本文選題：維生素A + 妊娠期高血壓疾病��； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:分析妊娠晚期、分娩前血清維生素A含量水平,研究其與妊娠期高血壓疾病及分娩結(jié)局可能存在的關系,為孕期營養(yǎng)指導及監(jiān)測、提前采取措施預防相關合并癥,避免不良預后提供科學依據(jù)。方法:收集2016年4月至2016年8月在大連大學附屬中山醫(yī)院產(chǎn)科產(chǎn)檢及分娩的妊娠患者血清樣本,采用高效液相色譜法分別定量檢測妊娠晚期(28周至36周末)及入院分娩前維生素A的含量。納入經(jīng)入院確診為妊娠期高血壓疾病(hypertensive disorder complicating pregnancy,HDCP)且沒有其他內(nèi)外科合并癥的孕婦相關數(shù)據(jù)資料,用SPSS20.0軟件進行統(tǒng)計處理分析不同維生素A含量與妊娠期高血壓疾病和分娩結(jié)局的關系。結(jié)果:2016年4月至2016年8月在大連大學附屬中山醫(yī)院產(chǎn)科產(chǎn)檢及分娩的妊娠患者共1023例,其中入院診斷為妊娠期高血壓疾病(包括妊娠期高血壓、輕度子癇前期、重度子癇前期)45例,發(fā)病率為4.4%。去除合并各種內(nèi)外科合并癥患者及符合排除標準后最后搜集歸納整理的研究對象共202例,正常妊娠孕婦162例(正常組),診斷妊娠期高血壓疾病孕婦40例(患病組),其中妊娠期高血壓患者18例,輕度子癇前期12例,重度子癇前期10例。結(jié)果患病組的維生素A含量在妊娠晚期和入院分娩前分別為0.2850±0.13681mg/L、0.2695±0.16852mg/L,均較正常組(0.5029±0.14257mg/L、0.4016±0.16705mg/L)顯著下降(P=0.00)。將202名孕婦按病情程度分為四組:正常妊娠組、妊娠期高血壓組、輕度子癇前期組、重度子癇前期組,分別統(tǒng)計得出各組維生素A逐漸下降,含量分別為0.4016±0.16705mg/L、0.3706±0.17877mg/L、0.2517±0.10373mg/L、0.1130±0.01059mg/L,通過比較顯示正常妊娠組與妊娠期高血壓組維生素A含量比較不具有統(tǒng)計學意義,而其余各組兩兩比較顯示均具有統(tǒng)計學意義(P0.05)。研究維生素A含量與分娩結(jié)局的關系發(fā)現(xiàn)維生素A含量正常組、輕度缺乏組、重度缺乏組三組間存在著隨維生素A含量的下降而多種分娩結(jié)局的發(fā)生率均上升的趨勢(除早產(chǎn)外),且在早產(chǎn)、剖宮產(chǎn)、低體重兒、產(chǎn)后出血四種分娩結(jié)局中差異顯著,具有統(tǒng)計學意義(P0.05),但在宮內(nèi)窘迫、1' Apgar評分兩項評價指標上卻出現(xiàn)不一樣結(jié)果,顯示為無差異性(P0.05),另外維生素A重度缺乏組較正常組發(fā)生早產(chǎn)、低體重兒、剖宮產(chǎn)、產(chǎn)后出血的風險分別約為4倍、4倍、8倍和3倍,均提示維生素A含量與分娩結(jié)局同樣密切相關。結(jié)論:晚期妊娠女性維生素A缺乏比例較高,且隨著孕周進展有進一步下降趨勢,在妊娠期高血壓疾病組中更加明顯。維生素A含量與妊娠期高血壓疾病發(fā)生、病情進展可能有明顯相關性,可能是較為重要發(fā)病因素之一。維生素A可能與早產(chǎn)、剖宮產(chǎn)、低體重兒、產(chǎn)后出血等多種不良分娩結(jié)局相關,而與宮內(nèi)窘迫、1' Apgar評分等無明顯相關性,應引起產(chǎn)科醫(yī)師引起重視。
[Abstract]:Objective: to analyze the level of serum vitamin A in the third trimester of pregnancy and before delivery, to study its relationship with hypertensive disorder complicating pregnancy and the outcome of delivery, to guide and monitor nutrition during pregnancy, and to take measures to prevent related complications in advance. To avoid adverse prognosis provides scientific basis. Methods: from April 2016 to August 2016, serum samples were collected from pregnant women in Zhongshan Hospital affiliated to Dalian University. High performance liquid chromatography (HPLC) was used to determine the content of vitamin A in the third trimester of pregnancy from 28 weeks to 36 weeks. Data of pregnant women diagnosed as hypertensive disorder complicating pregnancy (disorder complicating) without other internal and surgical complications were included. SPSS 20.0 software was used to analyze the relationship between different vitamin A content and hypertensive disorder complicating pregnancy and delivery outcome. Results: from April 2016 to August 2016, a total of 1023 pregnant women were diagnosed as hypertensive disorder complicating pregnancy (including gestational hypertension, mild preeclampsia) at the Zhongshan Hospital affiliated to Dalian University. There were 45 cases of severe preeclampsia with an incidence of 4.4%. A total of 202 cases were collected and sorted out after removing the patients with all kinds of internal and surgical complications and meeting the exclusion criteria. There were 162 normal pregnant women (normal group, 40 pregnant women with hypertension complicating pregnancy) (18 cases of hypertensive disorder complicating pregnancy, 12 cases of mild preeclampsia and 10 cases of severe preeclampsia). Results Vitamin A content in the patients was 0.2850 鹵0.13681mg / L 0.2695 鹵0.16852 mg / L respectively, which was significantly lower than that in the normal group (0.5029 鹵0.14257mg / L 0.4016 鹵0.16705mg / L). 202 pregnant women were divided into four groups according to their degree of illness: normal pregnancy group, gestational hypertension group, mild preeclampsia group, severe preeclampsia group. The content of vitamin A was 0.4016 鹵0.16705mg / L 0.3706 鹵0.17877mg / L 0.2517 鹵0.10373mg / L 0.1130 鹵0.01059mg / L respectively. To study the relationship between vitamin A content and delivery outcome, we found that vitamin A content in normal group, mild deficiency group, In the severe deficiency group, there was a tendency to increase the incidence of multiple delivery outcomes with the decrease of vitamin A content (except preterm delivery, and there were significant differences among the four delivery outcomes: premature delivery, cesarean section, low birth weight, postpartum hemorrhage). There was statistically significant difference in P0.05, but there were different results in the 1 'Apgar score of intrauterine distress, showing no difference (P0.05). In addition, premature delivery, low birth weight and cesarean section occurred in the severe vitamin A deficiency group than in the normal group. The risk of postpartum hemorrhage was about 4 times, 4 times and 3 times, respectively, indicating that the content of vitamin A was also closely related to the outcome of labor. Conclusion: the proportion of vitamin A deficiency in women with late pregnancy is higher, and it is more obvious in hypertensive disorder complicating pregnancy with the progress of gestational weeks. Vitamin A content may be one of the most important factors associated with the occurrence and progression of hypertensive disorder complicating pregnancy. Vitamin A may be associated with premature delivery, cesarean section, low birth weight, postpartum hemorrhage and other adverse outcomes of delivery, but not with intrauterine distress (1'Apgar) score, which should be paid attention to by obstetricians.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.246
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本文編號：2033684