnancy and the late trimester of pregnancy with pregnancy induced hypertension, preeclampsia and severe preeclampsia, and to provide a basis for the prediction, prevention and treatment of the changes of serum levels of 25 hydroxyvitamin D in the early pregnancy to the late pregnancy and the relationship between this change and the pathogenesis of pregnancy induced hypertension. A reasonable supplement of vitamin D. during pregnancy: a single pregnant early pregnant woman from July 1, 2015 to March 1, 2016 at the maternal and infant hospital of Shenyang city was selected to collect basic information, eliminate chronic complications and the patients with endocrine and metabolic diseases. The final 2008 were included in the study. The gestational weeks were verified by ultrasound at the early stage of pregnancy. Respectively, 8~13+6 Week, 32~36 week, during the period of one time, we left fasting venous blood 3ml, separated the bleeding and put it under the condition of -80 C. The patients were regularly examined, and the pregnancy outcome was traced according to the manual and the hospitalized cases. The outcome was divided into the pregnancy hypertension group (Group A) and the preeclampsia group (group B) according to the outcome. The severe preeclampsia group (group C) and the normal pregnancy group (group D).D were randomly selected 200 women from pregnant women who had no pregnancy induced hypertension. The four groups of all blood samples were unified to test the level of serum 25 hydroxyvitamin D. SPSS 21 software was used for statistical analysis. The difference of multiple groups was compared with ANOVA, and the paired t examination was used. Logistic regression analysis was used to evaluate the OR value and 95% confidence interval of 25 hydroxyvitamin D in predicting the incidence of pregnancy induced hypertension. The difference was statistically significant. Results: 206 people were withdrawn from or unable to track the outcome of pregnancy due to loss of visits, abortion, premature delivery, induction of labor and other reasons. A total of 1802 people completed pregnancy. At the early stage and the late pregnancy blood samples, 78 patients with hypertension, 46 preeclampsia, 37 severe preeclampsia, 1641 normal pregnancy and 0 eclampsia, 78 in group A, 46 in group B, 37 in group C and 200 in group D. There were no significant differences in age, BMI before pregnancy, pregnancy, and early pregnancy, and in the early pregnancy. There was no significant difference between pregnancy and pregnancy (P0.05). The level of serum 25 hydroxyvitamin D in early stage A, B, C, D group were 17.47 + 6.41ng/ml, 14.33 + 5.60ng/ml, 11.26 + 4.54ng/ml, and 25 hydroxyvitamin D level A in the late stage of 18.21 + 6.73ng/ml., 20.66 +, 16.54, 13.03 +, 21.04 + The average D water decreased significantly (P0.05), there was no significant difference between the.A group and the D group (P0.05). 22 compared with the A, B, C group, and the early pregnancy or late pregnancy, the average level of serum 25 hydroxyvitamin D decreased (P0.05). Compared with the serum 25 hydroxyvitamin D levels in the early pregnancy and late pregnancy, the late pregnancy was higher than that in the early pregnancy. High (P0.05). When serum 25 hydroxyvitamin D was in the early stage of pregnancy or late pregnancy (20ng/ml), the proportion of C group was the largest (89.19%, 81.08%), B group, A group, the proportion of D group was the smallest (66.50%, 60.50%); vitamin D level was normal (30~100ng/ml), the proportion of early pregnancy or late pregnancy was the smallest (7.20%, 12.19%). The early pregnancy serum 25 was the lowest (12.19%). The risk of 20ng/ml was significantly higher in B and C group (OR value 6.84,95%CI1.91-24.53; OR value 5.19,95%CI 1.28-21.09) than in C group (OR value 6.84,95%CI1.91-24.53; OR value 5.19,95%CI 1.28-21.09). The risk of 25 hydroxyvitamin D in pregnancy was higher than 5ng/ml. The decrease of serum 25 hydroxyvitamin D levels in early or late pregnancy is associated with preeclampsia and is not related to the onset of pregnancy induced hypertension. The level of serum 25 hydroxyvitamin D in the early pregnancy can be used as a risk predictor of preeclampsia, the level of serum 25 hydroxyvitamin D 20ng/ml at the early stage of pregnancy, which is an independent risk factor for preeclampsia. Vitamin D deficiency in the early pregnancy should supplement vitamin D.3. serum 25 hydroxyvitamin D in time with the severity of pregnancy induced hypertension and the level of vitamin D in late.4. pregnancy is higher than that of early pregnancy. When vitamin D supplementation is supplemented, the late pregnancy dose should be properly adjusted to the level of vitamin D at the early stage of pregnancy and when pregnant blood is in pregnancy. The risk of severe preeclampsia decreased when the level of hydroxyvitamin D 25 increased by more than 5ng/ml.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.246
本文編號：2136710
