妇科住院患者术前贫血及铁缺乏状况初步调查及原因分析

A preliminary investigation of pre-surgical anemia and iron deficiency of gynecological inpatients

目的 通过对妇科住院患者血红蛋白（hemoglobin,Hb）及血清铁蛋白（serum ferritin,SF）含量的检测,了解妇科住院患者术前贫血及铁缺乏情况及原因分析。方法 选择2014年5~8月北京大学人民医院妇科住院患者175例,分为绝经前组（124例）及绝经后组（51例）、对绝经前组又分为异常子宫出血患者（abnormal uterine bleeding,AUB）为AUB组（78例）及非AUB组（46例）,分别检查所有患者术前Hb及SF含量并对其进行相关性分析;应用PALM-COEIN分类系统分析AUB原因。结果 175例患者中,术前贫血34例（19.43%）,SF降低46例（26.29%）。绝经前组中32例（25.81%）为缺铁性贫血,44例（35.48%）SF含量降低;绝经后组中2例（3.92%）为缺铁性贫血和SF含量降低;绝经前组患者术前平均Hb含量[（119.56±18.38）g/L]、SF中位数（23.55μg/L）低于绝经后患者[（129.22±9.86）g/L、128μg/L]（P〈0.05）。AUB组术前Hb平均值[（117.26±21.28）g/L]、SF中位数（24.3μg/L）均低于非AUB者[（127.32±9.72）g/L、55.6μg/L]（P〈0.05）。应用PALM-COEIN分类系统对AUB进行分类,以子宫内膜息肉（30例）,子宫腺肌病（12例）及子宫肌瘤（27例）所致者最多。结论 妇科住院患者术前铁缺乏及缺铁性贫血发生率高,以绝经前患者为多,绝经前患者铁缺乏及缺铁性贫血发生的主要原因是异常子宫出血,导致AUB的三大原因分别是子宫内膜息肉,子宫腺肌病及子宫肌瘤,应重视绝经前患者AUB治疗及铁剂补充。

Objective To investigate pre - surgical anemia and iron deficiency of gynecological inpatients by examining the level of hemoglobin （Hb） and serum ferritin （SF） in blood. Methods A total of 175 patients admitted in Peking University People＇s Hospital from May 2014 to Aug 2014 were enrolled. All cases were divided into premenopause group （n = 124 ） and postmenopause group （n = 51 ） , premenopause group were also divided into abnormal uterine bleeding （AUB） group （n = 78） and non- AUB group （ n = 46）. A correlation analysis was performed to compare the Hb and SF levels between groups. The PALM - COEIN classificationsystem was used to analyze the causes of AUB. Results Of the 175 patients, 34 cases （ 19.43 % ） suffered from preoperative iron deficiency anemia and 46 cases （26. 29 % ） were with SF decrease. In premenopanse group, 32 cases （25.81%） had iron deficiency anemia and 44 cases （35.48 % ） had SF decrease. In postmenopause group, only 2 cases （3.92%） suffered from anemia and SF decrease respectively. The average Hb content [ （ 119. 56 ± 18.38） g/L] and median of SF （23. 55 g/L） in premenopause group were significantly lower than those in postmenopause group [ （ 129. 22 ± 9. 86） g/L, 128 μg/L ] （ P 〈 0. 05 ）. The average Hb content [ （117.26 ±21.28） g/L] and median of SF （24. 3 g/L） in AUB group were significantly lower than those in non- AUB group [ （127. 32 ±9. 72） g/L, 55.6 μg/L] （P 〈0.05）. By analyzing the causes of AUB according to the PALM -COEIN classification system, most of them suffered from endometrial polyps （ n = 30 cases）, adenomyosis （ n = 12 ） or uterine leiomyoma （ n = 27 ）. Conclusion The prevalence of iron deficiency and iron deficiency anemia in preoperative gynecological patients is high, especially in premenopausal patients. The main reasons for premenopansal patients to have iron deficiency and iron deficiency anemia are abnormal uterine bleeding, and the major causes of AUB are endometrial polyp, adenomyosis and uterine fibroids. Attention should be paid to the AUB treatment and iron supplement for premenopausal patients.