孕妇血清中维生素A、E水平调查和分析

发布时间：2018-07-18 21:52

【摘要】：目的调查孕妇早(11-13+6周)、中(24-25+6周)、晚(≥31周)期血清中维生素A、E水平,分析其相关影响因素,以及其与妊娠结局的关系,为孕妇进行合理营养指导提供依据。方法随机选取2015年10月至2016年3月在天津市中心妇产科医院产科门诊进行产前检查及孕晚期住院分娩的符合纳入标准的单胎孕妇2740例,采用高效液相色谱法定量测定血清维生素A、E的浓度,同时通过问答形式的问卷调查收集孕妇饮食及药物补充情况,并记录孕妇一般资料和最终妊娠结局。以妊娠结局为因变量(患某种病=1,未患某种病=0),孕妇外周血中维生素A、E水平、孕妇妊娠时年龄为自变量,采用非条件二项分类Logistic回归分析孕妇血清中维生素A、E水平与妊娠结局的关系。结果1.妊娠早、中、晚期孕妇血清中维生素A浓度分别为(0.47±0.095)mg/L、(0.48±0.323)mg/L、(0.39±0.111)mg/L,三期总异常率11.71%,以缺乏为主(88.81%)。晚期维生素A浓度最低(P0.05),异常率最高(19.65%),其中重度缺乏率(0.2mg/L)6.72%。2.妊娠早、中、晚期孕妇血清中维生素E浓度分别为(11.33±2.521)mg/L、(15.78±3.493)mg/L、(17.99±4.571)mg/L,三期总异常率16.21%,以过量为主(99.75%)。随孕周增加维生素E浓度和异常率均增加,妊娠晚期浓度最高,异常率最高(26.83%)(P0.05),为维生素E过量。3.维生素E浓度与年龄和孕产次呈正相关,但孕晚期与孕产次呈负相关且当孕妇年龄≥40时呈下降趋势。维生素A浓度与孕产次无明显相关,在孕早、中期与年龄呈正相关,孕晚期与年龄无相关。4在日常膳食基础上,孕早期坚果类食物摄入增加则维生素A、E浓度升高,孕晚期维生素A、E浓度随每日肉类摄入量和动物内脏的摄入频次增加而增加。5.在基础膳食情况近似的条件下,孕早期开始补充含维生素A、E的同种复合维生素其血清中维生素A、E浓度高于仅在孕中晚期补充者。6.孕早期和孕晚期血清中维生素A、E浓度对妊娠期高血压相关疾病(除外慢性高血压合并妊娠和子痫分型)、PROM和PPROM的发生无明显影响。7.孕妇血清中维生素A、E浓度与GDM的发生相关(P0.05),维生素A、E浓度在正常范围值时(维生素A浓度为0.3-0.7mg/L,维生素E浓度5-20mg/L)是GDM的保护因素,且孕早期开始补充复合维生素可明显降低GDM的发生率。8.GDM组维生素E过量率显著高于非GDM组。9.本研究人群中妊娠年龄越大GDM的发生风险越高。结论1.调查人群中维生素A异常以缺乏为主,建议孕期常规足量补充维生素A;维生素E异常以过量为主,占99.75%,应监测后合理补充。在日常膳食基础上,孕早期开始补充复合维生素可有效改善维生素A、E缺乏。2.孕期维生素A、E浓度受孕妇年龄、孕产次以及饮食多因素共同影响,孕期应定期监测,进行营养指导时根据孕妇自身需要制定个体化补充方案,避免维生素E过量。3.建议GDM高危孕妇应从孕早期开始口服含维生素A、E的复合维生素预防GDM的发生改善不良妊娠结局。4.由于维生素A、E无论缺乏还是过量GDM的发生风险均增加,因此在补充维生素A、E的同时应定期监测其浓度,避免因维生素A、E浓度异常导致不良妊娠结局。
[Abstract]:Objective to investigate the serum vitamin A and E levels in the serum of pregnant women (11-13+6 weeks), middle (24-25+6 weeks) and late (more than 31 weeks), and to analyze the related factors, as well as their relationship with pregnancy outcome, and provide basis for rational nutrition guidance for pregnant women. Methods randomly selected from October 2015 to March 2016 were carried out in the obstetric clinic in Tianjin Central Obstetrics and Gynecology Hospital. Prenatal examination and inpatient delivery in the late pregnancy were 2740 cases of single pregnant women who were included in the standard. The serum vitamin A, E concentration was measured by high performance liquid chromatography (HPLC), and the dietary and drug supplementation of pregnant women were collected through a question and answer questionnaire and the pregnant women's general information and final pregnancy outcome were recorded. The amount of vitamin A and E in pregnant women's peripheral blood and the age of pregnant women in pregnancy were independent variables. The relationship between vitamin A, E level and pregnancy outcome in pregnant women's serum was analyzed by unconditional two classification Logistic regression. Results the serum vitamin A concentration in pregnant women was (0.47 + 0.095) mg/L respectively (0.47 + 0.095) mg/L, respectively. (0.48 + 0.323) mg/L, (0.39 + 0.111) mg/L, three total abnormal rate 11.71%, with the lack of main (88.81%). The lowest (P0.05) in advanced vitamin A (P0.05), the highest rate (19.65%), of which severe deficiency (0.2mg/L) 6.72%.2. pregnancy early, in the late pregnant women, the concentration of vitamin E in the blood of the