α地中海贫血孕妇妊娠期血常规、血清铁蛋白变化及妊娠结局分析

发布时间：2018-05-04 02:03

本文选题：α地中海贫血 + 妊娠期　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：探讨不同类型α地中海贫血孕妇妊娠期血红蛋白(Hb)、平均红细胞容积(MCV)、平均红细胞血红蛋白(MCH)、血清铁蛋白(SF)水平的变化及对妊娠结局的影响,为不同类型α地中海贫血孕妇孕期保健提供依据。方法：选取2013年7月至2014年10月在我院产检的35例中间型α地贫孕妇(中间型组),随机选取同一时期的轻型α地贫孕妇35例(轻型组)、静止型α地贫孕妇35例(静止型组)、健康孕妇35例(对照组)分别在孕早期(孕13周末前)、孕中期(孕14至27周末)、孕晚期(孕28周至分娩)监测各组Hb、MCV、MCH及SF值,了解四组孕妇孕期上述指标的变化及观察其妊娠结局。结果：(1)中间型组孕妇孕早期、孕中期和孕晚期Hb值分别为103.00 ±14.45g/L、94.38±16.34g/L、80.38±18.54g/L,低于静止型组、轻型组及对照组；轻型组孕早期、孕中期和孕晚期Hb值低于静止型组及对照组；中间型组孕妇孕期Hb下降幅度分别为11.21±2.03g/L,高于静止型组、轻型组及对照组；轻型组高于静止型组及对照组。(2)中间型组孕妇孕早期、孕中期和孕晚期MCV分别为70.13±3.92fl、70.45±4.27fl、72.43±3.05f1,低于静止型组及对照组：轻型组MCV低于静止型组及对照组,高于中间型组；整个孕期轻型组、中间型组孕妇MCV值呈增加趋势、静止型组MCV值呈下降趋势,对照组MCV值孕中期上升、孕晚期下降。 (3)中间型组孕妇孕早期、孕中期和孕晚期MCH结果分别为20.85±2.56pg、20.03 ±2.67pg、19.91±1.88pg,低于轻型组、静止型组及对照组；轻型组低于静止型组及对照组；整个孕期中间型组、轻型组、静止型组MCH值均呈下降趋势,对照组MCH值于孕中期上升、孕晚期下降,孕晚期值低于孕早期。(4)中间型组孕妇孕早期、孕中期和孕晚期SF结果分别为120.01±42.33ng/ml、63.36±28.14ng/ml、41.38±20.94ng/ml；中间型组及轻型组孕妇孕早期SF水平高于静止型组及对照组；中间型组与轻型组、静止型组与对照组孕早期SF水平、四组孕妇孕中期及孕晚期SF水平无明显差别；孕期SF下降程度为：中间型组最大,轻型组次之,静止型组及对照组最小。(5)四组孕妇剖宫产原因比较：中间型组孕妇分娩时胎儿窘迫发生率最高,其余三组间无明显差别。 (6)中间型组孕妇分娩新生儿的出生体重为2941.65±634.25g,低于静止型组、轻型组及对照组；轻型组孕妇分娩新生儿的出生体重低于静止型组及对照组；四组孕妇新生儿1 min Apgar评分无明显差别。结论：(1)轻型及中间型地中海贫血孕妇孕期血红蛋白值低于静止型地贫孕妇及正常孕妇,孕妇孕期血红蛋白值均会下降,且地中海贫血基因缺失越多,贫血程度越重,血红蛋白下降程度越大。(2)轻型及中间型α地贫孕妇孕期MCV值上升,MCH值下降,但均低于正常值,临床上应重视MCV及MCH值,避免漏诊地中海贫血。(3)轻型及中间型α地贫孕妇孕早期时血清铁蛋白值高,孕妇随着孕周进展,铁消耗增加,部分患者孕晚期时会表现为缺铁状态,可加重贫血。(4)静止α地贫孕妇孕期血常规、血清铁蛋白与正常孕妇无明显差别,临床上应注意静止型地中海贫血的鉴别诊断,避免漏诊。(5)女性妊娠期贫血会影响妊娠结局,妊娠期女性应按时产检,定期监测相关指标,及时纠正贫血,减少不良妊娠结局发生。
[Abstract]:Objective: To investigate the changes of Hb, mean red blood cell volume (MCV), mean erythrocyte hemoglobin (MCH), serum ferritin (SF) level and pregnancy outcome in pregnant women with different types of alpha thalassemia, and to provide a basis for pregnancy health care for pregnant women of different types of alpha thalassemia. Methods: 10 from July 2013 to 2014. 35 cases of intermediate alpha poor pregnant women (intermediate group) in our hospital were randomly selected in the same period, 35 cases of light alpha poor pregnant women (light group), 35 cases of static alpha poor pregnant women (static group), 35 healthy pregnant women (control group) in the early pregnancy (13 weeks of pregnancy), middle pregnancy (14 to 27 weeks of pregnancy), and late pregnancy (pregnancy 28 to childbirth) monitoring. Group Hb, MCV, MCH and SF values, to understand the changes of the above indexes during pregnancy in four groups of pregnant women and to observe the outcome of pregnancy. Results: (1) the Hb values in the middle group were 103 + 14.45g/L, 94.38 + 16.34g/L, 80.38 + 18.54g/L, respectively, lower than the static group, the light group and the control group, and the early pregnancy, the middle pregnancy and the gestational night in the light group. The value of Hb was lower than that of the static group and the control group. The decrease amplitude of Hb in pregnant women in the middle group was 11.21 + 2.03g/L, higher than that in the static group, the light group and the control group; the light group was higher than the static group and the control group. (2) the intermediate group was 70.13 + 3.92fl, 70.45 + 4.27fl and 72.43 + 3.05f1 in the middle group of pregnant women in the early pregnancy, the middle of the pregnancy and the third trimester. The static group and the control group: the light group MCV was lower than the static group and the control group, which was higher than the middle type group. The MCV value of the pregnant women in the light group and the middle type group increased, the MCV value of the static group decreased, the MCV value of the control group rose in the middle period of pregnancy, and the late pregnancy decreased. (3) the MCH results in the early pregnancy, the middle pregnancy and the late trimester of pregnancy in the middle and middle type group were divided. 