妊娠早期铁代谢水平与妊娠中晚期贫血及妊娠结局的关系

Association between iron metabolism levels in early pregnancy and anemia in mid and late pregnancy as well as pregnancy outcomes

摘要

目的 探讨妊娠早期铁代谢水平与妊娠中晚期贫血及妊娠结局的关系。方法 回顾性选取2021年1月至2022年12月于南京市高淳人民医院建档并分娩的1 162例单胎妊娠孕妇为研究对象,根据妊娠中晚期是否出现贫血分为贫血组(209例)和正常组(953例)。对比两组孕妇妊娠早期血清铁(SI)、血清铁蛋白(SF)、可溶性转铁蛋白受体(sTfR)及血红蛋白(HB)水平,受试者工作特征(ROC)曲线分析铁代谢指标对妊娠中晚期贫血的预测价值,多因素Logistic回归分析SI、SF及sTfR水平与妊娠结局的相关性。结果 贫血组孕妇妊娠早期SI、SF水平显著低于正常组,sTfR水平则显著高于正常组(t=15.452、16.306、13.152,P<0.05)。SI、SF联合sTfR检测对妊娠中晚期贫血预测的曲线下面积为0.899,其预测灵敏度为80.9%,特异度为80.7%。贫血组孕妇胎儿生长受限、早产、胎膜早破、产后出血等不良妊娠结局发生率高于正常组(χ²=25.528、20.039、15.717、14.729,P<0.05)。不良妊娠结局孕妇SI、SF及HB水平低于妊娠良好孕妇,sTfR水平高于妊娠良好孕妇(t=4.676、3.165、2.028、2.816,P<0.05)。Logistic回归分析结果显示,SI、SF、sTfR及HB水平与贫血孕妇妊娠结局密切相关(OR=0.725、0.891、1.053、0.953,P<0.05)。结论 妊娠早期SI、SF及sTfR水平与妊娠中晚期贫血及妊娠结局密切相关,铁元素缺乏会增加妊娠期贫血和妊娠不良结局风险,联合检测SI、SF及sTfR水平可为早期预测妊娠中晚期贫血提供参考。因此,妊娠早期应注重监测铁代谢状况,及时补充铁元素,以最大限度提高孕期保健质量。

Abstract

Objective To investigate the association between iron metabolism levels in early pregnancy and anemia in mid and late pregnancy,as well as pregnancy outcomes. Methods A total of 1 162 pregnant women with singleton pregnancies who were registered and delivered at NanJing Gaochun People's Hospital between January 2021 and December 2022 were retrospectively enrolled.According to the presence of anemia in mid and late pregnancy,the participants were divided into an anemia group (n=209) and a normal group (n=953).The levels of serum iron (SI),serum ferritin (SF),soluble transferrin receptor (sTfR),and hemoglobin (HB) in early pregnancy were compared between the two groups.Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of iron metabolism indicators for anemia in mid and late pregnancy.Multivariate logistic regression analysis was conducted to assess the associations between SI,SF,and sTfR levels and pregnancy outcomes. Results The levels of SI and SF in early pregnancy were significantly lower in the anemia group than in the normal group,whereas the sTfR level was significantly higher in the anemia group (t=15.452,16.306,and 13.152,respectively,P<0.05).The area under the curve (AUC) for the combined detection of SI,SF,and sTfR in predicting anemia in mid and late pregnancy was 0.899,with a sensitivity of 80.9% and a specificity of 80.7%.The incidences of adverse pregnancy outcomes,including fetal growth restriction,preterm birth,premature rupture of membranes,and postpartum hemorrhage,were significantly higher in the anemia group than in the normal group (χ²=25.528,20.039,15.717,and 14.729,respectively,P<0.05).Pregnant women with adverse pregnancy outcomes had lower levels of SI,SF,and HB and higher levels of sTfR than those with favorable pregnancy outcomes (t=4.676,3.165,2.028,and 2.816,respectively,P<0.05).Logistic regression analysis showed that SI,SF,sTfR,and HB levels were closely associated with pregnancy outcomes in pregnant women with anemia (OR=0.725,0.891,1.053,and 0.953,respectively,P<0.05). Conclusion The levels of SI,SF,and sTfR in early pregnancy are closely associated with anemia in mid and late pregnancy and pregnancy outcomes.Iron deficiency increases the risk of anemia during pregnancy and adverse pregnancy outcomes.The combined detection of SI,SF,and sTfR may provide a valuable reference for the early prediction of anemia in mid and late pregnancy.Therefore,monitoring iron metabolism status in early pregnancy and timely iron supplementation are essential to maximize the quality of prenatal care.

关键词

妊娠期 / 贫血 / 妊娠结局 / 血清铁 / 血清铁蛋白 / 可溶性转铁蛋白受体

Key words

period of pregnancy / anaemia / pregnancy outcome / serum ferritin / soluble transferrin receptor

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基金资助

江苏大学2018年度临床医学科技发展基金(自然科学类)项目(JLY20180228)