妊娠期脂代谢异常的研究进展
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摘要
妊娠中晚期母体为适应胎儿正常生长发育和妊娠的需要而发生脂代谢改变,血浆血脂水平显著升高。脂代谢异常伴有不良妊娠结局的发生(先兆子痫、妊娠合并糖尿病、胎儿生长受限、早产等),严重影响母婴健康。脂代谢异常主要通过改变生活方式和膳食结构干预,必要时可药物干预。近年来,早期预测不良妊娠结局成为研究热点,妊娠期脂代谢水平对预测不良妊娠结局有一定价值,且可能与妊娠期高危因素或其他生化指标联合预测的价值更高,但目前研究较少。
In the middle and late pregnancy,the mother's fat metabolism changes in response to the normal growth and development of the fetus,and the plasma lipid level is significantly increased. Abnormal lipid metabolism is associated with adverse pregnancy outcomes( such as pre-eclampsia,pregnancy with diabetes,fetal growth restriction,preterm birth,etc.),which seriously affects maternal and child health. Treatment of abnormal lipid metabolism is mainly through interventions that alter lifestyle and dietary structure,and drug intervention if necessary. In recent years,early prediction of adverse pregnancy outcomes has become a research hotspot. The level of lipid metabolism during pregnancy has certain value for predicting adverse pregnancy outcomes,and may be associated with high risk factors or other biochemical indicators during pregnancy for better clinical value,but the current research is insufficient.
In the middle and late pregnancy,the mother's fat metabolism changes in response to the normal growth and development of the fetus,and the plasma lipid level is significantly increased. Abnormal lipid metabolism is associated with adverse pregnancy outcomes( such as pre-eclampsia,pregnancy with diabetes,fetal growth restriction,preterm birth,etc.),which seriously affects maternal and child health. Treatment of abnormal lipid metabolism is mainly through interventions that alter lifestyle and dietary structure,and drug intervention if necessary. In recent years,early prediction of adverse pregnancy outcomes has become a research hotspot. The level of lipid metabolism during pregnancy has certain value for predicting adverse pregnancy outcomes,and may be associated with high risk factors or other biochemical indicators during pregnancy for better clinical value,but the current research is insufficient.
引文
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[15]杨慧霞,魏玉梅.大数据时代下的妊娠合并糖尿病研究[J].中国实用妇科与产科杂志,2018,34(1):30-32.
[16]Ahmadi S,Jamilian M,Tajabadi-Ebrahimi M,et al.The effects of synbiotic supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes:A randomised,double-blind,placebo-controlled trial[J].Br J Nutr,2016,116(8):1394-1401.
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[18]Herrera E,Ortega-Senovilla H.Implications of Lipids in Neonatal Body Weight and Fat Mass in Gestational Diabetic Mothers and Non-Diabetic Controls[J].Curr Diab Rep,2018,18(2):7.
[19]张小松,杨慧霞.早产发生的影响因素及其流行病学研究进展[J].中华妇产科杂志,2017,52(5):344-347.
[20]Lizewska B,Teul J,Kuc P,et al.Maternal Plasma Metabolomic Profiles in Spontaneous Preterm Birth:Preliminary Results[J].Mediators Inflamm,2018,2018:9362820.
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[22]Barbour LA,Hernandez TL.Maternal Non-glycemic Contributors to Fetal Growth in Obesity and Gestational Diabetes:Spotlight on Lipids[J].Curr Diab Rep,2018,18(6):37.
[23]李婷,段涛.母体脂代谢与胎儿生长发育[J].中国实用妇科与产科杂志,2018,34(9):963-966.
[24]Herrera E,Ortega-Senovilla H.Lipid metabolism during pregnancy and its implications for fetal growth[J].Curr Pharm Biotechnol,2014,15(1):24-31.
[25]黄慧,陈瑜.母血与脐血血脂水平差异及对新生儿生长发育的影响[J].中国全科医学,2016,19(8):908-911.
[26]任艳,勾玲会.巨大儿与母亲孕晚期血脂水平的相关性分析[J].重庆医学,2017,46(28):3977-3979.
[27]许芙蓉.妊娠肝内胆汁淤积的发病机制研究进展[J].医学综述,2014,20(22):4109-4111.
[28]Ma L,Zhang X,Pan F,et al.Urinary metabolomic analysis of intrahepatic cholestasis of pregnancy based on high performance liquid chromatography/mass spectrometry[J].Clin Chim Acta,2017,471:292-297.
