轻型地中海贫血孕妇BMI、血清白蛋白水平与妊娠期铁代谢的关系

doi:10.12280/gjszjk.20220272

摘要/Abstract

摘要： 目的： 观察轻型地中海贫血孕妇以妊娠早期体质量指数（body mass index，BMI）及血清白蛋白水平标定的不同营养状态与不同妊娠期铁代谢水平变化的关系。方法： 回顾性研究2018年10月—2020年10月收治的634例轻型地中海贫血孕妇妊娠早、中、晚期血清铁（serum iron，SI）、血清铁蛋白（serum ferritin，SF）和血红蛋白（hemoglobin，Hb）水平，并根据妊娠早期的BMI及血清白蛋白水平将634例孕妇分为体质量过低-营养不良组（A组）、体质量过低-营养良好组（B组）、体质量良好-营养不良组（C组）及体质量良好-营养良好组（D组），分析4组孕妇不同妊娠期SI、SF和Hb的变化情况。结果： 随着孕周增加，4组孕妇的SI、SF、Hb水平均呈下降趋势，D组SF、SI水平在不同妊娠期均低于其他3组孕妇（均P<0.05）；A组SF水平在妊娠中、晚期均高于其他3组孕妇，SI水平在不同妊娠期均高于其他3组孕妇，Hb水平在不同妊娠期均低于其他3组孕妇（均P<0.05）。结论： 轻型地中海贫血孕妇，尤其是体质量过低-营养不良及体质量良好-营养良好者，均可能发生缺铁性贫血。因此轻型地中海贫血孕妇妊娠期需动态监测铁代谢水平，不能忽视妊娠早期铁负荷较高者或营养状态良好者，需针对不同个体给予营养或补铁治疗，以降低缺铁性贫血的发生风险。

关键词: 地中海贫血, 孕妇, 铁代谢障碍, 营养状况, 妊娠初期, 妊娠中期, 妊娠晚期

Abstract:

Objective: To observe the changes of the nutritional status calibrated by BMI and serum albumin in early-pregnant women with mild thalassemia, and iron metabolism levels, and to explore the relationship between nutritional status and iron metabolism in these pregnant women. Methods: The levels of serum iron (SI), serum ferritin (SF) and hemoglobin (Hb) in 634 pregnant women with mild thalassemia, from October 2018 to October 2020, were retrospectively analyzed. According to the nutritional status, the pregnant women were divided into the low weight-malnutrition group (group A), the low weight-good nutrition group (group B), the high weight-malnutrition group (group C) and the high weight-good nutrition group (group D). Results: With the increase of gestational age, the levels of SI, SF and Hb of pregnant women in the four groups showed a downward trend. The levels of SF and SI in group D were lower than those in other three groups at different gestational periods (all P<0.05). The levels of SF in group A were higher than those in the other three groups in the middle and late pregnancy, the levels of SI were higher than those in the other three groups at different gestational periods, while the levels of Hb were lower than those in the other three groups at different gestational periods (all P<0.05). Conclusions: Pregnant women with mild thalassemia, especially those with low weight- malnutrition and high weight-good nutrition, may have iron deficiency anemia. Therefore, it is necessary to dynamically monitor the level of iron metabolism during the pregnancy of mild thalassemia, and those with high iron load or good nutritional status in the early pregnancy should not be ignored. Nutrition or iron supplementation should be given to different individuals to reduce the risk of iron deficiency anemia.

Key words: Thalassemia, Pregnant women, Iron metabolism disorders, Nutritional status, Pregnancy trimester, first, Pregnancy trimester, second, Pregnancy trimester, third

彭晶, 劳少杏, 宋鹏书, 韦红卫, 杨娟娟, 杨钦灵. 轻型地中海贫血孕妇BMI、血清白蛋白水平与妊娠期铁代谢的关系[J]. 国际生殖健康/计划生育杂志, 2023, 42(2): 107-110.

PENG Jing, LAO Shao-xing, SONG Peng-shu, WEI Hong-wei, YANG Juan-juan, YANG Qin-ling. The Relationship between BMI, Serum Albumin and Iron Metabolism in Pregnant Women with Mild Thalassemia[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(2): 107-110.

