目的 了解高龄孕妇不同孕期正常血脂变化区间,以及血脂与分娩结局的相关性。方法 (1)收集2018-01至2019-12在首都医科大学附属北京妇产医院住院分娩的高龄孕妇共5470例的病历资料,最终可纳入建立孕妇妊娠期血脂功能指标参考区间的高龄孕产妇834例,采用美国临床实验室标准化协会(clinical laboratory standard institute,CLSI)的C28-A3文件推荐的直接法通过非参数法建立参考区间。(2)将5470例高龄孕产妇的孕中期、孕晚期的血脂变化指标,放入建立的血脂参考区间,分别分析孕中期、孕晚期的血脂异常与小于胎龄儿、大于胎龄儿、巨大儿、低出生体重儿的相关性。结果 (1)高龄孕妇妊娠期血脂水平显著升高。(2)建立妊娠期高龄孕妇血脂参考区间为:孕早期总胆固醇(3.169,5.868)mmol/L,三酰甘油(0.520,2.016)mmol/L,高密度脂蛋白(1.069,2.131)mmol/L,低密度脂蛋白(1.249,3.488)mmol/L;孕中期总胆固醇(4.690,8.170)mmol/L,三酰甘油(1.120,4.071)mmol/L,高密度脂蛋白(1.268,2.610)mmol/L,低密度脂蛋白(1.950,5.104)mmol/L;孕晚期胆固醇(5.210,8.861)mmol/L,三酰甘油(1.658,5.861)mmol/L,高密度脂蛋白(1.240,2.601)mmol/L,低密度脂蛋白(2.129,5.531)mmol/L。(3)高龄孕妇孕中期高密度脂蛋白降低、孕晚期三酰甘油升高是大于胎龄儿和巨大儿的风险因素;孕晚期高密度脂蛋白升高是大于胎龄儿和巨大儿的保护因素;孕晚期三酰甘油降低是低出生体重儿的风险因素,而孕晚期高密度脂蛋白升高是小于胎龄儿的风险因素。结论 高龄孕妇妊娠期血脂水平显著升高,故需要建立不同的参考值区间。高龄孕妇孕中期、孕晚期的三酰甘油和高密度脂蛋白水平与分娩结局密切相关。通过本研究得出的参考值范围定义的异常血脂值与分娩结局之间的关系,侧面验证了参考值范围的可靠性。

Objective To determine the normal range of blood lipid levels at different stages of pregnancy for women of advanced maternal age and study the correlations between blood lipid levels and delivery outcomes.Methods (1) The medical records of 5,470 cases of pregnant women of advanced maternalage were screened, who had delivered at Beijing Obstetrics and Gynecology Hospital between January 2018 and December 2019. A total of 834 cases of pregnancy at advanced maternal age were obtained that could be used to establish a reference range for blood lipid levels of pregnant women. The direct method recommended by the Clinical Laboratory Standard Institute (CLSI) in its document C28-A3 was employed to establish the reference range in conjunction with the non-parameter method. (2) The blood lipid levels for different stages of pregnancy among the 5,470 cases of advanced maternal age were inputted into the reference range established above to analyze correlations between the anomaly in blood lipid levels in middle and late pregnancy on one hand and small-for-gestational-age babies,large-for-gestational-age babies,macrosomia and low birth weight babies on the other hand.Results (1)Blood lipid levels at advanced maternal age increased significantly. (2) The reference range of blood lipid levels for advanced maternal age was as follows: total cholesterol (3.169,5.868) mmol/L,triglycerides (0.520,2.016)mmol/L,high density lipoprotein (1.069, 2.131) mmol/L,low density lipoprotein (1.249, 3.488) mmol/L in early pregnancy,total cholesterol(4.690, 8.170) mmol/L,triglycerides(1.120,4.071)mmol/L,high density lipoprotein(1.268, 2.610) mmol/L, low density lipoprotein (1.950, 5.104) mmol/L in middle pregnancy, and total cholesterol (5.210, 8.861) mmol/L,triglycerides (1.658, 5.861) mmol/L, high density lipoprotein (1.240, 2.601) mmol/L, low density lipoprotein (2.129, 5.531) mmol/L in late pregnancy. (3) The decrease of high density lipoprotein in middle pregnancy and increase of triglycerides in late pregnancy were risk factors for large-for-gestational-age babies and macrosomia,while the increase of high density lipoprotein in late pregnancy was a protection factor for large-for-gestational-age babies and macrosomia.The decrease of triglycerides in late pregnancy was a risk factor for low birth weight infants.The rise of high density lipoprotein in late pregnancy was a risk factor for small-for-gestational-age babies for women at advanced maternal age.Conclusions Blood lipid levels at advanced maternal age can increase significantly, so it is necessary to establish different reference ranges. The levels of triglycerides and high density lipoprotein in middle and late pregnancy are closely correlated with delivery outcomes. The correlations between the anomaly in blood lipid level as defined by this study and delivery outcomes has verified the reliability of the reference range.