舟山海岛地区孕妇妊娠期血红蛋白含量与血压的关系研究
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摘要
目的探讨舟山群岛地区孕妇妊娠期血红蛋白含量与血压的关系,为妊娠期高血压疾病(PIH)的病因学研究提供科学依据。方法采用回顾性调查研究,对2017年1月-2018年6月期间在该院进行围产保健的1 383名孕妇孕早、中、晚期的血红蛋白含量与血压进行监测,采用多元线性回归分析不同孕期血红蛋白含量、贫血与血压之间的关系。结果孕早、中、晚期平均血红蛋白分别为(121. 39±9. 06) g/L、(113. 89±8. 09) g/L和(115. 18±9. 01)/L,相应的贫血发生率分别为10. 77%、25. 45%和21. 40%,平均收缩压分别为(104. 20±8. 04) mm Hg、(106. 39±7. 37) mm Hg和(108. 04±9. 05) mm Hg;平均舒张压分别为(70. 80±7. 65) mm Hg、(73. 88±7. 52) mm Hg和(73. 80±7. 57) mm Hg。多元线性回归显示,孕期血红蛋白水平与孕期收缩压呈正相关,且孕早期的贫血或血红蛋白水平对各期的收缩压影响最大。对于孕晚期收缩压,孕早期血红蛋白水平的影响最大(β=0. 10,P<0. 001),而中、晚期血红蛋白水平的影响不明显;相应地,孕早期贫血对孕晚期收缩压的影响最大(β=-3. 17,P<0. 001),孕晚期贫血的影响相对较弱(β=-1. 66,P=0. 027),而与孕中期是否贫血无关。贫血或血红蛋白水平与舒张压水平的变化趋势类似于其与收缩压之间的关系,但舒张压基本只与同时期的血红蛋白水平或是否贫血有关,如孕晚期的舒张压只与孕晚期的血红蛋白水平有关(β=0. 09,P=0. 001),而与早期和中期的水平无关。结论妊娠期血红蛋白水平与孕早、中、晚期收缩压和舒张压均存在正相关,孕早期的血红蛋白水平对孕期收缩压的影响最大,而舒张压则与同时期的血红蛋白水平有关。通过定期测量孕期血红蛋白水平,可以指导临床医生更好地进行围产期保健,改善母婴预后。
Objective To explore the association between hemoglobin level during pregnancy with blood pressure in the Zhoushan Islands and provide scientific evidence for the etiological study of gestational hypertension. Methods A retrospective study was conducted to record the hemoglobin level and blood pressure among 1,383 pregnant women who received perinatal health care in Maternal and Child Health Care Hospital of Zhoushan from January 2017 to June 2018. Multiple linear regression models were used to explore the association between hemoglobin level,anemia and blood pressure in three trimesters. Results The mean hemoglobin levels were( 121. 39 ±9. 06) g/L,( 113. 89 ±8. 09) g/L and( 115. 18 ±9. 01) g/L in the first,second and third trimester,the corresponding prevalence of anemia were10. 77%,25. 45% and 21. 40%,respectively; mean systolic pressure( SBP) were( 104. 20±8. 04) mm Hg,( 106. 39±7. 37) mm Hg and( 108. 04±9. 05) mm Hg,respectively; mean diastolic pressure( DBP) were( 70. 80±7. 65) mm Hg,( 73. 88±7. 52) mm Hg and( 73. 80±7. 57) mm Hg,respectively. Multiple linear regressions showed that the hemoglobin level and the SBP during pregnancy had a significantly positive correlation,and anemia or hemoglobin level in early pregnancy had the greatest effect on the SBP at each trimester. For SBP in late pregnancy,hemoglobin level in the early trimester produced the highest effect( β = 0. 10,P<0. 001),while hemoglobin level in the middle and late trimester was not significantly associated with it. Accordingly,anemia in early pregnancy was most strongly associated with SBP in late pregnancy( β =-3. 17,P<0. 001),and the association of anemia in late pregnancy with SBP in late pregnancy was relatively weak( β =-1. 66,P = 0. 027),but there was not significant association between anemia in middle pregnancy and SBP in late pregnancy. The similar association was observed between of anemia or hemoglobin level and the DBP,but the significant associations were observed only between hemoglobin level and DBP of the same trimester. such as hemoglobin level at the third trimester only related with the DBP at the third trimester( β=0. 09,P=0. 001),not associated with DBP of the early or middle trimester. Conclusion There was a positive correlation between the hemoglobin level and SBP and DBP in early,middle and late pregnancy. The hemoglobin level in early pregnancy had the greatest influence on SBP during pregnancy,while the hemoglobin level was only related to DBP in the same trimester. The regularly measuring the hemoglobin level during pregnancy may benefit on perinatal care and improve maternal and child prognosis.