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参考文献 19

[1]	罗晓华, 史娜, 郭晓珮, 等. 妊娠期妇女血清铁、血清铁蛋白水平的相关研究[J]. 中国妇幼卫生杂志, 2019, 10(1):35-38. doi: 10.19757/j.cnki.issn1674-7763.2019.01.009. doi: 10.19757/j.cnki.issn1674-7763.2019.01.009
[2]	潘玥, 葛会生, 陈红. 妊娠合并轻型地中海贫血补铁治疗的临床探讨[J]. 中国计划生育和妇产科, 2019, 11(6):56-59. doi: 10.3969/j.issn.1674-4020.2019.06.16. doi: 10.3969/j.issn.1674-4020.2019.06.16
[3]	陈银凤, 黄为兰, 陈晴梅, 等. 轻型地中海贫血孕妇的补铁治疗探讨[J]. 江西医药, 2019, 54(12):1594-1596. doi: 10.3969/j.issn.1006-2238.2019.12.041. doi: 10.3969/j.issn.1006-2238.2019.12.041
[4]	Goldberg EK, Lal A, Fung EB. Nutrition in Thalassemia: A Systematic Review of Deficiency, Relations to Morbidity, and Supplementation Recommendations[J]. J Pediatr Hematol Oncol, 2022, 44(1):1-11. doi: 10.1097/MPH.0000000000002291. doi: 10.1097/MPH.0000000000002291 URL
[5]	中华医学会血液学分会红细胞疾病学组. 非输血依赖型地中海贫血诊断与治疗中国专家共识(2018年版)[J]. 中华血液学杂志, 2018, 39(9):705-708. doi: 10.3760/cma.j.issn.0253-2727.2018.09.001. doi: 10.3760/cma.j.issn.0253-2727.2018.09.001
[6]	黎牧夏, 朱文丽, 许雅君, 等. 居民营养素养评价工具的研究及应用[J]. 中华预防医学杂志, 2020, 54(10):1031-1034. doi: 10.3760/cma.j.cn112150-20200303-00236. doi: 10.3760/cma.j.cn112150-20200303-00236.
[7]	Nti AM, Botchway F, Salifu H, et al. Effects of Iron Supplements on Heme Scavengers in Pregnancy[J]. Am J Trop Med Hyg, 2021, 105(5):1163-1172. doi: 10.4269/ajtmh.20-0413. doi: 10.4269/ajtmh.20-0413 URL
[8]	李静, 周天红, 唐卒卒, 等. 广西重型β地中海贫血患者贫血和铁超载现状调查[J]. 中国输血杂志, 2019, 32(2):183-185. doi: 10.13303/j.cjbt.issn.1004-549x.2019.02.022. doi: 10.13303/j.cjbt.issn.1004-549x.2019.02.022
[9]	张丽蓉, 徐宏贵, 薛红漫, 等. 心脏MRI-T2*评价重型β-地中海贫血铁过载[J]. 中国热带医学, 2019, 19(5):476-479. doi: 10.13604/j.cnki.46-1064/r.2019.05.17. doi: 10.13604/j.cnki.46-1064/r.2019.05.17
[10]	Chen N, Li Z, Huang Y, et al. Iron parameters in pregnant women with beta-thalassaemia minor combined with iron deficiency anaemia compared to pregnant women with iron deficiency anaemia alone demonstrate the safety of iron supplementation in beta-thalassaemia minor during pregnancy[J]. Br J Haematol, 2022, 196(2):390-396. doi: 10.1111/bjh.17827. doi: 10.1111/bjh.17827 URL
[11]	闫琪, 李光辉. 妊娠期母体铁营养状态及铁补充剂应用对围生结局影响的研究进展[J]. 中国全科医学, 2019, 22(3):258-262. doi: 10.12114/j.issn.1007-9572.2018.00.315.
[12]	崔宇童, 李笑天. 孕期贫血与不良妊娠结局[J]. 中国实用妇科与产科杂志, 2020, 36(5):408-412. doi: 10.19538/j.fk2020050107
[13]	程君. 轻型地中海贫血患者妊娠期血红蛋白、铁蛋白水平变化以及妊娠结局情况[J]. 吉林医学, 2021, 42(7):1718-1719. doi: 10.3969/j.issn.1004-0412.2021.07.071. doi: 10.3969/j.issn.1004-0412.2021.07.071
[14]	陈年坤, 李仲均, 黄莺莺, 等. 轻型β地中海贫血合并缺铁性贫血与单纯缺铁性贫血孕妇补铁治疗前后铁代谢参数变化的特点[J]. 实用医学杂志, 2022, 38(3):340-343. doi:10.3969/j.issn.1006-5725.2022.03.015. doi: 10.3969/j.issn.1006-5725.2022.03.015
[15]	Suteerojntrakool O, Khongcharoensombat T, Chomtho S, et al. Anthropometric Markers and Iron Status of 6-12-Year-Old Thai Children: Associations and Predictors[J]. J Nutr Metab, 2021, 2021: 9629718. doi: 10.1155/2021/9629718. doi: 10.1155/2021/9629718
[16]	中华医学会围产医学分会, 中华医学会妇产科学分会产科学组. 地中海贫血妊娠期管理专家共识[J]. 中华围产医学杂志, 2020, 23(9):577-584. doi: 10.3760/cma.j.cn113903-20200401-00293. doi: 10.3760/cma.j.cn113903-20200401-00293.
[17]	中华医学会血液学分会/中国医师协会血液科医师分会. 铁过载诊断与治疗的中国专家共识[J]. 中华血液学杂志, 2011, 32(8):572-574. doi: 10.3760/cma.j.issn.0253-2727.2011.08.021. doi: 10.3760/cma.j.issn.0253-2727.2011.08.021
[18]	Vázquez-López MA, López-Ruzafa E, Ibáñez-Alcalde M, et al. The usefulness of reticulocyte haemoglobin content, serum transferrin receptor and the sTfR-ferritin index to identify iron deficiency in healthy children aged 1-16 years[J]. Eur J Pediatr, 2019, 178(1):41-49. doi: 10.1007/s00431-018-3257-0. doi: 10.1007/s00431-018-3257-0 pmid: 30264352
[19]	Siridamrongvattana S, Van Hoa N, Sanchaisuriya K, et al. Burden of anemia in relation to thalassemia and iron deficiency among Vietnamese pregnant women[J]. Acta Haematol, 2013, 130(4):281-287. doi: 10.1159/000351168. doi: 10.1159/000351168 URL