[Abstract]:Objective: 1. to explore the relationship between the level of serum 25 hydroxyvitamin D in the early pregnancy and the late trimester of pregnancy with pregnancy induced hypertension, preeclampsia and severe preeclampsia, and to provide a basis for the prediction, prevention and treatment of the changes of serum levels of 25 hydroxyvitamin D in the early pregnancy to the late pregnancy and the relationship between this change and the pathogenesis of pregnancy induced hypertension. A reasonable supplement of vitamin D. during pregnancy: a single pregnant early pregnant woman from July 1, 2015 to March 1, 2016 at the maternal and infant hospital of Shenyang city was selected to collect basic information, eliminate chronic complications and the patients with endocrine and metabolic diseases. The final 2008 were included in the study. The gestational weeks were verified by ultrasound at the early stage of pregnancy. Respectively, 8~13+6 Week, 32~36 week, during the period of one time, we left fasting venous blood 3ml, separated the bleeding and put it under the condition of -80 C. The patients were regularly examined, and the pregnancy outcome was traced according to the manual and the hospitalized cases. The outcome was divided into the pregnancy hypertension group (Group A) and the preeclampsia group (group B) according to the outcome. The severe preeclampsia group (group C) and the normal pregnancy group (group D).D were randomly selected 200 women from pregnant women who had no pregnancy induced hypertension. The four groups of all blood samples were unified to test the level of serum 25 hydroxyvitamin D. SPSS 21 software was used for statistical analysis. The difference of multiple groups was compared with ANOVA, and the paired t examination was used. Logistic regression analysis was used to evaluate the OR value and 95% confidence interval of 25 hydroxyvitamin D in predicting the incidence of pregnancy induced hypertension. The difference was statistically significant. Results: 206 people were withdrawn from or unable to track the outcome of pregnancy due to loss of visits, abortion, premature delivery, induction of labor and other reasons. A total of 1802 people completed pregnancy. At the early stage and the late pregnancy blood samples, 78 patients with hypertension, 46 preeclampsia, 37 severe preeclampsia, 1641 normal pregnancy and 0 eclampsia, 78 in group A, 46 in group B, 37 in group C and 200 in group D. There were no significant differences in age, BMI before pregnancy, pregnancy, and early pregnancy, and in the early pregnancy. There was no significant difference between pregnancy and pregnancy (P0.05). The level of serum 25 hydroxyvitamin D in early stage A, B, C, D group were 17.47 + 6.41ng/ml, 14.33 + 5.60ng/ml, 11.26 + 4.54ng/ml, and 25 hydroxyvitamin D level A in the late stage of 18.21 + 6.73ng/ml., 20.66 +, 16.54, 13.03 +, 21.04 + The average D water decreased significantly (P0.05), there was no significant difference between the.A group and the D group (P0.05). 22 compared with the A, B, C group, and the early pregnancy or late pregnancy, the average level of serum 25 hydroxyvitamin D decreased (P0.05). Compared with the serum 25 hydroxyvitamin D levels in the early pregnancy and late pregnancy, the late pregnancy was higher than that in the early pregnancy. High (P0.05). When serum 25 hydroxyvitamin D was in the early stage of pregnancy or late pregnancy (20ng/ml), the proportion of C group was the largest (89.19%, 81.08%), B group, A group, the proportion of D group was the smallest (66.50%, 60.50%); vitamin D level was normal (30~100ng/ml), the proportion of early pregnancy or late pregnancy was the smallest (7.20%, 12.19%). The early pregnancy serum 25 was the lowest (12.19%). The risk of 20ng/ml was significantly higher in B and C group (OR value 6.84,95%CI1.91-24.53; OR value 5.19,95%CI 1.28-21.09) than in C group (OR value 6.84,95%CI1.91-24.53; OR value 5.19,95%CI 1.28-21.09). The risk of 25 hydroxyvitamin D in pregnancy was higher than 5ng/ml. The decrease of serum 25 hydroxyvitamin D levels in early or late pregnancy is associated with preeclampsia and is not related to the onset of pregnancy induced hypertension. The level of serum 25 hydroxyvitamin D in the early pregnancy can be used as a risk predictor of preeclampsia, the level of serum 25 hydroxyvitamin D 20ng/ml at the early stage of pregnancy, which is an independent risk factor for preeclampsia. Vitamin D deficiency in the early pregnancy should supplement vitamin D.3. serum 25 hydroxyvitamin D in time with the severity of pregnancy induced hypertension and the level of vitamin D in late.4. pregnancy is higher than that of early pregnancy. When vitamin D supplementation is supplemented, the late pregnancy dose should be properly adjusted to the level of vitamin D at the early stage of pregnancy and when pregnant blood is in pregnancy. The risk of severe preeclampsia decreased when the level of hydroxyvitamin D 25 increased by more than 5ng/ml.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.246
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相關(guān)期刊論文 前4條
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