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中国临床药理学与治疗学 ›› 2024, Vol. 29 ›› Issue (12): 1380-1388.doi: 10.12092/j.issn.1009-2501.2024.12.008

• “特殊人群药物精准治疗服务与研究”专栏 • 上一篇    下一篇

妊娠合并高甘油三酯血症诊治和管理研究进展

李志敏1,2,李诗然1,2,谢婧娴1,3,张娇1,2,4,李鹏飞1,2,5,曾思羽1,2,杨勇1,2   

  1. 1四川省医学科学院·四川省人民医院/电子科技大学附属四川省人民医院 药学部,成都  610072,四川;2电子科技大学医学院 个体化药物治疗四川省重点实验室,成都  610054,四川;3西南医科大学 药学院,泸州  646000,四川;4重庆市红十字会医院(江北区人民医院)药学部,重庆  400020;5重庆医科大学附属璧山医院 药学部,重庆  402760

  • 收稿日期:2024-06-19 修回日期:2024-07-22 出版日期:2024-12-26 发布日期:2024-11-18
  • 通讯作者: 杨勇,男,博士,主任药师,研究方向:抗菌药物合理使用,妊娠和哺乳期、感染性疾病和呼吸系统疾病合理用药。 E-mail: yyxpower@126.com
  • 作者简介:李志敏,女,研究生,研究方向:临床药学。 E-mail: lzmx612@163.com
  • 基金资助:
    四川省科技厅-重点研发项目(2022YFS0059);教育部中国高校产学研创新基金(H04W231563)

Advances in diagnosis, treatment and management of hypertriglyceridemia in pregnancy

LI Zhimin1,2, LI Shiran1,2, XIE Jingxian1,3, ZHANG Jiao1,2,4, LI Pengfei1,2,5, ZENG Siyu1,2, YANG Yong1,2   

  1. 1 Department of Pharmacy, Sichuan Academy of Medical Sciences-Sichuan Provincial People's Hospital/University of Electronic Science and Technology of Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan, China; 2 Sichuan Key Laboratory of Individualized Pharmacotherapy, University of Electronic Science and Technology of China School of Medicine, Chengdu 610054, Sichuan, China; 3 School of Pharmacy, Southwest Medical University, Luzhou 646000, Sichuan, China; 4 Department of Pharmacy, Chongqing Red Cross Hospital (Jiangbei People's Hospital), Chongqing 400020, China; 5 Department of Pharmacy, Bishan Hospital, Chongqing Medical University, Chongqing 402760, China
  • Received:2024-06-19 Revised:2024-07-22 Online:2024-12-26 Published:2024-11-18

摘要:

妊娠期合并高甘油三酯血症(HTG)可能引起急性胰腺炎、妊娠期糖尿病、先兆子痫等严重并发症,尤其孕产妇急性胰腺炎的高死亡率值得关注。妊娠期甘油三酯(TG)水平的生理性增高为HTG的诊断带来了挑战,目前尚未有针对孕妇的诊断标准。妊娠期HTG的管理重点仍然是早期筛查和科学地限制脂肪饮食。在严格饮食限制和生活方式改变后仍不能控制者,可考虑ω-3脂肪酸治疗,贝特类在获益大于风险的情况下,在妊娠晚期酌情使用,对于极其严重的患者血浆置换可能是一个安全有效的选择。此外,妊娠早期TG水平与母亲产后和新生儿的预后有关联。期待妊娠期HTG药物治疗与管理的进一步研究。

关键词: 高甘油三酯血症, 妊娠, 妊娠并发症

Abstract:

Hypertriglyceridemia (HTG) during pregnancy may cause serious complications such as acute pancreatitis, gestational diabetes mellitus, and preeclampsia, especially the high mortality rate of maternal acute pancreatitis is of concern.The physiologic increase in triglyceride (TG) levels during pregnancy poses a challenge for the diagnosis of HTG, there are no diagnostic criteria for pregnant women. The management of HTG in pregnancy remains focused on early screening and a scientifically based fat-restricted diet. Omega-3 fatty acid therapy may be considered for those who cannot be controlled after strict dietary restriction and lifestyle changes, and fibrates may be  used in late pregnancy when the benefits outweigh the risks, as appropriate, and plasma exchange may be a safe and effective option for extremely severe patients. TG levels in early pregnancy are associated with maternal postpartum and neonatal prognosis. Further studies on pharmacologic treatments and management for HTG in pregnancy are expected.

Key words: hypertriglyceridemia, pregnancy, pregnancy complications

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