20.85 + 2.56pg, 20.03 + 2.67pg, 19.91 + 1.88pg, lower than the light group, the static group and the control group; the light group was lower than the static group and the control group. The MCH value of the middle stage group, the light group and the static group decreased, the MCH value of the control group rose in the middle of pregnancy, the late pregnancy was lower and the late pregnancy was lower than that in the early pregnancy. (4) intermediate group. The SF results in the early pregnancy, mid pregnancy and late trimester of pregnant women were 120.01 + 42.33ng/ml, 63.36 + 28.14ng/ml and 41.38 + 20.94ng/ml respectively. The SF level in the middle group and the light group was higher than that of the static group and the control group. The middle group and the light group, the static group and the control group were SF level in the early pregnancy, and the four groups of pregnant women and the SF level in the late trimester of pregnancy. There was no significant difference in the degree of SF decline during pregnancy: the largest in the middle group, the light group, the static group and the control group. (5) the reasons for cesarean section in the four groups were compared: the middle group had the highest rate of fetal distress during childbirth, and there was no significant difference between the other three groups. (6) the birth weight of the newborns in the middle type pregnant women was 2941.65 +. 634.25g, lower than the static group, the light group and the control group, the birth weight of the newborn babies in the light group was lower than that of the static group and the control group. The 1 min Apgar score of the four groups of pregnant women had no significant difference. Conclusion: (1) the value of the serum erythrocyte of pregnant women with mild and intermediate thalassemia was lower than that of the static poor pregnant women and the normal pregnant women. The value of hemoglobin in pregnant women will decrease, and the more gene deletion of thalassemia, the greater the degree of anemia and the greater the decrease of hemoglobin. (2) the MCV value of pregnant women in light and intermediate type alpha poor pregnant women increase, MCH values decrease, but they are lower than normal values. The value of MCV and MCH should be paid more attention to to avoid missed diagnosis of thalassemia. (3) light and intermediate alpha The serum ferritin value of pregnant women in the early stage of pregnancy is high. With the progress of pregnancy and the increase of iron consumption in pregnant women, some patients will appear iron deficiency during the late pregnancy. (4) there is no significant difference between the serum ferritin and normal pregnant women, and the differential diagnosis of static thalassemia should be paid attention to. No missed diagnosis. (5) female pregnancy anemia will affect pregnancy outcome, pregnancy women should be timely examination, regular monitoring of relevant indicators, timely correction of anemia, and reduce the outcome of bad pregnancy.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R714.254

【参考文献】