Relationship between iron deficiency anemia during pregnancy and paraoxonase-1 level and perinatal outcome
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摘要: 目的 分析妊娠期缺铁性贫血指标，铁蛋白(SF)、转铁蛋白(TRF)、总铁结合力(TIBC)及对氧磷酶-1(PON-1)水平与围生结局的关系。方法 选取2017年1月—2020年1月收治的116例妊娠期贫血患者作为观察组，并选取同期100例妊娠期正常女性作为对照组，检测血清SF、TRF、TIBC、PON-1水平，并记录围生结局，采用多因素logistic回归分析影响围生结局的独立危险因素；同时绘制ROC曲线分析血清SF、TRF、TIBC、PON-1水平预测围生结局的价值。结果 观察组血清SF、PON-1水平低于对照组，TRF、TIBC高于对照组(P< 0.05)；观察组妊娠期高血压、产后出血、胎膜早破及早产发生率高于对照组(P< 0.05)；妊娠期高血压、产后出血、胎膜早破及早产患者血清SF、PON-1水平低于非妊娠期高血压、产后出血、胎膜早破及早产患者，TRF、TIBC水平高于非妊娠期高血压、产后出血、胎膜早破及早产患者(P< 0.05)；多因素logistic回归分析显示，血清SF、TRF、TIBC、PON-1水平是影响围生结局的独立危险因素(P< 0.05)；ROC曲线分析显示，血清SF、TRF、TIBC、PON-1水平联合预测围生结局的敏感度及特异度均高于单独预测(P< 0.05)。结论 妊娠期贫血患者血清SF、PON-1水平呈低表达，TRF、TIBC水平呈高表达，对围生结局预测价值较高，同时也是影响妊娠期贫血围生结局的独立危险因素。Abstract: Objective To analyze the relationship between the levels of ferritin(SF), transferrin(TRF), total iron binding force(TIBC) and paraoxonase-1(PON-1) and the perinatal outcome of iron deficiency anemia during pregnancy.Methods A total of 116 patients with gestational anemia admitted to the hospital from January 2017 to January 2020 were enrolled as observation group, while other 100 normal pregnant women were enrolled as control group. The levels of SF, TRF, TIBC and PON-1 were detected, and perinatal outcomes were recorded. The independent risk factors affecting perinatal outcomes were analyzed by multivariate logistic regression analysis. The predictive value of serum SF, TRF, TIBC and PON-1 levels for perinatal outcomes was analyzed by ROC curves.Results The levels of SF and PON-1 in observation group were lower than those in control group, while TRF and TIBC were higher than those in control group(P< 0.05). The incidences of gestational hypertension, postpartum hemorrhage, premature rupture of membranes and premature delivery in observation group were higher than those in control group(P< 0.05). The levels of serum SF and PON-1 in the patients with gestational hypertension, postpartum hemorrhage, premature rupture of membranes and premature delivery were lower than those without gestational hypertension, postpartum hemorrhage, premature rupture of membranes or premature delivery, while TRF and TIBC were higher than those patients(P< 0.05). Multivariate logistic regression analysis showed that levels of SF, TRF, TIBC and PON-1 were independent risk factors affecting perinatal outcomes(P< 0.05). ROC curves analysis showed that sensitivity and specificity of SF combined with TRF, TIBC and PON-1 for predicting perinatal outcomes were higher than those of single index(P< 0.05).Conclusion The levels of SF and PON-1 are low, while levels of TRF and TIBC are high in the patients with gestational anemia. They may be of high predictive value for perinatal outcomes, which can be also independent risk factors that affect perinatal outcomes of gestational anemia.
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表 1 2组血清SF、TRF、TIBC、PON-1水平比较
X±S 组别 SF/(μg·L-1) TRF/(g·L-1) TIBC/(μmol·L-1) Pon-1/(U·L-1) 观察组(n=116) 63.40±10.57 3.58±1.02 75.29±14.37 460.22±42.37 对照组(n=100) 97.52±15.22 2.20±0.57 51.42±9.55 652.77±50.28 t 19.337 12.007 14.135 78.132 P < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 2组围生结局比较
例(%) 组别 妊娠期高血压 产后出血 胎膜早破 早产 观察组(n=116) 12(10.34) 13(11.21) 18(15.52) 13(11.21) 对照组(n=100) 3(3.00) 3(3.00) 2(2.00) 3(3.00) χ2 4.483 5.274 11.679 5.274 P 0.034 0.022 0.001 0.022
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表 3 不同围生结局血清SF、TRF、TIBC、PON-1水平比较
X±S 组别 SF/(μg·L-1) TRF/(g·L-1) TIBC/(μmol·L-1) Pon-1/(U·L-1) 妊娠期高血压 有(n=11) 57.64±7.621) 3.19±0.531) 70.22±12.031) 496.20±46.341) 无(n=105) 75.22±12.04 2.36±0.25 57.22±9.34 600.23±50.17 产后出血 有(n=10) 56.19±7.501) 3.15±0.501) 69.19±11.971) 497.03±46.381) 无(n=106) 76.23±12.18 2.41±0.30 57.90±10.17 601.22±50.87 胎膜早破 有(n=18) 55.28±6.961) 3.12±0.471) 70.30±12.111) 496.88±46.451) 无(n=98) 74.98±11.95 2.34±0.24 58.04±9.24 602.31±51.04 早产 有(n=13) 56.07±7.421) 3.17±0.521) 70.10±11.821) 497.23±16.501) 无(n=103) 74.80±11.88 2.36±0.25 57.92±10.20 600.88±50.24 与无妊娠期高血压、无产后出血、无胎膜早破及无早产患者比较，1)P < 0.05。
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表 4 影响围生结局的多因素logistic回归分析
因素 β SE Wald χ2 P OR 95%CI SF 1.177 0.347 11.505 0.001 3.245 1.644~6.405 TRF 1.135 0.352 10.397 0.002 3.111 1.561~6.202 TIBC 1.124 0.402 7.818 0.005 3.077 1.399~6.766 Pon-1 1.117 0.380 8.641 0.003 3.056 1.451~6.435
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