late pregnant women is (11.33 + 2.521) mg/L, (15.78 + 3.493) mg/L, (17.99 + 4.571) mg/. L, the total abnormal rate of the three stage was 16.21%, which was overdose (99.75%). The concentration and abnormal rate of vitamin E increased with the gestational age, the highest in the late pregnancy, the highest (26.83%) (P0.05). The concentration of vitamin E overdose.3. vitamin E was positively correlated with age and pregnancy, but the late pregnancy was negatively correlated with pregnancy and when the age of pregnant women was more than 40 There was no significant correlation between the concentration of vitamin A and pregnancy. It was positively correlated with age in the early pregnancy and the middle period. The late pregnancy and age did not relate to.4 on the basis of daily diet, the increase of vitamin A, E concentration in the early pregnancy and the increase of vitamin A, E concentration in the late pregnancy increased with the daily intake of meat and the intake frequency of animal viscera. Adding and increasing.5. in the condition of the basic diet, the early pregnancy began to supplement vitamin A, E, and vitamin A in the serum, E concentration was higher than the serum vitamin A in the early and late trimester of pregnancy and in the late trimester of pregnancy, and the concentration of E for high blood pressure related diseases of pregnancy (except for chronic hypertension combined with pregnancy and pregnancy). The occurrence of PROM and PPROM had no significant effect on vitamin A in serum of.7. pregnant women, and the concentration of E was associated with the occurrence of GDM (P0.05). The concentration of vitamin A and E at the normal range (vitamin A concentration was 0.3-0.7mg/L, vitamin E concentration) was a protective factor. The rate of vitamin E overdose in the group.8.GDM was significantly higher than that in the non GDM group, and the higher the risk of GDM was higher in the group of.9.. Conclusion the abnormal vitamin A in the 1. population was mainly deficient in vitamin A, and the vitamin A supplementation was recommended during pregnancy; the abnormal vitamin E was mainly excessive, accounting for 99.75%. In the early pregnancy, supplementation of vitamin A in the early pregnancy can effectively improve vitamin A, E lack of vitamin A during pregnancy, E concentration is affected by pregnant women's age, pregnant times and dietary factors. The pregnancy should be monitored regularly during pregnancy. In the course of nutrition guidance, a individualized supplemental scheme is made according to the needs of pregnant women to avoid vitamin E excessive.3. to suggest GDM risk. Pregnant women should begin to take oral vitamin A, E complex vitamins to prevent GDM from the early pregnancy to improve the adverse pregnancy outcome,.4. due to vitamin A, E no matter or excessive GDM risk increased, therefore, vitamin A, E should be regularly monitored at the same time, avoid due to vitamin A, E concentration abnormal lead to adverse pregnancy outcomes.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714

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