孕早期血清维生素E水平与妊娠期高血压疾病发病风险的关系

doi:10.19723/j.issn.1671-167X.2020.03.012

北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (3): 470-478. doi: 10.19723/j.issn.1671-167X.2020.03.012

孕早期血清维生素E水平与妊娠期高血压疾病发病风险的关系

孟文颖¹,黄琬桐²,张杰²,焦明远³,金蕾⁴,靳蕾^2,^△()

1. 北京市通州区妇幼保健院产科,北京 101100
2. 北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京大学公共卫生学院流行病与卫生统计学系,北京 100191
3. 北京市通州区妇幼保健院检验科,北京 101100
4. 北京市通州区妇幼保健院妇女保健科,北京 101100

收稿日期:2020-02-16 出版日期:2020-06-18 发布日期:2020-06-30
通讯作者: 靳蕾 E-mail:songyi@bjmu.edu.cn
基金资助:
国家重点研发计划(2018YFC1004301)

Relationship between serum vitamin E concentration in first trimester and the risk of developing hypertension disorders complicating pregnancy

Wen-ying MENG¹,Wan-tong HUANG²,Jie ZHANG²,Ming-yuan JIAO³,Lei JIN⁴,Lei JIN^2,^△()

1. Department of Obstetrics, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
2. Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
3. Department of Clinical Laboratory, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
4. Department of Maternal Health Care, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China

Received:2020-02-16 Online:2020-06-18 Published:2020-06-30
Contact: Lei JIN E-mail:songyi@bjmu.edu.cn
Supported by:
National Key R&D Program of China(2018YFC1004301)

摘要/Abstract

摘要：

目的了解北京妇女妊娠期高血压疾病(hypertension disorders complicating pregnancy, HDCP)发病率和孕早期维生素E(vitamin E, VE)营养状况,探究孕早期血清VE浓度与HDCP发病率的关系。方法以北京市通州区孕期保健系统和通州区妇幼保健院医院信息系统为基础,利用2016年1月至 2018年12月在北京市通州区妇幼保健院分娩并在孕早期测定了血清VE浓度的22 283名单胎孕产妇的信息进行回顾性队列研究,用非条件Logistic回归模型分析不同血清VE浓度与HDCP发病风险的关系。结果 HDCP总发病率为5.4%,其中妊娠期高血压发病率为2.1%,子痫前期-子痫发病率为3.3%。妇女孕早期血清VE浓度中位值为10.1(8.8 ~ 11.6) mg/L,99.7%的妇女孕早期血清VE水平处于正常参考值范围内。3年间,妇女孕早期血清VE浓度(P < 0.001)及HDCP的发病率(P = 0.005)均有逐年上升趋势。单因素与多因素Logistic回归分析结果显示,血清VE浓度较高的孕妇HDCP的发病风险更高;在多因素Logistic回归分析中,与血清VE浓度在百分位数 $P 25$ ~ P₇₅范围内的孕妇相比,血清VE浓度高于P₇₅的孕妇HDCP(OR = 1.34,P < 0.001)、妊娠期高血压(OR = 1.39,P = 0.002)和子痫前期-子痫(OR = 1.34,P = 0.001)的发病风险均较高。与血清VE浓度在百分位数P₄₀ ~ P₆₀范围内的孕妇相比,当血清VE浓度达到11.2 mg/L时,HDCP的发病风险显著升高,且随着血清VE浓度的升高而升高。结论北京地区妊娠妇女孕早期VE营养状况良好,孕早期血清VE浓度高与妇女HDCP发病率相关,可以预示HDCP发生风险升高的孕早期血清维生素E浓度的临界值可能是11.2 mg/L,提示妊娠妇女应慎重服用含有VE的营养补充剂。

关键词: 高血压, 子痫, 妊娠, 维生素E, 队列研究

Abstract:

Objective: To investigate the incidence of hypertension disorders complicating pregnancy (HDCP) and vitamin E (VE) nutritional status among pregnant women in Beijing, and to determine the relationship between serum VE concentration in the first trimester of pregnancy and the risk of developing HDCP.Methods: A retrospective cohort study was performed including 22 283 cases of pregnant women who underwent singleton deliveries in Tongzhou Maternal & Child Health Hospital of Beijing from January 2016 through December 2018 and received tests of serum VE concentrations in the first trimester of pregnancy. Nonconditional Logistic regression model was used to analyze the association between serum VE concentration levels and the risk of developing HDCP.Results: The total incidence of HDCP was 5.4%, with the incidence of gestational hypertension around 2.1% and the incidence of preeclampsia-eclampsia around 3.3%. The median concentration of serum VE in early pregnancy was 10.1 (8.8-11.6) mg/L, and 99.7% of the participants had normal serum VE concentrations. The incidence of gestational hypertension and that of preeclampsia-eclampsia had been annually increasing in three years; a linear-by-linear association had also been observed between the serum VE concentrations and the years of delivery. According to the results of the univariable and the multivariable Logistic regression analyses, higher risks of developing HDCP had been observed among women with higher serum VE concentrations. Compared to those with serum VE concentrations in interquartile range (P₂₅-P₇₅) of all the participants, the women whose serum VE concentrations above P₇₅ were at higher risks to be attacked by HDCP (OR = 1.34, P < 0.001), gestational hypertension (OR = 1.39, P = 0.002), or preeclampsia-eclampsia (OR = 1.34, P = 0.001), as suggested by the results of the multivariable Logistic regression model analyses. In addition, the women with serum VE concentrations of 11.2 mg/L or above had a significantly higher risk of developing HDCP than those whose serum VE concentrations of P₄₀-P₆₀ of all the participants, and this risk grew higher as serum VE concentrations in the first trimester of pregnancy increased.Conclusion: Women in Beijing are at good nutritional status. From January 2016 to December 2018, the incidence of HDCP increased with serum VE concentration level, and serum VE concentration of 11.2 mg/L is an indicator of an increased risk of developing HDCP, suggesting that pregnant women should take nutritional supplements containing VE carefully.

