苏州市吴江地区妊娠期血脂参考值范围的探讨

摘要/Abstract

摘要： 目的

观察苏州市吴江地区妊娠不同时期血脂水平分布情况，建立本地区的参考范围。

方法

将在我院建册系统检查至足月分娩的单胎妊娠1388例孕妇作为研究对象，通过对孕11～13⁺⁶周，孕28～31⁺⁶周，孕35～36⁺⁶周，孕38～41⁺⁶周四个不同孕期的血液中甘油三酯、总胆固醇、低密度脂蛋白和高密度脂蛋白的检查结果进行统计分析，初步建立本地区妊娠各时期孕妇血脂的参考范围。

结果

妊娠期血脂水平会随孕期逐渐升高，孕中后期明显超过非孕期水平。

结论

妊娠期的血脂不适合用非孕期的参考标准进行分析与管理，本研究以百分位数法划定本地区正常值参考范围，供临床医师对妊娠不同时期血脂结果进行合理解读。

关键词:妊娠,血脂,参考范围

Abstract: Objective

To observe the distribution of blood lipids during different gestation periods in Wujiang District of Suzhou City， to establish the reference range of this region， and to provide reference for clinicians to make decisions.

Methods

A total of 1388 pregnant women with single pregnancy who were registered in our hospital until their delivery to full term were selected as the research subjects. The blood triglyceride， total cholesterol， low density lipoprotein and high density lipoprotein of 11 to 13⁺⁶weeks of pregnancy， 28 to 31⁺⁶weeks of pregnancy， 35 to 36⁺⁶weeks of pregnancy and 38 to 41⁺⁶weeks of pregnancy were analyzed statistically to establish the reference range of blood lipids of pregnant women at various stages of pregnancy in the local area.

Results

The level of blood lipid during pregnancy gradually increased with pregnancy and obviously exceeded the level of non-pregnancy after the middle and late pregnancy.

Conclusion

Pregnant women have physiological blood lipid elevation， and the reference range of normal values in this area is defined by percentile method， so as to provide clinicians with reasonable interpretation of blood lipid results at different stages of pregnancy.

Key words:pregnancy,blood lipids,reference range

中图分类号:

R446.1

张旭, 杨鸿林. 苏州市吴江地区妊娠期血脂参考值范围的探讨[J]. betway必威登陆网址（betway.com ）学报, 2021, 42(9): 680-684.

Xu Zhang, HongLin Yang. Discussion on the reference range of blood lipids during pregnancy in Wujiang area of Suzhou city[J]. Journal of Shandong First Medical Unversity & Shandong Academy of Medical Sciences, 2021, 42(9): 680-684.

图/表6

妊娠时期	血脂	平均值	标准差	K-S test
孕11～13⁺⁶周	TG	1.447 4	0.677 74	<0.001^c	否
TC	4.682 5	0.797 79	<0.001^c	否
LDL-C	2.415 8	0.654 67	<0.001^c	否
HDL-C	1.842 2	0.394 98	0.007^c	否
孕28～31⁺⁶周	TG	2.136 7	1.334 15	<0.001^c	否
TC	5.367 3	1.314 56	<0.001^c	否
LDL-C	3.429 7	1.000 88	<0.001^c	否
HDL-C	1.969 5	0.436 24	<0.001^c	否
孕35～36⁺⁶周	TG	2.931 9	1.430 71	<0.001^c	否
TC	6.127 7	1.154 30	0.003^c	否
LDL-C	2.942 3	1.041 77	<0.001^c	否
HDL-C	1.865 1	0.434 36	<0.001^c	否
孕38～41⁺⁶周	TG	3.416 4	1.469 98	<0.001^c	否
TC	6.242 6	1.212 12	0.001^c	否
LDL-C	3.497 5	1.049 01	<0.001^c	否
HDL-C	1.884 7	0.445 84	<0.001^c	否

