妊娠晚期及分娩前孕妇维生素A含量与妊娠期高血压疾病和分娩结局的关系

发布时间：2018-06-18 02:48

  本文选题：维生素A + 妊娠期高血压疾病　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:分析妊娠晚期、分娩前血清维生素A含量水平,研究其与妊娠期高血压疾病及分娩结局可能存在的关系,为孕期营养指导及监测、提前采取措施预防相关合并症,避免不良预后提供科学依据。方法:收集2016年4月至2016年8月在大连大学附属中山医院产科产检及分娩的妊娠患者血清样本,采用高效液相色谱法分别定量检测妊娠晚期(28周至36周末)及入院分娩前维生素A的含量。纳入经入院确诊为妊娠期高血压疾病(hypertensive disorder complicating pregnancy,HDCP)且没有其他内外科合并症的孕妇相关数据资料,用SPSS20.0软件进行统计处理分析不同维生素A含量与妊娠期高血压疾病和分娩结局的关系。结果:2016年4月至2016年8月在大连大学附属中山医院产科产检及分娩的妊娠患者共1023例,其中入院诊断为妊娠期高血压疾病(包括妊娠期高血压、轻度子痫前期、重度子痫前期)45例,发病率为4.4%。去除合并各种内外科合并症患者及符合排除标准后最后搜集归纳整理的研究对象共202例,正常妊娠孕妇162例(正常组),诊断妊娠期高血压疾病孕妇40例(患病组),其中妊娠期高血压患者18例,轻度子痫前期12例,重度子痫前期10例。结果患病组的维生素A含量在妊娠晚期和入院分娩前分别为0.2850±0.13681mg/L、0.2695±0.16852mg/L,均较正常组(0.5029±0.14257mg/L、0.4016±0.16705mg/L)显著下降(P=0.00)。将202名孕妇按病情程度分为四组:正常妊娠组、妊娠期高血压组、轻度子痫前期组、重度子痫前期组,分别统计得出各组维生素A逐渐下降,含量分别为0.4016±0.16705mg/L、0.3706±0.17877mg/L、0.2517±0.10373mg/L、0.1130±0.01059mg/L,通过比较显示正常妊娠组与妊娠期高血压组维生素A含量比较不具有统计学意义,而其余各组两两比较显示均具有统计学意义(P0.05)。研究维生素A含量与分娩结局的关系发现维生素A含量正常组、轻度缺乏组、重度缺乏组三组间存在着随维生素A含量的下降而多种分娩结局的发生率均上升的趋势(除早产外),且在早产、剖宫产、低体重儿、产后出血四种分娩结局中差异显著,具有统计学意义(P0.05),但在宫内窘迫、1' Apgar评分两项评价指标上却出现不一样结果,显示为无差异性(P0.05),另外维生素A重度缺乏组较正常组发生早产、低体重儿、剖宫产、产后出血的风险分别约为4倍、4倍、8倍和3倍,均提示维生素A含量与分娩结局同样密切相关。结论:晚期妊娠女性维生素A缺乏比例较高,且随着孕周进展有进一步下降趋势,在妊娠期高血压疾病组中更加明显。维生素A含量与妊娠期高血压疾病发生、病情进展可能有明显相关性,可能是较为重要发病因素之一。维生素A可能与早产、剖宫产、低体重儿、产后出血等多种不良分娩结局相关,而与宫内窘迫、1' Apgar评分等无明显相关性,应引起产科医师引起重视。
[Abstract]:Objective: to analyze the level of serum vitamin A in the third trimester of pregnancy and before delivery, to study its relationship with hypertensive disorder complicating pregnancy and the outcome of delivery, to guide and monitor nutrition during pregnancy, and to take measures to prevent related complications in advance. To avoid adverse prognosis provides scientific basis. Methods: from April 2016 to August 2016, serum samples were collected from pregnant women in Zhongshan Hospital affiliated to Dalian University. High performance liquid chromatography (HPLC) was used to determine the content of vitamin A in the third trimester of pregnancy from 28 weeks to 36 weeks. Data of pregnant women diagnosed as hypertensive disorder complicating pregnancy (disorder complicating) without other internal and surgical complications were included. SPSS 20.0 software was used to analyze the relationship between different vitamin A content and hypertensive disorder complicating pregnancy and delivery outcome. Results: from April 2016 to August 2016, a total of 1023 pregnant women were diagnosed as hypertensive disorder complicating pregnancy (including gestational hypertension, mild preeclampsia) at the Zhongshan Hospital affiliated to Dalian University. There were 45 cases of severe preeclampsia with an incidence of 4.4%. A total of 202 cases were collected and sorted out after removing the patients with all kinds of internal and surgical complications and meeting the exclusion criteria. There were 162 normal pregnant women (normal group, 40 pregnant women with hypertension complicating pregnancy) (18 cases of hypertensive disorder complicating pregnancy, 12 cases of mild preeclampsia and 10 cases of severe preeclampsia). Results Vitamin A content in the patients was 0.2850 卤0.13681mg / L 0.2695 卤0.16852 mg / L respectively, which was significantly lower than that in the normal group (0.5029 卤0.14257mg / L 0.4016 卤0.16705mg / L). 202 pregnant women were divided into four groups according to their degree of illness: normal pregnancy group, gestational hypertension group, mild preeclampsia group, severe preeclampsia group. The content of vitamin A was 0.4016 卤0.16705mg / L 0.3706 卤0.17877mg / L 0.2517 卤0.10373mg / L 0.1130 卤0.01059mg / L respectively. To study the relationship between vitamin A content and delivery outcome, we found that vitamin A content in normal group, mild deficiency group, In the severe deficiency group, there was a tendency to increase the incidence of multiple delivery outcomes with the decrease of vitamin A content (except preterm delivery, and there were significant differences among the four delivery outcomes: premature delivery, cesarean section, low birth weight, postpartum hemorrhage). There was statistically significant difference in P0.05, but there were different results in the 1 'Apgar score of intrauterine distress, showing no difference (P0.05). In addition, premature delivery, low birth weight and cesarean section occurred in the severe vitamin A deficiency group than in the normal group. The risk of postpartum hemorrhage was about 4 times, 4 times and 3 times, respectively, indicating that the content of vitamin A was also closely related to the outcome of labor. Conclusion: the proportion of vitamin A deficiency in women with late pregnancy is higher, and it is more obvious in hypertensive disorder complicating pregnancy with the progress of gestational weeks. Vitamin A content may be one of the most important factors associated with the occurrence and progression of hypertensive disorder complicating pregnancy. Vitamin A may be associated with premature delivery, cesarean section, low birth weight, postpartum hemorrhage and other adverse outcomes of delivery, but not with intrauterine distress (1'Apgar) score, which should be paid attention to by obstetricians.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.246
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本文编号：2033684