[29]乔晓亮.血清肝胆酸、总胆汁酸及血脂水平检测在妊娠期肝内胆汁淤积症中的临床意义[J].医药论坛杂志,2017,38(3):43-45.
[30]肖文波.脂代谢检测对妊娠期肝内胆汁淤积症的防治价值分析[J].中国妇幼保健,2017,32(14):3140-3143.
[31]李嘉蔚,牛建民,周平,等.妊娠期肝内胆汁淤积症患者糖脂代谢特点及其围产结局的观察[J].中国计划生育学杂志,2015,23(12):815-818,821.
[32]郝志敏,刘忠,杨素芬.妊娠期肝内胆汁淤积症患者血脂水平变化及临床意义[J].中国妇产科临床杂志,2016,17(4):359-361.
[33]杨怡珂,丁新.妊娠期血脂的相关研究进展[J].医学综述,2017,23(15):3002-3007.
[34]Maierean SM,Mikhailidis DP,Toth PP,et al.The potential role of statins in preeclampsia and dyslipidemia during gestation:A narrative review[J].Expert Opin Investig Drugs,2018,27(5):427-435.
[35]Phang M,Skilton MR.Marine Omega-3 Fatty Acids,Complications of Pregnancy and Maternal Risk Factors for Offspring Cardio-Metabolic Disease[J].Mar Drugs,2018,16(5).pii:E138.
[36]杨扬,孟涛.血脂干预对子痫前期早期预防作用[J].中国实用妇科与产科杂志,2014,30(10):766-769.
[37]Mudd LM,Evenson KR.Review of impacts of physical activity on maternal metabolic health during pregnancy[J].Curr Diab Rep,2015,15(2):572.
[38]Ramírez-Vélez R,Lobelo F,Aguilar-de Plata AC,et al.Exercise during pregnancy on maternal lipids:A secondary analysis of randomized controlled trial[J].BMC Pregnancy Childbirth,2017,17(1):396.
[2]Jin WY,Lin SL,Hou RL,et al.Associations between maternal lipid profile and pregnancy complications and perinatal outcomes:A population-based study from China[J].BMC Pregnancy Childbirth,2016,16:60.
[3]Boeldt DS,Bird IM.Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia[J].J Endocrinol,2017,232(1):R27-44.
[4]田杰,李楠,方娜.妊娠期糖尿病孕妇血脂变化及其影响[J].中国医刊,2015,50(6):85-87.
[5]Russi G.Severe dyslipidemia in pregnancy:The role of therapeutic apheresis[J].Transfus Apher Sci,2015,53(3):283-287.
[6]吴琳琳,雷琼,段冬梅,等.妊娠期代谢综合征:一个值得探讨的科学问题[J].中国实用妇科与产科杂志,2018,34(9):989-993.
[7]Wild R,Weedin EA,Gill EA.Women's Health Considerations for Lipid Management[J].Endocrinol Metab Clin North Am,2016,45(1):65-85.
[8]刘晓洁,李力.基因多态性与子痫前期[J].中国实用妇科与产科杂志,2013,29(10):825-829.
[9]Brown MA,Magee LA,Kenny LC,et al.Hypertensive Disorders of Pregnancy:ISSHP Classification,Diagnosis,and Management Recommendations for International Practice[J].Hypertension,2018,72(1):24-43.
[10]蒋立,于蕾,刘滢瑜,等.孕妇血脂异常与子痫前期的关系[J].中国妇产科临床杂志,2018,19(5):451-452.
[11]Goulopoulou S,Davidge ST.Molecular mechanisms of maternal vascular dysfunction in preeclampsia[J].Trends Mol Med,2015,21(2):88-97.
[12]Serrano NC,Guio-Mahecha E,Quintero-Lesmes DC,et al.Lipid profile,plasma apolipoproteins,and pre-eclampsia risk in the GenPE case-control study[J].Atherosclerosis,2018,276:189-194.
[13]俞巧稚,张文颖.妊娠期糖尿病发病相关因素的研究进展[J].中国妇产科临床杂志,2015,16(2):187-190.
[14]赵霞,张国华,高亚楠.孕期系统化管理对妊娠期糖尿病妊娠结局影响研究[J].中国实用妇科与产科杂志,2018,34(6):680-683.
[15]杨慧霞,魏玉梅.大数据时代下的妊娠合并糖尿病研究[J].中国实用妇科与产科杂志,2018,34(1):30-32.
