【作者】 范雪瑾；

【导师】 柯雪琴；

【作者基本信息】 浙江大学 ， 流行病与卫生统计学， 2005， 硕士

【摘要】 目的 世界卫生组织(WHO)的《健康与发展中的营养问题》一文指出:铁缺乏是世界范围内最常见的营养失调,影响着所有发达和发展中国家的人群,全世界有近20亿人或世界人口的1/3患缺铁性贫血(iron deficiency anemia,IDA),而患缺铁的则是该数的两倍以上。39%的学龄前儿童和52%的孕母患有IDA,其中超过90%的患病者在发展中国家。关于孕母缺铁是否对胎儿及婴幼儿铁营养状况有影响的问题,一直存在争议。上世纪90年代以前多数学者认为孕母无论铁缺乏症如何严重,总是无私地向胎儿供铁,即孕母铁营养状况不影响胎儿按其自身的需要从母体获取铁。上世纪90年代后期至今,越来越多的学者认为孕母缺铁到一定程度会影响胎儿铁营养状况。2002年出版的临床医学7年制规划教材《儿科学》也认为,孕母严重缺铁方会影响胎儿获取铁量。但随着社会、经济的发展,人们生活水平的改善,孕母严重IDA的病例已日趋减少,临床上多见以轻度IDA为主的铁缺乏症患者。然而,我国婴幼儿总体IDA和铁缺乏症患病率与上世纪90年代相比并没有明显降低。因此,孕母轻度铁缺乏是否会对胎、婴、幼儿铁营养状况和生长发育造成影响,有待论证。本研究通过对孕母及其新生儿脐血铁相关指标的检测分析,探究孕母铁贮备与新生儿铁水平的关系。更多还原

【Abstract】 ObjectivesIt was pointed out in the "NUTRITION for Health and Development" by the WHO that iron deficiency is the world’s most widespread nutritional disorder, affecting both industrialized and developing countries. While anemia affects nearly 2000 million people worldwide, or about a third of the world’s population, iron deficiency may affect over twice as many. Overall, 39% of preschool children and 52% of pregnant women are anemic, of whom more than 90% live in developing countries. The issue about whether maternal iron deficiency can affect the nutrition status of iron in fetuses and infants is always controversial. Before the 90’s of last century, the majority of researchers considered that the pregnant woman would offer iron to fetus selflessly regardless of how serious her own iron deficiency is, that is, the nutrition status of iron in pregnant woman do not influence fetus on obtaining iron from mother according to its own need. From late 90’s to now, more and more researchers believe that to certain point, the maternal iron deficiency could affect the nutrition status of iron in fetus. The programming textbook "Pediatrics" for seven-year-system students in clinical medicine which was published in 2002 also point out that only whenmother is in severe IDA, may it reduce the level of iron in fetus. However, with the social development and economic growth, people’s living standard has been improved, the number of severe iron deficiency anemia cases has decreased rapidly. Patients with iron deficiency in clinic at setting are mainly cases with mild IDA. Anyway, the prevalence rates of IDA and iron deficiency in infants don’t reduce obviously compared with those in the 90’s of last century in our country. It should be demonstrated further whether maternal mild iron deficiency will have influence on the nutrition condition of iron in fetus and infant and children’s growth and development. This study tries to explore the relationship between the iron status in pregnant woman and the iron level in umbilical blood of newborns.MethodsEighty one pregnant women were traced completely, and the study population was analyzed at five different pregnancy periods, i.e. the first trimester, the second trimester, the third trimester, complete pregnancy period and the latter two trimester pregnancy periods. Subjects in each different pregnancy period were classified into IDA, LID and normal groups according to the diagnostic criteria. Iron relevant indicators in the umbilical blood of newborns and their relationships with the iron status in pregnant woman were compared across groups. Five milliliters of venous blood were taken from pregnant women at the first trimester (the eleventh or twelfth weeks), the second trimester (the twenty-third or twenty-forth weeks), the third trimester (the thirty-fifth or thirty-sixth weeks) respectively and five milliliters of umbilical blood at delivery. The measuring indexes included hemoglobin (Hb), reticulocyte (Ret), reticulocyte maturity index (RMI), serum iron (SI), serum ferritin (SF) and serum transferrin receptor concentrations (sTfR) and so on. Hb was measured using Blood cell analyzer, the Flow cytometry was used to detect Ret and calculate RMI, SI was determined by Atom absorb spectrophotometer, SF was measured by Chemiluminescence, double antibody sandwich method in ELISA wasused to detect sTfR. All the data was inputted using Epidata3.0, and analyzed using the SPSS 13.0 program. The statistic methods included T test, Chi-square test, ANOVA and correlation analysis.ResultsThe highest prevalence rate of iron deficiency is found in the third trimester, then in the second trimester, and that in the first trimester is the lowest one. The differences between groups were statistically significant (P<0.05 or p<0.01). The prevalence rate of LID (latent iron deficiency) during the first trimester, the second trimester and the third trimester is 2.11, 1.36, and 1.61 times the prevalence rate of IDA respectively. The value of Hb for each pregnant woman with IDA is no less than 90 g/L, who could更多还原