Key words: Hypertension, Eclampsia, Pregnancy, Vitamin E, Cohort study

中图分类号:

R172

孟文颖,黄琬桐,张杰,焦明远,金蕾,靳蕾. 孕早期血清维生素E水平与妊娠期高血压疾病发病风险的关系[J]. 北京大学学报（医学版）, 2020, 52(3): 470-478.

Wen-ying MENG,Wan-tong HUANG,Jie ZHANG,Ming-yuan JIAO,Lei JIN,Lei JIN. Relationship between serum vitamin E concentration in first trimester and the risk of developing hypertension disorders complicating pregnancy[J]. Journal of Peking University (Health Sciences), 2020, 52(3): 470-478.

图/表 10

图1

表1

表2

2016年1月至2018年12月研究对象孕早期血清VE水平的变化趋势"

Year of delivery	n	Median ( $P 25$ - P₇₅)/ (mg/L)^a	Number of women in different serum vitamin E concentration levels, n (%)
Year of delivery	n	Median ( $P 25$ - P₇₅)/ (mg/L)^a	< P₂₀	$P 20$ - P₄₀	$P 40$ - P₆₀	$P 60$ - P₈₀	> P₈₀	P^b
2016	7 216	9.7 (8.5-11.2)	1 776 (24.6)	1 573 (21.8)	1 392 (19.3)	1 313 (18.2)	1 162 (16.1)	<0.001
2017	7 677	10.2 (9.0-11.8)	1 269 (16.5)	1 500 (19.5)	1 522 (19.8)	1 618 (21.1)	1 768 (23.0)
2018	7 390	10.3 (8.9-11.8)	1 319 (17.8)	1 406 (19.0)	1 383 (18.7)	1 541 (20.9)	1 741 (23.6)
Total	22 283	10.1 (8.8-11.6)	4 364 (19.6)	4 479 (20.1)	4 297 (19.3)	4 472 (20.1)	4 671 (21.0)

表2

表3

2016年1月至2018年12月HDCP发病情况[n(%)]"

Year of delivery	n	HDCP	Gestational hypertension	Mild preeclampsia	Severe preeclampsia	Eclampsia
2016	7 216	345 (4.8)	150 (2.1)	95 (1.3)	100 (1.4)	0 (0.0)
2017	7 677	428 (5.6)	147 (1.9)	152 (2.0)	126 (1.6)	3 (< 0.1)
2018	7 390	432 (5.8)	179 (2.4)	115 (1.6)	136 (1.8)	2 (< 0.1)
Total	22 283	1 205 (5.4)	476 (2.1)	362 (1.6)	362 (1.6)	5 (< 0.1)
$χ trend 2 a$	-	8.058	2.286	1.420	5.435^b
P	-	0.005	0.131	0.233	0.020

