石家庄市孕产妇血清中营养素含量与妊娠并发症的患病状况研究

发布时间：2017-12-27 20:26

本文关键词：石家庄市孕产妇血清中营养素含量与妊娠并发症的患病状况研究　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:1了解石家庄市孕产妇常见营养素的总体检测水平及其缺乏情况。2探讨孕产妇在不同观察因素下血清中各营养素浓度的差异。3了解石家庄市妊娠并发症的患病现状,以及影响妊娠并发症发病的相关因素,为制定预防妊娠并发症发生的有效措施提供理论依据。方法:以2015年6月至9月在石家庄市某医院产科住院分娩的孕产妇为研究对象,选择做孕期妊娠糖尿病筛查以及产前检查的孕产妇纳入本研究,其中产前检查主要包括一般检查(身高、体重、血压等)、血常规、甲状腺功能三项、血清中营养素(总蛋白、钙、铁、锌)含量检测。采用Epidata软件对上述资料录入,用SPSS19.0软件对数据进行描述和分析。结果:1研究对象的一般特征:共4431例研究对象纳入本次研究,年龄在25~30岁者最多,为2203人,占49.7%;研究对象中无业组共1892人,占总人数的42.7%;居住在市区的研究对象占66.4%,农村的占33.6%;孕前体重正常者共2811人,占63.4%,消瘦和超重者分别占15.5%和16.5%,肥胖者占4.6%;研究对象的孕期增重范围在≤15kg、15~20kg和≥20kg者,分别为1871人(占42.2%)、1677人(占37.8%)和883人(占19.9%);孕周在37~42周时分娩的研究对象居多,占总人数的96.2%;胎次为1和≥2胎时,分别为2936人(占66.3%)和1495(占33.7%)。2血清中营养素的检测状况:3755例孕产妇中,血清中总蛋白浓度为60.53±5.80g/L,缺乏率为36.7%;3594例孕产妇中,血清钙浓度为2.11±0.31umol/L,缺乏率为69.3%;3616例孕产妇中,血清铁浓度为11.73±6.45umol/L,缺乏率为40.1%;3590例孕产妇中,血清锌浓度为8.74±1.89 umol/L,缺乏率为60.4%。3影响血清中总蛋白浓度的单因素分析:孕妇血清中总蛋白浓度随着年龄增长而降低,差异有统计学意义(P0.001)。居住在农村地区的孕妇血清总蛋白浓度略高于市区(60.80±5.80 g/L vs60.39±5.79 g/L),组间差异有统计学意义(P0.05)。随孕期增重程度的增长,孕妇的血清总蛋白浓度呈降低趋势,组间差异有统计学意义(P0.05)。随怀孕周数增长,孕妇的血清总蛋白浓度呈现两头高中间低现象,差异有统计学意义(P0.001)。4影响血清中钙浓度的单因素分析结果显示:不同年龄、职业、居住地、孕前BMI、孕期增重、孕周以及胎次对孕产妇血清钙浓度的影响均无统计学意义(P0.05)。5影响血清中铁浓度的单因素分析结果显示:在胎次分别为1组和≥2组,孕产妇的血清铁浓度分别为10.19±1.64μmol/L和10.72±1.59μmol/L,差异有统计学意义(P=0.002)。6影响血清中锌浓度的单因素分析:孕妇血清锌浓度在不同职业和不同居住地间差异显著,差异有统计学意义(P0.05)。胎次为≥2的孕产妇血清锌浓度高于胎次为1的孕产妇,组间差异有统计学意义(P0.05)。7 4431例孕产妇中,妊娠糖尿病的患病率为8.4%,妊娠高血压的患病率为6.1%,妊娠期贫血的患病率为47.4%,妊娠合并甲减的患病率为5.4%。8妊娠糖尿病的相关因素分析:单因素结果显示,在不同年龄、居住地、孕前BMI、孕期增重、孕周、血清钙和血清铁浓度间,孕产妇GD的患病率均不同,组间差异均有统计学意义(P0.05)。多因素logistic回归结果得出,排除其他混杂因素后,年龄、居住地、孕前BMI、孕期增重、孕周和血清铁浓度仍是GD的影响因素(P0.05),其中年龄和孕前BMI是GD的危险因素,孕妇的孕前BMI每增加一个等级,GD的患病风险增加2.012倍。9妊娠高血压的相关因素分析:单因素结果显示,在不同年龄、职业、居住地、孕前BMI、孕期增重、孕周、血清总蛋白以及血清锌浓度间,孕妇高血压的患病率均不同,组间差异有统计学意义(P0.05)。在排除其他混杂因素后,年龄和血清锌浓度对孕妇高血压影响无统计学意义,而不同胎次对其影响见统计学差异(P0.05)。与无业组相比较,商管及专技组、个体及自由职业组和其他职业组的孕产妇较无业组的GH1患病风险均降低(OR1),而科教文卫组与无业组的孕产妇GH1患病率无明显差异(P0.05)。孕前BMI和孕期增重每增加一个等级,孕妇高血压患病风险分别增长2.338倍和1.442倍。孕妇血清总蛋白浓度是GH1患病的保护因素,即孕妇血清中总蛋白浓度愈高,其患高血压的可能性愈低(OR=0.442)。10妊娠期贫血的相关因素分析:单因素结果显示,在不同年龄、职业、居住地、孕前BMI、孕期增重、血清钙、血清铁以及血清锌浓度间,孕妇GA的患病率均不同,组间差异有统计学意义(P0.05)。经多因素logistic回归分析得出,居住地、孕前BMI、孕期增重、血清钙、血清铁以及血清锌浓度仍是孕产妇GA的影响因素(P0.05),孕期增重是GA的危险因素(OR1),孕期增重程度每增加一个等级,GA患病风险增加1.108倍,95%CI为1.005~1.221。孕妇血清中钙、铁以及锌浓度是GA的保护因素,即随三种微量元素浓度的升高,GA患病可能性均降低(OR=0.521、0.625、0.847)。11妊娠合并甲减的相关因素分析:经单因素和多因素分析得出,在不同居住地生活的孕产妇,其GH2的患病率存在差异,且差异有统计学意义(P0.05),而且居住在市区的孕妇患GH2的可能性是农村地区的1.577倍,95%CI=1.059~2.351。结论:1石家庄市孕产妇常见营养素的缺乏率均较高,有待改善。2年龄较大、孕期增重过多的孕妇血清总蛋白浓度较低;≥2胎次的孕产妇的血清铁和血清锌浓度较1胎次的均高;职业较自由的孕妇血清锌浓度不易缺乏。3石家庄市孕产妇不同妊娠并发症的发病率在全国均处于较高水平。4控制孕妇怀孕年龄、孕前BMI、孕期增重,并且注重孕期营养素的补充,能有效地控制妊娠并发症的发生。
[Abstract]:Objective: 1 to understand the general level and lack of common nutrients in pregnant and lying in women in Shijiazhuang. 2 to explore the difference of serum levels of nutrients in pregnant and lying in women under different observation factors. 