Objective To explore the association between hemoglobin level during pregnancy with blood pressure in the Zhoushan Islands and provide scientific evidence for the etiological study of gestational hypertension. Methods A retrospective study was conducted to record the hemoglobin level and blood pressure among 1,383 pregnant women who received perinatal health care in Maternal and Child Health Care Hospital of Zhoushan from January 2017 to June 2018. Multiple linear regression models were used to explore the association between hemoglobin level,anemia and blood pressure in three trimesters. Results The mean hemoglobin levels were( 121. 39 ±9. 06) g/L,( 113. 89 ±8. 09) g/L and( 115. 18 ±9. 01) g/L in the first,second and third trimester,the corresponding prevalence of anemia were10. 77%,25. 45% and 21. 40%,respectively; mean systolic pressure( SBP) were( 104. 20±8. 04) mm Hg,( 106. 39±7. 37) mm Hg and( 108. 04±9. 05) mm Hg,respectively; mean diastolic pressure( DBP) were( 70. 80±7. 65) mm Hg,( 73. 88±7. 52) mm Hg and( 73. 80±7. 57) mm Hg,respectively. Multiple linear regressions showed that the hemoglobin level and the SBP during pregnancy had a significantly positive correlation,and anemia or hemoglobin level in early pregnancy had the greatest effect on the SBP at each trimester. For SBP in late pregnancy,hemoglobin level in the early trimester produced the highest effect( β = 0. 10,P<0. 001),while hemoglobin level in the middle and late trimester was not significantly associated with it. Accordingly,anemia in early pregnancy was most strongly associated with SBP in late pregnancy( β =-3. 17,P<0. 001),and the association of anemia in late pregnancy with SBP in late pregnancy was relatively weak( β =-1. 66,P = 0. 027),but there was not significant association between anemia in middle pregnancy and SBP in late pregnancy. The similar association was observed between of anemia or hemoglobin level and the DBP,but the significant associations were observed only between hemoglobin level and DBP of the same trimester. such as hemoglobin level at the third trimester only related with the DBP at the third trimester( β=0. 09,P=0. 001),not associated with DBP of the early or middle trimester. Conclusion There was a positive correlation between the hemoglobin level and SBP and DBP in early,middle and late pregnancy. The hemoglobin level in early pregnancy had the greatest influence on SBP during pregnancy,while the hemoglobin level was only related to DBP in the same trimester. The regularly measuring the hemoglobin level during pregnancy may benefit on perinatal care and improve maternal and child prognosis.
引文
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[7] Huisman A,Aanoudse JG. Increased 2nd-trimester hemoglobin concentration in pregnancies later complicated by hypertension and growth retardation Early evidence of a reduced plasma volume[J]. Acta Obstet Gynecol Scand,1986,65(6):605-608.
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[11] Davis MR,Fitzpatrick CM,Dixon PM,et al. Thrombs-induced endothelial dysfunction:hemoglobin and fibrin decrease nitric oxide bioac-tivity without altering e NOS[J]. J Surg Tes,2004,122(1):121-129.
[12]钟海兰,卢新政,陈秀梅,等.外周血中血红蛋白含量与血压水平的关系[J].中华高血压杂志,2008,16(12):1111-1114.
[2]李玉艳,武俊青,赵瑞,等.母亲妊娠期和围生期因素与青少年血压的关系[J].中华疾病控制杂志,2016,20(1):34-37,41.
[3] Jwa SC,Fujiwara T,Yamanobe Y,et al. Changes in maternal hemoglobin during pregnancy and birth outcomes[J]. BMC Pregnancy Childbirth,2015,15(1):80.
[4]邵炎涛,黄东萍,刘顺等.壮族地区孕前体质指数、孕期增重及孕期贫血对小于胎龄儿影响研究[J].中华疾病控制杂志,2018,22(7):663-666.
[5]乐杰,谢幸,林仲秋,等.妇产科学[M].第7版,北京:人民卫生出版社,2008:36.
[6]蒲柳艳,吴金华,黄满仙,等.浙江省舟山市40 819名孕妇妊娠期血压变化趋势及影响因素研究[J].疾病监测,2018,33(9):770-774.
[7] Huisman A,Aanoudse JG. Increased 2nd-trimester hemoglobin concentration in pregnancies later complicated by hypertension and growth retardation Early evidence of a reduced plasma volume[J]. Acta Obstet Gynecol Scand,1986,65(6):605-608.
[8] Heilmann L,Rath W,Pollow K. Hemorheological changes in women with severe preeclampsia[J]. Clin Hemorheol Microcirc,2004,31(1):49-58.
[9]姚立岩,柏学民,张毓洪,等. PIH危险因素调查分析[J].中国妇幼保健,2004,19(20):116-117.
[10] Cabrales P,Han G,Nacharaju P,et al. Reversal of hemoglobininduced vasoconstriction with sustained release of nitric oxide[J].Am J Physiol Heart Circ Physiol,2011,300(1):49-56.
[11] Davis MR,Fitzpatrick CM,Dixon PM,et al. Thrombs-induced endothelial dysfunction:hemoglobin and fibrin decrease nitric oxide bioac-tivity without altering e NOS[J]. J Surg Tes,2004,122(1):121-129.
[12]钟海兰,卢新政,陈秀梅,等.外周血中血红蛋白含量与血压水平的关系[J].中华高血压杂志,2008,16(12):1111-1114.