妊娠时期	血脂	平均值	标准差	K-S test
孕11～13⁺⁶周	TG	1.447 4	0.677 74	<0.001^c	否
TC	4.682 5	0.797 79	<0.001^c	否
LDL-C	2.415 8	0.654 67	<0.001^c	否
HDL-C	1.842 2	0.394 98	0.007^c	否
孕28～31⁺⁶周	TG	2.136 7	1.334 15	<0.001^c	否
TC	5.367 3	1.314 56	<0.001^c	否
LDL-C	3.429 7	1.000 88	<0.001^c	否
HDL-C	1.969 5	0.436 24	<0.001^c	否
孕35～36⁺⁶周	TG	2.931 9	1.430 71	<0.001^c	否
TC	6.127 7	1.154 30	0.003^c	否
LDL-C	2.942 3	1.041 77	<0.001^c	否
HDL-C	1.865 1	0.434 36	<0.001^c	否
孕38～41⁺⁶周	TG	3.416 4	1.469 98	<0.001^c	否
TC	6.242 6	1.212 12	0.001^c	否
LDL-C	3.497 5	1.049 01	<0.001^c	否
HDL-C	1.884 7	0.445 84	<0.001^c	否

百分位数		孕11～13⁺⁶周		孕28～31⁺⁶周
P_2.5		0.627 3	3.310 0	1.330 0	1.160 0		0.490 0	3.300 0	1.711 8	1.210 0
P₅		0.704 5	3.490 0	1.500 0	1.230 0		0.594 5	3.534 5	1.960 0	1.290 0
P₁₀		0.810 0	3.720 0	1.680 0	1.350 0		0.729 0	3.830 0	2.210 0	1.410 0
P₁₅		0.890 0	3.883 5	1.800 0	1.430 0		0.893 5	4.020 0	2.423 5	1.520 0
P₂₀		0.968 0	4.000 0	1.860 0	1.490 0		1.010 0	4.190 0	2.568 0	1.590 0
P₂₅		1.020 0	4.120 0	1.960 0	1.560 0		1.110 0	4.382 5	2.712 5	1.680 0
P₃₀		1.080 0	4.220 0	2.050 0	1.610 0		1.230 0	4.547 0	2.850 0	1.730 0
P₃₅		1.120 0	4.331 5	2.120 0	1.670 0		1.360 0	4.700 0	2.980 0	1.780 0
P₄₀		1.170 0	4.430 0	2.206 0	1.726 0		1.520 0	4.856 0	3.116 0	1.840 0
P₄₅		1.220 0	4.530 0	2.270 0	1.780 0		1.720 0	5.060 0	3.260 0	1.880 5
P₅₀		1.280 0	4.630 0	2.350 0	1.820 0		1.850 0	5.220 0	3.385 0	1.940 0
P₅₅		1.350 0	4.739 5	2.440 0	1.880 0		2.040 0	5.380 0	3.510 0	1.990 0
P₆₀		1.430 0	4.820 0	2.510 0	1.930 0		2.204 0	5.574 0	3.610 0	2.060 0
P₆₅		1.500 0	4.910 0	2.580 0	1.970 0		2.390 0	5.770 0	3.730 0	2.110 0
P₇₀		1.600 0	5.040 0	2.680 0	2.030 0		2.610 0	5.980 0	3.903 0	2.180 0
P₇₅		1.710 0	5.160 0	2.770 0	2.090 0		2.867 5	6.190 0	4.080 0	2.250 0
P₈₀		1.830 0	5.310 0	2.882 0	2.170 0		3.160 0	6.450 0	4.250 0	2.332 0