3 understand the prevalence of pregnancy complications in Shijiazhuang, and the related factors that affect the incidence of pregnancy complications, so as to provide a theoretical basis for developing effective measures to prevent pregnancy complications. Methods: from June 2015 to September in maternal obstetric hospital delivery in a hospital in Shijiazhuang city as the research object, choose to do pregnancy gestational diabetes screening and antenatal examination included in the study, which mainly includes the general inspection of prenatal examination (height, weight, blood pressure, blood, etc.) three thyroid function and serum nutrients (total protein, calcium, iron, zinc) content detection. Epidata software is used to record the above data, and the data are described and analyzed with SPSS19.0 software. Results: the general characteristics of the 1 subjects: the study included a total of 4431 subjects, age at 25~30 years old, 2203 people, accounting for 49.7% of the unemployed group; a total of 1892 people in the study, 42.7% of the total number of living in the city; the research object in rural areas accounted for 66.4%, accounted for 33.6%; pregnancy a total of 2811 people of normal weight, overweight and weight loss accounted for 63.4%, accounted for 15.5% and 16.5%, obesity accounted for 4.6%; the research object's weight gain during pregnancy in the range of less than 15kg, 15~20kg and 20kg, respectively, 1871 (42.2%), 1677 (37.8%) and 883 (19.9%) the object of study; gestational weeks at 37~42 weeks of delivery in the majority, accounting for 96.2% of the total number of 1; and more than 2 parity births, respectively 2936 (66.3%) and 1495 (33.7%). Detection of nutrients in the serum of 2: 3755 cases of pregnant women, serum total protein concentration was 60.53 + 5.80g/L, the lack rate is 36.7%; 3594 cases of pregnant women, serum calcium concentration was 2.11 + 0.31umol/L, the lack rate is 69.3%; 3616 cases of pregnant women, serum iron concentration was 11.73 + 6.45umol/L, the lack rate is 40.1%; 3590 cases of pregnant women, the serum zinc concentration was 8.74 + 1.89 umol/L, the lack rate is 60.4%. 3 the single factor analysis of the total protein concentration in serum: the total protein concentration in pregnant women's serum decreased with age, and the difference was statistically significant (P0.001). The serum total protein concentration of pregnant women living in rural areas was slightly higher than that in urban areas (60.80 + 5.80 g/L vs60.39 + 5.79 g/L), and there was a significant difference between groups (P0.05). The serum total protein concentration of pregnant women decreased with the increase of weight gain during pregnancy, and there was a significant difference between the groups (P0.05). With the increase of the number of pregnant weeks, the serum total protein concentration of pregnant women showed low between two high schools, and the difference was statistically significant (P0.001). 4 the effect of single factor analysis showed calcium concentration in serum showed that the effects of different age, occupation, residence, pre pregnancy BMI, weight gain during pregnancy, gestational age and parity on maternal serum calcium concentrations were not statistically significant (P0.05). 5 Effect of single factor analysis results showed that the serum iron concentration in parity were 1 group and above 2 groups, serum iron concentration of pregnant women were 10.19 + 1.64 and 10.72 + mol/L 1.59 mol/L, the difference was statistically significant (P=0.002). 