孕中晚期维生素D水平与妊娠期高血压疾病发病风险相关性的回顾性研究-东南大学学报医学版

孕中晚期维生素D水平与妊娠期高血压疾病发病风险相关性的回顾性研究

单位：1. 西北妇女儿童医院医学检验中心, 陕西西安 710061;
2. 陕西省核工业二一五医院检验科, 陕西咸阳 712000

分类号：R714.246

出版年·卷·期（页码）：2025·44·第三期（433-439）

摘要：

目的: 探究孕中晚期维生素D[25-羟维生素D,25(OH)D]水平与妊娠期高血压疾病(HDP)发病风险的相关性。方法: 选取180例于2020年2月至2023年2月收治的HDP孕妇归为研究组(n=180),根据HDP类型将研究组分为妊娠期高血压组(n=65)、轻度子痫前期组(n=61)、重度子痫前期组(n=54)。另选取正常健康孕妇为对照组(n=120)。比较两组血清25(OH)D、同型半胱氨酸(Hcy)、钙水平,应用多因素Logistic回归分析上述指标与HDP的关系;使用受试者工作特征(ROC)曲线评估血清25(OH)D、Hcy、钙水平对孕妇发生HDP的预测价值。结果: 研究组低密度脂蛋白(LDL)、血清Hcy均显著高于对照组,而高密度脂蛋白(HDL)、血清25(OH)D、钙水平均显著低于对照组(均P＜0.05);在研究组内,妊娠期高血压组血清25(OH)D、钙水平均显著高于轻度子痫前期组和重度子痫前期组,而血清Hcy水平均显著低于轻度子痫前期组、重度子痫前期组(均P＜0.05)。Logistic回归分析显示,HDL、血清25(OH)D、钙是影响孕妇发生HDP的保护因素,而血清Hcy是影响孕妇发生HDP的危险因素(P＜0.05);血清25(OH)D、Hcy、钙及三者联合预测孕妇发生HDP的曲线下面积(AUC)分别为0.804、0.818、0.809、0.924,三者联合优于各自单独预测(Z_{三者联合-25(OH)D}=4.826、Z_{三者联合-Hcy}=4.517、Z_{三者联合-钙}=4.726,均P＜0.001),其敏感度和特异度分别为83.33%、90.00%。结论: 孕中晚期HDP孕妇血清25(OH)D、钙水平明显下降,而血清Hcy水平明显上升,三者均为HDP的独立影响因素。血清25(OH)D、Hcy、钙联合预测HDP风险的效能优于单一指标,具有较高的临床应用价值。

Objective: To investigate the relationship between the level of vitamin D[25-hydroxyvitamin D, 25(OH)D] in the middle and late stages of pregnancy and the risk of hypertensive disorders of pregnancy(HDP). Methods: A total of 180 pregnant women with HDP admitted to our hospital from February 2020 to February 2023 were included as the study group(n=180). According to the type of HDP, the study group was grouped into gestational hypertension group(n=65), mild preeclampsia group(n=61), and severe preeclampsia group(n=54). Normal healthy pregnant women were selected as the control group(n=120). The serum levels of 25(OH)D, homocysteine(Hcy) and calcium were compared between the two groups. Multivariate Logistic regression was used to analyze the relationship between the above indexes and HDP. The receiver operating characteristic(ROC) curve was applied to evaluate the predictive value of serum 25(OH)D, Hcy, and calcium levels for the occurrence of HDP in pregnant women. Results: The low-density lipoprotein(LDL) and serum Hcy in the study group were greatly higher than those in the control group, while the high-density lipoprotein(HDL), serum 25(OH)D, and calcium levels were greatly lower than those in the control group(P<0.05). Within the study group, the serum 25(OH)D and calcium expression levels in the gestational hypertension group were greatly higher than those in the mild preeclampsia group and severe preeclampsia group, while the serum Hcy expression level was greatly lower than that in the mild preeclampsia group and severe preeclampsia group(P<0.05). Logistic regression analysis showed that HDC, serum 25(OH)D and calcium were protective factors for HDP in pregnant women, while serum Hcy was a risk factor for HDP in pregnant women(P<0.05). The area under the curve(AUC) of serum 25(OH)D, Hcy, calcium, and their combined prediction of HDP in pregnant women was 0.804, 0.818, 0.809, and 0.924, respectively. The combined prediction of the three was better than their individual predictions(Z _{combination-25(OH)D}=4.826, Z _{combination-Hcy}=4.517, Z _{combination-calcium}=4.726, all P<0.001), with a sensitivity and specificity of 83.33% and 90.00%, respectively. Conclusion: Serum 25(OH)D and calcium levels greatly decrease in pregnant women with HDP in the middle and late stages of pregnancy, while serum Hcy level greatly increases, and three factors are all independent influencing factors of HDP. The combined performance of serum 25(OH)D, Hcy and calcium in predicting the risk of HDP is better than that of a single index, and has high clinical application value.

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