基于队列研究的中药治疗对妊娠合并地中海贫血疗效及妊娠结局的影响分析

Efficacy of Chinese Medicine for the Treatment of Pregnancy Complicated with Thalassemia and Its Influence on Pregnancy Outcomes:A Cohort Study

【目的】分析中药治疗妊娠合并地中海贫血(简称地贫)的疗效及对妊娠结局的影响。【方法】采用回顾性队列研究设计,收集符合研究条件的175例地贫孕妇,根据治疗方法分为中药组105例、补铁组41例和未治疗组29例,比较3组地贫孕妇孕中晚期血液学指标变化及妊娠结局;进一步将中药组分为中成药组56例、单味中药组20例及中药复方组29例3个亚组,比较3个亚组地贫孕妇孕中晚期血液学指标的变化情况;同时,对地贫孕妇妊娠期管理的规范性进行分析。【结果】(1)中药组孕晚期血红蛋白(Hb)浓度较孕中期升高(2.28±7.27)g/L,疗效优于补铁组和未治疗组(P<0.05);中药组分娩前Hb浓度较孕中期升高(12.17±10.81)g/L,上升幅度显著大于其他两组(P<0.05)。(2)3组地贫孕妇孕晚期血清铁蛋白(FER)水平均较孕中期下降,补铁组FER水平下降幅度明显小于其他两组(P<0.05)。(3)单味中药组和中药复方组孕妇孕晚期Hb浓度较孕中期分别上升(4.50±4.66)和(3.62±8.77)g/L,上升幅度显著大于中成药组(P<0.05)。(4)3组地贫孕妇的妊娠结局比较,差异均无统计学意义(P>0.05)。(5)仅52.0%(91/175)的地贫孕妇在孕20~24周后进行了3次及以上的血常规检测,34.3%(60/175)的孕妇未复查FER水平,21.2%(37/175)的孕妇未规范补铁治疗。【结论】中药治疗可改善地贫孕妇贫血,中药复方及单味中药较中成药疗效更佳,且未增加不良妊娠结局风险。口服铁剂治疗可提升地贫孕妇的铁储备,但改善贫血的效果不及中药。地贫孕妇贫血和铁代谢指标的监测,以及补铁剂和中成药运用的规范性问题值得关注。

Objective To observe the efficacy of Chinese medicine in the treatment of pregnancy complicated with thalassemia and to investigate its influence on pregnancy outcomes.Methods A retrospective cohort study was carried out in 175 pregnant women complicated with thalassemia who met the inclusion criteria.According to the treatment methods,the patients were divided into Chinese medicine group(105 cases),iron supplementation group(41 cases)and untreated group(29 cases).The changes of hematological indicators and pregnancy outcomes in the second and third trimesters of pregnancy were compared among the three groups.The Chinese medicine group was further divided into three subgroups:56 cases in the Chinese patent medicine group,20 cases in the single Chinese medicine group and 29 cases in the Chinese herbal compound group.The changes of hematological indexes in the second and third trimesters of pregnancy in the three subgroups were compared.Moreover,the normative management of pregnant women with thalassemia during pregnancy was explored.Results(1)The concentration of hemoglobin(Hb)in the third trimester of the Chinese medicine group was(2.28±7.27)g/L higher than that in the second trimester,and the curative effect of Chinese medicine group was superior to that in the iron supplementation group and the untreated group(P<0.05).The Hb concentration in the Chinese medicine group before delivery was(12.17±10.81)g/L higher than that in the second trimester,and the increase in the Chinese medicine group was more significantly than that in the other two groups(P<0.05).(2)The level of serum ferritin(FER)in the third trimester of the three groups was lower than that in the second trimester,and the decrease of FER level in the iron supplementation group was less significantly than that in the other two groups(P<0.05).(3)The Hb concentration in the third trimester of the single Chinese medicine group and the Chinese herbal compound group increased by(4.50±4.66),(3.62±8.77)g/L respectively compared with that in the second trimester,and the increase in the above two groups was more significantly than that in the Chinese patent medicine group(P<0.05).(4)There was no significant difference in pregnancy outcomes among the three groups of pregnant women with thalassemia(P>0.05).(5)Only 52.0%(91/175)of pregnant women with thalassemia underwent three or more blood routine tests after 20-24 weeks of pregnancy,34.3%(60/175)of pregnant women failed in reexamining the FER levels,and 21.2%(37/175)of pregnant women had no standardized iron supplementation.Conclusion Chinese medicine therapy is effective on improving anemia in pregnant women with thalassemia.Chinese herbal compound and single Chinese medicinal are more effective than Chinese patent medicine,and have not increased the risk of adverse pregnancy outcomes.Oral administration of iron can increase the iron reserve of pregnant women with thalassemia,but its effect on improving anemia is not as good as that of Chinese medicine.Attention should be got to the monitoring of anemia and iron metabolism indicators as well as the standardized use of iron supplements and Chinese patent medicines in pregnant women with thalassemia.