贫血孕妇血清铁及可溶性血清转铁蛋白受体检测对妊娠结局的预测价值

Predictive value of serum iron and soluble serum transferrin receptor detection for pregnancy outcome in pregnant women with anemia

目的探究妊娠期贫血孕妇血清铁(serum iron,SI)及可溶性血清转铁蛋白受体(soluble serum transferrin receptor,sTfR)检测与妊娠结局的关系及临床意义。方法选取2020年1月至2021年6月同济大学附属第一妇婴保健院收治的1000例孕妇作为研究对象,根据有无贫血分为贫血组(n=195)和无贫血组(n=805),比较两组孕妇的一般资料、SI、sTfR水平。随访至妊娠结束,比较两组孕妇不良妊娠结局发生情况。比较不同妊娠结局贫血孕妇的SI、sTfR水平,采用受试者操作特征(receiver operating characteristic,ROC)曲线和曲线下面积(area under the curve,AUC)评估SI、sTfR水平对贫血孕妇妊娠结局的预测价值。统计学方法采用独立样本t检验和χ^(2)检验。结果妊娠期贫血的发生率为19.50%(195/1000)。贫血组孕妇SI水平低于无贫血组[(5.5±1.0)与(18.2±6.0)μmol/L,t=29.370,P<0.001];sTfR水平高于无贫血组[(3.8±1.3)与(1.9±0.6)mg/L,t=31.638,P<0.001]。贫血组孕妇不良妊娠结局总发生率高于无贫血组[23.59%(46/195)与4.10%(33/805),χ^(2)=81.957,P<0.05]。发生与未发生不良妊娠结局贫血孕妇的SI水平分别为[(4.6±0.8)与(5.7±0.8)μmol/L,t=15.366,P<0.001],发生较未发生不良妊娠结局贫血孕妇低;sTfR水平分别为[(4.6±1.2)与(3.6±1.0)mg/L,t=8.985,P<0.001],发生较未发生不良妊娠结局贫血孕妇高。SI、sTfR单独预测的AUC分别为0.743、0.770,联合预测的AUC最大,为0.924,最佳诊断敏感度、特异性分别为80.43%、87.92%。结论SI、sTfR水平变化与妊娠期贫血的发生密切相关,联合检测对于妊娠期贫血孕妇的妊娠结局具有较高预测价值,可作为临床早期评估预测的辅助指标。

Objective To explore the relationship and clinical significance of serum iron(SI)and soluble serum transferrin receptor(sTfR)detection in pregnant women with anemia during pregnancy and pregnancy outcome.Method A total of 1000 pregnant women from the First Maternal and Infant Health Hospital Affiliated to Tongji University from January 2020 to June 2021 were selected as the research objects.They were divided into anemia group(n=195)and non-anemia group(n=805)according to anemia or not.The general data,SI and sTfR levels of pregnant women in the two groups were compared.Follow-up was conducted until the end of pregnancy,and adverse pregnancy outcomes were compared between the two groups.SI and sTfR levels were compared among pregnant women with anemia for different pregnancy outcomes.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of SI and sTfR levels for pregnancy outcomes in anemic pregnant women.Statistical methods performed by independent sample t-test andχ^(2)test.Result The incidence of anemia during pregnancy was 19.50%(195/1000).The level of SI in the anemia group was lower than that in the non-anemia group[(5.5±1.0)vs(18.2±6.0)μmol/L,t=29.370,P<0.001].The level of sTfR was higher than that in the non-anemia group[(3.8±1.3)vs(1.9±0.6)mg/L,t=31.638,P<0.001].The overall incidence of adverse pregnancy outcomes in the anemia group was higher than that in the non-anemia group[23.59%(46/195)vs 4.10%(33/805),χ^(2)=81.957,P<0.05].The level of SI of anemic pregnant women with and without adverse pregnancy outcome was[(4.6±0.8)vs(5.7±0.8)μmol/L,t=15.366,P<0.001],and the level of SI for anemic pregnant women with adverse pregnancy outcome was lower than that of anemic pregnant women without adverse pregnancy outcome.The level of sTfR was[(4.6±1.2)vs(3.6±1.0)mg/L,t=8.985,P<0.001],which was higher in the anemic pregnant women than that without adverse pregnancy outcomes.The AUC predicted by SI and sTfR alone was 0.743 and 0.770,respectively.The AUC predicted by SI and sTfR together was the largest(0.924),and the best diagnostic sensitivity and specificity were 80.43%and 87.92%,respectively.Conclusion The changes of SI and sTfR levels are closely related to the occurrence of anemia in pregnancy.Combined detection has a high predictive value for pregnancy outcomes in pregnant women with anemia,and can be used as an auxiliary index for early clinical evaluation and prediction.