P₈₅		1.996 5	5.486 5	3.010 0	2.260 0		3.520 0	6.806 5	4.436 5	2.440 0
P₉₀		2.221 0	5.671 0	3.240 0	2.361 0		3.920 0	7.170 0	4.691 0	2.550 0
P₉₅		2.70 55	6.045 5	3.565 5	2.535 5		4.495 5	7.740 0	5.075 5	2.730 0
P_97.5		3.118 2	6.500 0	3.892 7	2.682 7		5.233 7	8.190 0	5.448 2	2.890 0
百分位数		孕35～36⁺⁶周		孕38～41⁺⁶周
	TG	TC	LDL-c	HDL-c		TG	TC	LDL-c	HDL-c
P_2.5		1.010 0	3.960 0	1.450 0	1.110 0		1.540 0	4.067 3	1.700 0	1.120 0
P₅		1.224 5	4.320 0	1.610 0	1.200 0		1.734 5	4.394 5	1.924 5	1.240 0
P₁₀		1.609 0	4.730 0	1.810 0	1.310 0		1.940 0	4.760 0	2.240 0	1.340 0
P₁₅		1.783 5	4.983 5	1.910 0	1.410 0		2.110 0	5.010 0	2.450 0	1.440 0
P₂₀		1.930 0	5.160 0	2.048 0	1.480 0		2.260 0	5.190 0	2.590 0	1.510 0
P₂₅		2.07 5	5.322 5	2.170 0	1.540 0		2.380 0	5.380 0	2.740 0	1.580 0
P₃₀		2.200 0	5.480 0	2.280 0	1.610 0		2.530 0	5.530 0	2.910 0	1.630 0
P₃₅		2.321 5	5.681 5	2.400 0	1.670 0		2.680 0	5.710 0	3.050 0	1.681 5
P₄₀		2.440 0	5.816 0	2.526 0	1.730 0		2.820 0	5.890 0	3.160 0	1.730 0
P₄₅		2.570 0	5.940 0	2.640 0	1.790 0		3.010 0	6.030 0	3.290 0	1.790 0
P₅₀		2.690 0	6.080 0	2.745 0	1.845 0		3.130 0	6.150 0	3.410 0	1.860 0
P₅₅		2.830 0	6.190 0	2.880 0	1.890 0		3.309 5	6.319 5	3.530 0	1.910 0
P₆₀		2.970 0	6.350 0	3.020 0	1.950 0		3.454 0	6.490 0	3.670 0	1.960 0
P₆₅		3.130 0	6.500 0	3.220 0	2.000 0		3.628 5	6.630 0	3.830 0	2.010 0
P₇₀		3.300 0	6.680 0	3.360 0	2.050 0		3.843 0	6.840 0	3.980 0	2.080 0
P₇₅		3.510 0	6.880 0	3.530 0	2.140 0		4.077 5	7.030 0	4.150 0	2.160 0
P₈₀		3.770 0	7.080 0	3.760 0	2.230 0		4.352 0	7.220 0	4.360 0	2.250 0
P₈₅		4.026 5	7.290 0	4.020 0	2.320 0		4.680 0	7.476 5	4.546 5	2.340 0
P₉₀		4.392 0	7.591 0	4.350 0	2.470 0		5.171 0	7.800 0	4.861 0	2.451 0
P₉₅		5.221 0	8.015 5	4.846 5	2.6000		6.126 5	8.340 0	5.270 0	2.690 0
P_97.5		6.044 7	8.371 0	5.390 0	2.775 5		6.972 7	8.760 0	5.802 7	2.852 7