[16]Ahmadi S,Jamilian M,Tajabadi-Ebrahimi M,et al.The effects of synbiotic supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes:A randomised,double-blind,placebo-controlled trial[J].Br J Nutr,2016,116(8):1394-1401.
[17]Khosrowbeygi A,Shiamizadeh N,Taghizadeh N.Maternal circulating levels of some metabolic syndrome biomarkers in gestational diabetes mellitus[J].Endocrine,2016,51(2):245-255.
[18]Herrera E,Ortega-Senovilla H.Implications of Lipids in Neonatal Body Weight and Fat Mass in Gestational Diabetic Mothers and Non-Diabetic Controls[J].Curr Diab Rep,2018,18(2):7.
[19]张小松,杨慧霞.早产发生的影响因素及其流行病学研究进展[J].中华妇产科杂志,2017,52(5):344-347.
[20]Lizewska B,Teul J,Kuc P,et al.Maternal Plasma Metabolomic Profiles in Spontaneous Preterm Birth:Preliminary Results[J].Mediators Inflamm,2018,2018:9362820.
[21]Catov JM,Bodnar LM,Kip KE,et al.Early pregnancy lipid concentrations and spontaneous preterm birth[J].AM J Obstet Gynecol,2007,197(6):610.e1-7.
[22]Barbour LA,Hernandez TL.Maternal Non-glycemic Contributors to Fetal Growth in Obesity and Gestational Diabetes:Spotlight on Lipids[J].Curr Diab Rep,2018,18(6):37.
[23]李婷,段涛.母体脂代谢与胎儿生长发育[J].中国实用妇科与产科杂志,2018,34(9):963-966.
[24]Herrera E,Ortega-Senovilla H.Lipid metabolism during pregnancy and its implications for fetal growth[J].Curr Pharm Biotechnol,2014,15(1):24-31.
[25]黄慧,陈瑜.母血与脐血血脂水平差异及对新生儿生长发育的影响[J].中国全科医学,2016,19(8):908-911.
[26]任艳,勾玲会.巨大儿与母亲孕晚期血脂水平的相关性分析[J].重庆医学,2017,46(28):3977-3979.
[27]许芙蓉.妊娠肝内胆汁淤积的发病机制研究进展[J].医学综述,2014,20(22):4109-4111.
[28]Ma L,Zhang X,Pan F,et al.Urinary metabolomic analysis of intrahepatic cholestasis of pregnancy based on high performance liquid chromatography/mass spectrometry[J].Clin Chim Acta,2017,471:292-297.
[29]乔晓亮.血清肝胆酸、总胆汁酸及血脂水平检测在妊娠期肝内胆汁淤积症中的临床意义[J].医药论坛杂志,2017,38(3):43-45.
[30]肖文波.脂代谢检测对妊娠期肝内胆汁淤积症的防治价值分析[J].中国妇幼保健,2017,32(14):3140-3143.
[31]李嘉蔚,牛建民,周平,等.妊娠期肝内胆汁淤积症患者糖脂代谢特点及其围产结局的观察[J].中国计划生育学杂志,2015,23(12):815-818,821.
[32]郝志敏,刘忠,杨素芬.妊娠期肝内胆汁淤积症患者血脂水平变化及临床意义[J].中国妇产科临床杂志,2016,17(4):359-361.
[33]杨怡珂,丁新.妊娠期血脂的相关研究进展[J].医学综述,2017,23(15):3002-3007.
[34]Maierean SM,Mikhailidis DP,Toth PP,et al.The potential role of statins in preeclampsia and dyslipidemia during gestation:A narrative review[J].Expert Opin Investig Drugs,2018,27(5):427-435.
[35]Phang M,Skilton MR.Marine Omega-3 Fatty Acids,Complications of Pregnancy and Maternal Risk Factors for Offspring Cardio-Metabolic Disease[J].Mar Drugs,2018,16(5).pii:E138.
[36]杨扬,孟涛.血脂干预对子痫前期早期预防作用[J].中国实用妇科与产科杂志,2014,30(10):766-769.
[37]Mudd LM,Evenson KR.Review of impacts of physical activity on maternal metabolic health during pregnancy[J].Curr Diab Rep,2015,15(2):572.
[38]Ramírez-Vélez R,Lobelo F,Aguilar-de Plata AC,et al.Exercise during pregnancy on maternal lipids:A secondary analysis of randomized controlled trial[J].BMC Pregnancy Childbirth,2017,17(1):396.