孕中期维生素D水平与脂代谢关联的研究

金丹; 陶瑞雪; 尹万军; 姚梦楠; 余宛琪; 朱鹏

Abstract

金丹,陶瑞雪,尹万军,姚梦楠,余宛琪,朱鹏.孕中期维生素D水平与脂代谢关联的研究[J].Chinese journal of Epidemiology,2019,40(7):815-820

孕中期维生素D水平与脂代谢关联的研究

Association between vitamin D level and lipid metabolism during second trimester

Received:December 17, 2018

DOI：10.3760/cma.j.issn.0254-6450.2019.07.016

KeyWord: 孕中期维生素D 脂代谢

English Key Word: Second trimester Vitamin D Lipid metabolism

FundProject:国家自然科学基金（81872631，81472991）；安徽省高校优秀青年人才基金重点项目（gxyqZD2018025）；安徽省学术和技术带头人后备人选科研项目（2017H141）；合肥市卫生与计划生育委员会应用医学研究项目（hwk2018zd002）；国家级大学生创新训练项目（201710366029）

Author Name	Affiliation	E-mail
Jin Dan	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
Tao Ruixue	Department of Gynecology and Obstetrics, Hefei First People's Hospital, Hefei 230031, China
Yin Wanjun	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
Yao Mengnan	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
Yu Wanqi	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China
Zhu Peng	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China Key Laboratory of Population Health and Eugenics, Anhui Medical University, Hefei 230032, China	pengzhu@ahmu.edu.cn

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Abstract:

目的探讨孕中期维生素D水平与脂代谢指标的关系。方法于2015年3月至2018年2月在合肥3家医院产科门诊招募1 875名处于孕中期的孕妇作为研究对象。进行问卷调查并留取清晨空腹静脉血，检测其血清25（OH）D、脂代谢指标TC、TG、HDL-C和LDL-C。采用Cubic非线性模型和线性回归模型分析孕中期维生素D水平与脂代谢指标间的关系。结果孕中期维生素D缺乏率为75.3%，TC、TG、HDL-C和LDL-C均值分别是（233.22±38.87）、（226.24±83.88）、（79.04±12.77）和（109.54±25.95）mg/dl。多因素线性回归结果显示，以25（OH）D五分位组（Q1～Q5）中Q5为对照组，Q1～Q4组的TC、TG均显著升高，Q1和Q2组的LDL-C显著升高，且在Q1组观察到TC、TG和LDL-C的最高差值（TC：β=16.88，95% CI：10.50～23.26；TG：β=34.92，95% CI：21.32～48.53；LDL-C：β=9.06，95% CI：4.77～13.35）。未观察到5组间HDL-C的显著差异。以维生素D是否缺乏分层后结果显示，当25（OH）D<50 nmol/L时，25（OH）D每增加10 nmol/L，TC、TG和LDL-C分别降低3.53 mg/dl（95% CI：1.30～5.75）、7.42 mg/dl（95% CI：2.41～12.44）和2.08 mg/dl（95% CI：0.60～3.57），差异有统计学意义；而当25（OH）D≥50 nmol/L时，未发现25（OH）D与TC、TG和LDL-C间存在显著关联。无论维生素D是否缺乏，均未观察到25（OH）D与HDL-C的显著关系。结论孕中期维生素D水平与脂代谢指标间存在非线性关系，仅在维生素D缺乏状态下，25（OH）D与脂代谢指标存在显著负相关。

English Abstract:

Objective To explore the relationship between the vitamin D levels and lipid metabolism during second trimester. Methods A total of 1 875 pregnant women who were in the second trimester and had antenatal care in 3 hospitals in Hefei of Anhui province from March 2015 to February 2018 were included. Baseline questionnaire survey was performed, and fasting venous blood samples were collected from the pregnant women to detect serum 25(OH)D, cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) levels. Cubic non-linear model and linear regression model were used to analyze the linear relationship between vitamin D levels and lipid metabolism indicators in the second trimester. Results The vitamin D deficiency rate was 75.3% (1 412/1 875) in the pregnant women. The mean levels of lipid metabolism indicators TC, TG, HDL-C and LDL-C were (233.22±38.87), (226.24±83.88), (79.04±12.77), and (109.54±25.95) mg/dl respectively. Multivariate linear regression model results showed, compared with Q5 of the 25(OH)D, the TC and TG levels of Q1-Q4 groups significantly increased, and the LDL-C of Q1 and Q2 groups significantly increased. The highest difference between TC, TG and LDL-C was observed in Q1 group. (TC:β=16.88, 95%CI:10.50-23.26; TG:β=34.92, 95%CI:21.32-48.53; LDL-C:β=9.06, 95%CI:4.77-13.35). No significant differences in HDL-C level among the 5 groups were observed. When stratified with vitamin D deficiency the results showed that, when 25(OH)D was <50 nmol/L, TC, TG and LDL-C levels decreased by 3.53 (95%CI:1.30-5.75), 7.42 (95%CI:2.41 to 12.44) and 2.08 mg/dl (95%CI:0.60-3.57) along with a 10 nmol/L increase of 25(OH)D, the difference was statistically significant, and when 25(OH)D was ≥ 50 nmol/L, no significant correlation was found between 25(OH)D level and TC, TG and LDL-C levels. No significant relationship between 25(OH)D level and HDL-C level was observed regardless of vitamin D deficiency. Conclusions There was a nonlinear relationship between vitamin D levels and lipid metabolism indicators in the second trimester. There was a significant negative correlation between 25(OH)D level and lipid metabolism indicators only in the deficiency of vitamin D.

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