Plasma Lipoproteins and Preeclampsia in Women with Type 1 Diabetes: A Prospective Study
Plasma Lipoproteins and Preeclampsia in Women with Type 1 Diabetes: A Prospective Study
复制标题
DOI：
10.1210/jc.2011-3255
复制
发表时间：
2012-05-01
影响因子：
5.8
通讯作者：
Lyons, Timothy J.
中科院分区：
文献类型：
--
作者：
Basu, Arpita;Alaupovic, Petar;Lyons, Timothy J.
背景：在非糖尿病妊娠中，横断面研究显示孕妇血脂异常与先兆子痫（PE）之间存在关联。在1型糖尿病（T1DM）中，PE的患病率增加了4倍，但与血浆脂蛋白的前瞻性关联尚不清楚。目的：本研究的目的是确定脂蛋白相关标志物和T1DM中PE的潜在机制。设计和设置：我们对T1DM妊娠进行了一项多中心前瞻性研究。患者：我们研究了118名T1DM女性（26名发生PE， 92名保持血压正常）。受试者在PE发病前（妊娠12.2 +/- 1.9、21.6 +/- 1.5和31.5 +/- 1.7周（平均+/- SD））和足月（37.6 +/- 2.0周）进行三次随访。纳入非糖尿病正常孕妇（n = 21）作为参考。主要结局指标：在合并和不合并PE的T1DM女性中，测量了常规脂质谱、脂蛋白亚类[由大小（核磁共振）和载脂蛋白含量定义]、血清载脂蛋白（ApoAI、ApoB和ApoCIII）和脂肪分解（ApoCIII比率）。结果：与未发生PE的女性相比，在第一次和/或第二次研究访问时：低密度脂蛋白(LDL)-胆固醇，总LDL和大（但不是小）LDL颗粒浓度，血清ApoB和ApoB: ApoAI比值均升高（P < 0.05）；外周血脂蛋白脂解降低（P < 0.01）。这些早期差异在协变量分析（糖化血红蛋白、实际膳食状态、体重、体重指数和糖尿病持续时间）中仍然显著，但在第三次研究访问时不存在。高密度脂蛋白和极低密度脂蛋白亚类在PE发病前各组间无差异。结论：妊娠早期，高胆固醇脂蛋白的增加和外周脂肪溶解减少的指数与T1DM妇女随后的PE相关。背景：母亲的脂蛋白特征，可能被妊娠后期的影响所掩盖，可能影响PE的风险。[J] .中华内分泌杂志，2012,31(5):557 - 557。
Context: In nondiabetic pregnancy, cross-sectional studies have shown associations between maternal dyslipidemia and preeclampsia (PE). In type 1 diabetes mellitus (T1DM), the prevalence of PE is increased 4-fold, but prospective associations with plasma lipoproteins are unknown.Objectives: The aim of this study was to define lipoprotein-related markers and potential mechanisms for PE in T1DM.Design and Settings: We conducted a multicenter prospective study in T1DM pregnancy.Patients: We studied 118 T1DM women (26 developed PE, 92 remained normotensive). Subjects were studied at three visits before PE onset [12.2 +/- 1.9, 21.6 +/- 1.5, and 31.5 +/- 1.7 wk gestation (means +/- SD)] and at term (37.6 +/- 2.0 wk). Nondiabetic normotensive pregnant women (n = 21) were included for reference.Main Outcome Measures: Conventional lipid profiles, lipoprotein subclasses [defined by size (nuclear magnetic resonance) and by apolipoprotein content], serum apolipoproteins (ApoAI, ApoB, and ApoCIII), and lipolysis (ApoCIII ratio) were measured in T1DM women with and without subsequent PE.Results: In women with vs. without subsequent PE, at the first and/or second study visits: low-density lipoprotein (LDL)-cholesterol, particle concentrations of total LDL and large (but not small) LDL, serum ApoB, and ApoB: ApoAI ratio were all increased (P < 0.05); peripheral lipoprotein lipolysis was decreased (P < 0.01). These early differences remained significant in covariate analysis (glycated hemoglobin, actual prandial status, gravidity, body mass index, and diabetes duration) but were not present at the third study visit. High-density lipoprotein and very low-density lipoprotein subclasses did not differ between groups before PE onset.Conclusions: Early in pregnancy, increased cholesterol-rich lipoproteins and an index suggesting decreased peripheral lipolysis were associated with subsequent PE in T1DM women. Background maternal lipoprotein characteristics, perhaps masked by effects of late pregnancy, may influence PE risk. (J Clin Endocrinol Metab 97: 1752-1762, 2012)