6 the single factor analysis of the concentration of zinc in serum: the serum zinc concentration in pregnant women was significantly different between different occupations and different places of residence, and the difference was statistically significant (P0.05). The maternal serum zinc concentration is more than 2 higher than the parity parity of 1 pregnant women, there was significant difference between the groups (P0.05). Among 74431 pregnant women, the prevalence of gestational diabetes was 8.4%, the prevalence of pregnancy induced hypertension was 6.1%, the prevalence of anemia in pregnancy was 47.4%, and the incidence of pregnancy with hypothyroidism was 5.4%. 8 factors related to gestational diabetes mellitus: single factor results showed that the prevalence of GD was different among different age, residence, pre pregnancy BMI, gestational weight gain, gestational age, serum calcium and serum iron concentration, and the difference between groups was statistically significant (P0.05). Multivariate logistic regression results, excluding other confounding factors, influencing factors of age, place of residence, pre pregnancy BMI, weight gain during pregnancy, gestational age and serum iron concentration is GD (P0.05), the age and BMI before pregnancy is a risk factor for GD, every increase of pregnant women before pregnancy BMI a grade, the risk for GD an increase of 2.012 times. Analysis of related factors of 9 pregnancy induced hypertension: the results of univariate analysis showed that in different age, occupation, residence, BMI, pre pregnancy weight gain during pregnancy, gestational weeks, serum total protein and serum zinc concentration among pregnant women, the prevalence rate of hypertension was different, there was significant difference between the groups (P0.05). In the exclusion of other confounding factors, age and serum zinc concentration had no significant influence on pregnant women with hypertension, and the effect of Different Parities see statistical difference (P0.05). Compared with the unemployed group, maternal business and technical group, individual freedom and occupation groups and other occupation group with no industry group decreased risk of GH1 (OR1), and the science and education group and non industry group maternal morbidity rate of GH1 had no significant difference (P0.05). The risk of high blood pressure in pregnant women increased by 2.338 times and 1.442 times, respectively, at the level of BMI and weight gain during pregnancy. The concentration of serum total protein in pregnant women is a protective factor for GH1 disease, that is, the higher the total protein concentration in the serum of pregnant women, the lower the possibility of high blood pressure (OR=0.442). 10, the related factors of anemia in pregnancy: single factor results showed that the prevalence of GA was different in different age, occupation, residence, pre pregnancy BMI, gestational weight gain, serum calcium, serum iron and serum zinc concentration, and the difference between groups was statistically significant (P0.05). By multivariate logistic regression analysis, place of residence, BMI before pregnancy, pregnancy weight gain, serum calcium, serum iron and serum zinc concentration is maternal factors of GA (P0.05), weight gain during pregnancy is a risk factor for GA (OR1), every increase in weight gain during pregnancy of a grade, the risk of GA is increased 1.108 times 95%CI, 1.005~1.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.25

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