营养状态	n	妊娠早期	妊娠中期	妊娠晚期
A组	86	185.49±48.48	75.85±35.94^a	57.45±28.89^ab
B组	207	178.06±46.06	46.80±21.80^Aa	35.41±16.39^Aab
C组	92	178.95±31.71	37.51±13.02^ABa	32.95±13.18^Aa
D组	249	105.44±12.96^ABC	29.90±13.17^ABCa	16.24±6.96^ABCab
F_营养状态			426.13**
F_妊娠时期			4 410.99**
F_交互			79.28**

营养状态	n	妊娠早期	妊娠中期	妊娠晚期
A组	86	185.49±48.48	75.85±35.94^a	57.45±28.89^ab
B组	207	178.06±46.06	46.80±21.80^Aa	35.41±16.39^Aab
C组	92	178.95±31.71	37.51±13.02^ABa	32.95±13.18^Aa
D组	249	105.44±12.96^ABC	29.90±13.17^ABCa	16.24±6.96^ABCab
F_营养状态			426.13**
F_妊娠时期			4 410.99**
F_交互			79.28**

营养状态	n	妊娠早期	妊娠中期	妊娠晚期
A组	86	18.00±1.26	16.07±1.26^a	14.98±1.13^ab
B组	207	17.05±1.16^A	14.95±1.21^Aa	14.60±2.02^Aab
C组	92	17.01±1.15^A	14.99±1.20^Aa	13.73±1.11^ABab
D组	249	11.10±1.13^ABC	10.92±1.13^ABCa	11.50±0.87^ABC
F_营养状态			1 952.90**
F_妊娠时期			273.91**
F_交互			85.37**

营养状态	n	妊娠早期	妊娠中期	妊娠晚期
A组	86	18.00±1.26	16.07±1.26^a	14.98±1.13^ab
B组	207	17.05±1.16^A	14.95±1.21^Aa	14.60±2.02^Aab
C组	92	17.01±1.15^A	14.99±1.20^Aa	13.73±1.11^ABab
D组	249	11.10±1.13^ABC	10.92±1.13^ABCa	11.50±0.87^ABC
F_营养状态			1 952.90**
F_妊娠时期			273.91**
F_交互			85.37**

营养状态	n	妊娠早期	妊娠中期	妊娠晚期
A组	86	103.72±3.15	100.92±3.00^a	99.58±2.55^ab
B组	207	105.97±2.76^A	104.99±3.24^Aa	100.65±3.31^Aab
C组	92	105.44±2.89^A	102.57±3.35^ABa	101.84±3.03^ABa
D组	249	107.33±3.13^ABC	107.32±3.20^ABCa	106.46±2.61^ABCab
F_营养状态			283.72**
F_妊娠时期			176.96**
F_交互			29.35**