百分位数		孕11～13⁺⁶周		孕28～31⁺⁶周
P_2.5		0.627 3	3.310 0	1.330 0	1.160 0		0.490 0	3.300 0	1.711 8	1.210 0
P₅		0.704 5	3.490 0	1.500 0	1.230 0		0.594 5	3.534 5	1.960 0	1.290 0
P₁₀		0.810 0	3.720 0	1.680 0	1.350 0		0.729 0	3.830 0	2.210 0	1.410 0
P₁₅		0.890 0	3.883 5	1.800 0	1.430 0		0.893 5	4.020 0	2.423 5	1.520 0
P₂₀		0.968 0	4.000 0	1.860 0	1.490 0		1.010 0	4.190 0	2.568 0	1.590 0
P₂₅		1.020 0	4.120 0	1.960 0	1.560 0		1.110 0	4.382 5	2.712 5	1.680 0
P₃₀		1.080 0	4.220 0	2.050 0	1.610 0		1.230 0	4.547 0	2.850 0	1.730 0
P₃₅		1.120 0	4.331 5	2.120 0	1.670 0		1.360 0	4.700 0	2.980 0	1.780 0
P₄₀		1.170 0	4.430 0	2.206 0	1.726 0		1.520 0	4.856 0	3.116 0	1.840 0
P₄₅		1.220 0	4.530 0	2.270 0	1.780 0		1.720 0	5.060 0	3.260 0	1.880 5
P₅₀		1.280 0	4.630 0	2.350 0	1.820 0		1.850 0	5.220 0	3.385 0	1.940 0
P₅₅		1.350 0	4.739 5	2.440 0	1.880 0		2.040 0	5.380 0	3.510 0	1.990 0
P₆₀		1.430 0	4.820 0	2.510 0	1.930 0		2.204 0	5.574 0	3.610 0	2.060 0
P₆₅		1.500 0	4.910 0	2.580 0	1.970 0		2.390 0	5.770 0	3.730 0	2.110 0
P₇₀		1.600 0	5.040 0	2.680 0	2.030 0		2.610 0	5.980 0	3.903 0	2.180 0
P₇₅		1.710 0	5.160 0	2.770 0	2.090 0		2.867 5	6.190 0	4.080 0	2.250 0
P₈₀		1.830 0	5.310 0	2.882 0	2.170 0		3.160 0	6.450 0	4.250 0	2.332 0
P₈₅		1.996 5	5.486 5	3.010 0	2.260 0		3.520 0	6.806 5	4.436 5	2.440 0
P₉₀		2.221 0	5.671 0	3.240 0	2.361 0		3.920 0	7.170 0	4.691 0	2.550 0
P₉₅		2.70 55	6.045 5	3.565 5	2.535 5		4.495 5	7.740 0	5.075 5	2.730 0
P_97.5		3.118 2	6.500 0	3.892 7	2.682 7		5.233 7	8.190 0	5.448 2	2.890 0
百分位数		孕35～36⁺⁶周		孕38～41⁺⁶周
	TG	TC	LDL-c	HDL-c		TG	TC	LDL-c	HDL-c
P_2.5		1.010 0	3.960 0	1.450 0	1.110 0		1.540 0	4.067 3	1.700 0	1.120 0
P₅		1.224 5	4.320 0	1.610 0	1.200 0		1.734 5	4.394 5	1.924 5	1.240 0
P₁₀		1.609 0	4.730 0	1.810 0	1.310 0		1.940 0	4.760 0	2.240 0	1.340 0
P₁₅		1.783 5	4.983 5	1.910 0	1.410 0		2.110 0	5.010 0	2.450 0	1.440 0
P₂₀		1.930 0	5.160 0	2.048 0	1.480 0		2.260 0	5.190 0	2.590 0	1.510 0
P₂₅		2.07 5	5.322 5	2.170 0	1.540 0		2.380 0	5.380 0	2.740 0	1.580 0
P₃₀		2.200 0	5.480 0	2.280 0	1.610 0		2.530 0	5.530 0	2.910 0	1.630 0
P₃₅		2.321 5	5.681 5	2.400 0	1.670 0		2.680 0	5.710 0	3.050 0	1.681 5
P₄₀		2.440 0	5.816 0	2.526 0	1.730 0		2.820 0	5.890 0	3.160 0	1.730 0
P₄₅		2.570 0	5.940 0	2.640 0	1.790 0		3.010 0	6.030 0	3.290 0	1.790 0
P₅₀		2.690 0	6.080 0	2.745 0	1.845 0		3.130 0	6.150 0	3.410 0	1.860 0
P₅₅		2.830 0	6.190 0	2.880 0	1.890 0		3.309 5	6.319 5	3.530 0	1.910 0
P₆₀		2.970 0	6.350 0	3.020 0	1.950 0		3.454 0	6.490 0	3.670 0	1.960 0
P₆₅		3.130 0	6.500 0	3.220 0	2.000 0		3.628 5	6.630 0	3.830 0	2.010 0
P₇₀		3.300 0	6.680 0	3.360 0	2.050 0		3.843 0	6.840 0	3.980 0	2.080 0
P₇₅		3.510 0	6.880 0	3.530 0	2.140 0		4.077 5	7.030 0	4.150 0	2.160 0
P₈₀		3.770 0	7.080 0	3.760 0	2.230 0		4.352 0	7.220 0	4.360 0	2.250 0
P₈₅		4.026 5	7.290 0	4.020 0	2.320 0		4.680 0	7.476 5	4.546 5	2.340 0
P₉₀		4.392 0	7.591 0	4.350 0	2.470 0		5.171 0	7.800 0	4.861 0	2.451 0
P₉₅		5.221 0	8.015 5	4.846 5	2.6000		6.126 5	8.340 0	5.270 0	2.690 0
P_97.5		6.044 7	8.371 0	5.390 0	2.775 5		6.972 7	8.760 0	5.802 7	2.852 7

