【摘要】 目的 分析育龄期妇女孕前血清血红蛋白（Hb）水平与流产的关系，为筛查流产风险提供参考。方法 采用巢式病例对照研究，选择2019年1月-2020年6月在新疆生产建设兵团第八师石河子市妇幼保健院进行孕前健康检查并建立档案的育龄期妇女1 483例。随访1年，共1 472例完成随访，发生流产者为135例，将其纳入病例组。根据1∶4的配对原则，选择同期建档日期前后不超过1周、居住在同街道并在同级医院分娩的540例孕妇作为对照组。比较两组育龄期妇女的社会人口学特征、生育史等，分析社会经济学地位（SES）。检测血清Hb水平，收集各项体检资料包括孕前血糖（GLU）、孕前促甲状腺激素（TSH）、孕前空腹血糖（GPT）水平。采用单因素及多因素logistic回归分析流产的影响因素。同时采用限制性立方样条（RCS）探讨孕前Hb水平与流产之间的剂量-反应关系。结果 育龄期妇女流产的发病率为9.17%（135/1 472）。两组年龄（t=8.06,P<0.001）、SES（t=5.59,P<0.001）、孕前TSH（T=5.103,P<0.001）、孕前GPT（T=2.22,P=0.026）差异有统计学意义。多因素分析结果显示，高龄、孕前贫血及高Hb（Hb≥150 g/L）均是流产发生的危险因素（O R分别为1.84、1.98、1.32,P均<0.05）;在完全调整的模型（模型Ⅲ）中，与正常Hb的育龄期妇女相比，高Hb的育龄期妇女流产风险增加1.32倍（95%CI:1.07～2.54）;在粗模型（模型Ⅰ）中，与正常Hb的育龄期妇女相比，贫血的育龄期妇女流产风险增加2.04倍（95%CI:1.38～3.85）。RCS结果显示，孕前Hb水平与流产呈U型剂量反应关系，不同模型的结果一致(P_non-liner<0.05)。结论 孕前贫血与高Hb均可增加育龄期妇女流产的发生风险，孕前Hb水平与育龄期妇女流产呈非线性剂量-反应关系。更多还原

【Abstract】 Objective To analyze the relationship between pre-pregnancy Hb levels and abortion in women of childbearing age to inform screening for risk of miscarriage. Methods A nested case-control study was used to select 1 483 women of childbearing age who came to Shihezi Maternal and Child Health Hospital of the 8th Division of Xinjiang Corps from January 2019 to June 2020 for pre-pregnancy health examination and establishment of records.A total of 1 472 patients were followed up for 1 year, and 135 aborted patients were included in the case group.According to the matching principle of 1∶4 540 pregnant women who lived in the same street and gave birth in the same hospital within 1 week before and after the same filing date were selected as the control group.The social demographic characteristics, reproductive history, and preconception Hb level of the 2 groups were compared.The influencing factors of abortion were analyzed by univariate and multivariate logistic regression.At the same time, the dose-response relationship between preconception Hb level and abortion was investigated by using restricted cubic spline(RCS). Results The incidence of miscarriage was 9.17%(135/1 472).There were significant differences in age(t=8.06,P<0.001),socioeconomic status(SES)(t=5.59,P<0.001),pre-pregnancy thyroid hormone level(TSH)(T=5.103,P<0.001),glutamic-pyruginous transaminase(GPT)(T=2.22,P=0.026) between the 2 groups.The results of multifactorial analysis showed that advanced age, pre-pregnancy anemia and high Hb were all risk factors for the occurrence of miscarriage(OR advanced age=1.84,OR anemia = 1.98,OR high Hb=1.32,P<0.05);In the fully adjusted model(Model Ⅲ),women with Hb ≥150 g/L had a significantly increased risk of miscarriage by 1.32(95%CI:1.07,2.54) compared to women with Hb of 110-149 g/L.In the crude model(Model I),the risk of miscarriage was significantly increased 2.04(95%CI:1.38,3.85) in the anemic group compared with normal Hb.The RCS results showed a U-shaped dose-response relationship between pre-pregnancy Hb concentration and miscarriage, and the results remained consistent across models. Conclusion Both pre-pregnancy anemia and high Hb can increase the risk of abortion, and pre-pregnancy Hb concentration shows a non-linear dose-response relationship with abortion.更多还原