表3

表4

表5

表6

表7

图2

图3

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Characteristics	Total number (n = 22 283), n (%)	VE normal^a (n = 22 206), n (%)	VE deficient^a (n = 13), n (%)	VE excessive^a (n = 64), n (%)	P
Delivery year
2016	7 216 (32.4)	7 194 (32.4)	10 (76.9)	12 (18.8)	0.001^b
2017	7 677 (34.5)	7 653 (34.5)	1 (7.7)	23 (35.9)
2018	7 390 (33.2)	7 359 (33.1)	2 (15.4)	29 (45.3)
Maternal age/years
17 -	1 996 (9.0)	1 988 (9.0)	4 (30.8)	4 (6.3)	0.001^b
25 -	10 501 (47.1)	10 476 (47.2)	6 (46.2)	19 (29.7)
30 -	7 313 (32.8)	7 287 (32.8)	2 (15.4)	24 (37.5)
35 - 51	2 473 (11.1)	2 455 (11.1)	1 (7.7)	17 (26.6)
Ethnic
Han	20 959 (94.1)	20 885 (94.1)	12 (92.3)	62 (96.9)	0.523^b
Others	1 324 (5.9)	1 321 (5.9)	1 (7.7)	2 (3.1)
Education level
Middle school or lower	1 905 (8.5)	1 902 (8.6)	2 (15.4)	1 (1.6)	0.080^b
High school or secondary technical school	4 219 (18.9)	4 199 (18.9)	4 (30.8)	16 (25.0)
College	7 168 (32.2)	7 140 (32.2)	5 (38.5)	23 (35.9)
University or above	8 991 (40.3)	8 965 (40.4)	2 (15.4)	24 (37.5)
Pre-pregnant BMI
Normal	14 079 (63.2)	14 046 (63.3)	9 (69.2)	24 (37.5)	<0.001^b
Underweight	2 340 (10.5)	2 334 (10.5)	2 (15.4)	4 (6.3)
Overweight	4 501 (20.2)	4 473 (20.1)	2 (15.4)	26 (40.6)
Obesity	1 363 (6.1)	1 353 (6.1)	0 (0.0)	10 (15.6)
Parity
Nulliparity	12 039 (54.0)	11 996 (54.0)	7 (53.8)	36 (56.3)	0.957
Multiparity	10 244 (46.0)	10 210 (46.0)	6 (46.2)	28 (43.8)
Family history of hypertension
No	21 337 (95.8)	21 261 (95.7)	13 (100.0)	63 (98.4)	0.731^b
Yes	946 (4.2)	945 (4.3)	0 (0.0)	1 (1.6)
Family history of diabetes
No	21 871 (98.2)	21 795 (98.1)	13 (100.0)	63 (98.4)	1.000 ^b
Yes	412 (1.8)	411 (1.9)	0 (0.0)	1 (1.6)

Outcome	VE concentration levels /(mg/L)	n	Incidences, n (%)	Crude OR (95%CI)	P	Adjusted OR (95%CI)^a	P
HDCP
	8.8 - 11.6	11 360	567 (5.0)	1.00		1.00
	< 8.8	5 442	250 (4.6)	0.92 (0.79 - 1.07)	0.263	0.98 (0.84 - 1.14)	0.766
	> 11.6	5 481	388 (7.1)	1.45 (1.27 - 1.66)	<0.001	1.34 (1.17 - 1.53)	<0.001
Gestational hypertension
	8.8 - 11.6	11 008	215 (2.0)	1.00		1.00
	< 8.8	5 303	111 (2.1)	1.07 (0.85 - 1.35)	0.550	1.13 (0.89 - 1.42)	0.321
	> 11.6	5 243	150 (2.9)	1.48 (1.20 - 1.83)	<0.001	1.39 (1.13 - 1.72)	0.002
Preeclampsia-eclampsia
	8.8 - 11.6	11 145	352 (3.2)	1.00		1.00
	< 8.8	5 331	139 (2.6)	0.82 (0.67 - 1.00)	0.052	0.88 (0.72 - 1.07)	0.206
	> 11.6	5 331	238 (4.5)	1.43 (1.21 - 1.70)	<0.001	1.34 (1.13 - 1.59)	0.001

Year of delivery	n	Underweight	Normal	Overweight	Obesity	P^a
2016	7 216	790 (10.9)	4 596 (63.7)	1 353 (18.8)	477 (6.6)	0.651
2017	7 677	786 (10.2)	4 788 (62.4)	1 644 (21.4)	459 (6.0)
2018	7 390	764 (10.3)	4 695 (63.5)	1 504 (20.4)	427 (5.8)
Total	22 283	2 340 (10.5)	14 079 (63.2)	4 501 (20.2)	1 363 (6.1)

Pre-pregnant BMI	n	HDCP		VE concentration/(mg/L)
Pre-pregnant BMI	n	Incidence (n, %)^a	AOR (95%CI)^b	Median (P₂₅ - P₇₅)	P^c	P^d	P^e
Underweight	2 340	62 (2.6)	0.64 (0.49 - 0.83)	9.8 (8.5 - 11.2)	<0.001	<0.001	-
Normal	14 079	568 (4.0)	1.00	10.0 (8.7 - 11.5)		-	-
Overweight	4 501	374 (8.3)	2.15 (1.87 - 2.47)	10.4 (9.1 - 12.0)		<0.001	0.723
Obesity	1 363	201 (14.7)	4.12 (3.46 - 4.91)	10.5 (9.1 - 12.2)		<0.001
All participants	22 283	1 205 (5.4)	-	10.1 (8.8 - 11.6)		-	-

孕早期血清维生素E水平与妊娠期高血压疾病发病风险的关系

Relationship between serum vitamin E concentration in first trimester and the risk of developing hypertension disorders complicating pregnancy

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VE nutritional status^a	n	HDCP	Gestational hypertension	Mild preeclampsia	Severe preeclampsia	Eclampsia
Normal	22 206	1 197 (5.4)	472 (2.1)	359 (1.6)	361 (1.6)	5 (< 0.1)
Deficient	13	1 (7.7)	1 (7.7)	0 (0.0)	0 (0.0)	0 (0.0)
Excessive	64	7 (10.9)	3 (4.7)	3 (4.7)	1 (1.6)	0 (0.0)
Total	22 283	1 205 (5.4)	476 (2.1)	362 (1.6)	362 (1.6)	5 (< 0.1)

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