血脂	孕11~13⁺⁶周	孕28~31⁺⁶周	孕35~36⁺⁶周	孕38~41⁺⁶周
TG	0.62~3.11	0.49~5.23	1.01~6.04	1.54~6.97
TC	3.31~6.50	3.30~8.19	3.96~8.37	4.06~8.76
LDL-c	<3.57	<5.08	<4.85	<5.27
HDL-c	>1.23	>1.21	>1.20	>1.24

血脂	孕11~13⁺⁶周	孕28~31⁺⁶周	孕35~36⁺⁶周	孕38~41⁺⁶周
TG	0.62~3.11	0.49~5.23	1.01~6.04	1.54~6.97
TC	3.31~6.50	3.30~8.19	3.96~8.37	4.06~8.76
LDL-c	<3.57	<5.08	<4.85	<5.27
HDL-c	>1.23	>1.21	>1.20	>1.24

血脂	孕28~30⁺⁶周	孕35~36⁺⁶周
TG	0	1
TC	0	0
LDL-c	1	0
HDL-c	2	0

血脂	孕28~30⁺⁶周	孕35~36⁺⁶周
TG	0	1
TC	0	0
LDL-c	1	0
HDL-c	2	0

诊断标准		孕11～13⁺⁶周		孕28～31⁺⁶周
2016年修订标准	升高		131	50	22	0		519	344	194	0
降低	0	0	0	16		0	0	0	15
本研究标准	升高		35	35	69	0		34	36	55	0
降低	0	0	0	66		0	0	0	117
χ²			344.527	960.828	427.324	324.222		58.358	112.165	352.372	164.729
P			< 0.05	< 0.05	< 0.05	< 0.05		< 0.05	< 0.05	< 0.05	< 0.05
诊断标准		孕35～36⁺⁶周		孕38～41⁺⁶周
	T G	T C	LDL-c	HDL-c		T G	T C	LDL-c	HDL-c
2016年修订标准	升高		926	621	343	0		1083	673	364	0
降低	0	0	0	8		0	0	0	14
本研究标准	升高		34	34	103	0		35	35	72	0
降低	0	0	0	30		0	0	0	68
χ²			17.389	43.048	338.958	364.233		10.112	38.146	213.631	274.534
P			< 0.05	< 0.05	< 0.05	< 0.05		< 0.05	< 0.05	< 0.05	< 0.05

诊断标准		孕11～13⁺⁶周		孕28～31⁺⁶周
2016年修订标准	升高		131	50	22	0		519	344	194	0
降低	0	0	0	16		0	0	0	15
本研究标准	升高		35	35	69	0		34	36	55	0
降低	0	0	0	66		0	0	0	117
χ²			344.527	960.828	427.324	324.222		58.358	112.165	352.372	164.729
P			< 0.05	< 0.05	< 0.05	< 0.05		< 0.05	< 0.05	< 0.05	< 0.05
诊断标准		孕35～36⁺⁶周		孕38～41⁺⁶周
	T G	T C	LDL-c	HDL-c		T G	T C	LDL-c	HDL-c
2016年修订标准	升高		926	621	343	0		1083	673	364	0
降低	0	0	0	8		0	0	0	14
本研究标准	升高		34	34	103	0		35	35	72	0
降低	0	0	0	30		0	0	0	68
χ²			17.389	43.048	338.958	364.233		10.112	38.146	213.631	274.534
P			< 0.05	< 0.05	< 0.05	< 0.05		< 0.05	< 0.05	< 0.05	< 0.05

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