轻型地中海贫血孕妇妊娠晚期贫血的其他相关因素探讨

Other anemia related factors of thalassemia minor during the third trimester of pregnancy

目的探讨轻型地中海贫血孕妇妊娠晚期贫血的其他相关因素,揭示妊娠期铁(Fe)、维生素B12(Vit B12)、叶酸(Fol)的代谢状况,旨在为临床提高轻型地中海贫血孕妇血红蛋白水平提供理论依据。方法选取在我院定期产检的孕28～40周孕妇84例,α地贫23例(A组)、β地贫21例(B组)、100g/L<血红蛋白(HGB)<110g/L 19例(C组)、HGB≥110g/L 21例(D组)。所有病例检测血红蛋白(HGB)、血清铁蛋白(SF)、血清维生素B12(Vit B12)、血清叶酸(Fol),同时对各项指标进行统计分析。结果①A组HGB较B组高(P<0.05),A组发生贫血风险是B组的0.285倍。②SF比较:除A组低于D组(P<0.05)、B组高于C组(P<0.05)、C组低于D组(P<0.05)外,其余各组间比较P>0.05。Fol、Vit B12在四组间比较P>0.05。③储铁缺乏率:A组高于D组(P=0.0048);C组高于D组(P=0.0016);储铁减少率四组间比较P>0.05。④储铁缺乏风险:A组是D组的3.196倍(P<0.05);C组是D组的3.592倍(P<0.05)。储铁减少风险:B组是C组的0.704倍(P<0.05);C组是D组的1.530倍(P<0.05)。结论①轻型地贫并不增加晚期妊娠孕妇铁负荷,与正常孕妇一样可出现铁缺乏;②β地贫低HGB水平较α地贫多,提示β地贫孕妇更应该密切动态关注HGB水平,分析贫血的其他相关因素;③α地贫孕妇缺铁风险较非贫血的正常孕妇高,应高度重视合理的铁补充;④地贫孕妇出现HGB降低,且存在SF低时,在实验室的监测下补铁是安全的;⑤HGB 100～110 g/L时,即是缺铁的高危界限,此时及时补铁,可防止HGB进行性降低致妊娠期贫血;⑥Vit B12、Fol与晚期妊娠轻型地贫贫血无明显相关性。

Objectives： Discuss other anemia related factors whether to affect thalassemia minor during the third trimester and show the metabolic conditions of iron （Fe）, vitamin B12 （Vit B12 ）, relic acid （Fol）, which is on the purpose of providing the theoretical evidence for correcting low hemoglobin of thalassemia minor during pregnancy. Methods： 84 gravidas （in 28 -40 week of pregnancy） enrolled in were all receiving normal antenatal care from the Second Hospital of Guangdong Province, and were divided into four groups ： Group A, 23 α - thalassemia trait; Group B, 2113 - thalassemia trait ; Group C, 19 cases with 100g/L 〈 hemoglobin （HGB） 〈 110g/L; Group D, 21 cases with HGB≤110g/L. Check the blood for HGB, serum ferritin （SF）, Vit B12, Fol. Results： （1）I-IGB in group A was significantly higher than group B （P 〈 0. 05 ）, the risk of anemia of group A was O. 285 time as high as group B ; （2）SF condition ： Compared with group D, group A was lower （P 〈 O. 05） ; Compared with group C, group B was significantly higher （P 〈 0. 05） ; Compared with group D, group C was lower （P 〈 0.05 ） ; no significant difference was found in other either two group （P 〉 O. 05）. The conditions of Fol and Vit Bt2 were no significantly different between the four groups. （3）Percentage of iron depletion： Group A was higher than group D （P =0. 0048） ; Group C was higher than Group D （P =0. 0016）. Percentage of decreasing iron store： no significant difference was found between the four groups （P 〉 0. 05）. （4）The risk of iron depletion： Group A was 3. 196 times as high as group D （P 〈 0. 05） ; Group C was 3. 592 times as high as group D （P 〈 O. 05）. The risk of decreasing iron store ： Group B was 0. 702 time of group C （ P 〉 0.05 ）. Group C was 1. 530 times as high as group D （ P 〈 0.05 ）. Conclusion： （1）During the third trimester, iron state of thalassemia minor is not higher than normal gravida, but on the contrary they would develop iron deficiency. （2） HGB of β - thalassemia trait is lower than α - thalassemia trait. Therefore, we should monitor their HGB and analysis anemia related factors dynamically. （3）Iron supplements should be provided to α - thalassemia trait meet the need because the risk of iron depletion is high. （4）We should mind the iron state of thalassemia minor during of pregnancy. It is safe to provide iron supplement tO. gravida under closely laboratory test if they are accompanying with low SF and HGB. （5）We can mark 100g/L 〈 HGB 〈 110g/L as an warning level of iron deficiency. Iron supplements should be supplied for gravida in order to stop the stage of iron deficiency aggravating to iron deficiency anemia. （6） Vit B12. Fol are not significantly related to the anemia of thalassemia minor during the third trimester.