本文選題：α地中海貧血 + 妊娠期��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：探討不同類型α地中海貧血孕婦妊娠期血紅蛋白(Hb)、平均紅細胞容積(MCV)、平均紅細胞血紅蛋白(MCH)、血清鐵蛋白(SF)水平的變化及對妊娠結(jié)局的影響,為不同類型α地中海貧血孕婦孕期保健提供依據(jù)。方法：選取2013年7月至2014年10月在我院產(chǎn)檢的35例中間型α地貧孕婦(中間型組),隨機選取同一時期的輕型α地貧孕婦35例(輕型組)、靜止型α地貧孕婦35例(靜止型組)、健康孕婦35例(對照組)分別在孕早期(孕13周末前)、孕中期(孕14至27周末)、孕晚期(孕28周至分娩)監(jiān)測各組Hb、MCV、MCH及SF值,了解四組孕婦孕期上述指標(biāo)的變化及觀察其妊娠結(jié)局。結(jié)果：(1)中間型組孕婦孕早期、孕中期和孕晚期Hb值分別為103.00 ±14.45g/L、94.38±16.34g/L、80.38±18.54g/L,低于靜止型組、輕型組及對照組；輕型組孕早期、孕中期和孕晚期Hb值低于靜止型組及對照組；中間型組孕婦孕期Hb下降幅度分別為11.21±2.03g/L,高于靜止型組、輕型組及對照組；輕型組高于靜止型組及對照組。(2)中間型組孕婦孕早期、孕中期和孕晚期MCV分別為70.13±3.92fl、70.45±4.27fl、72.43±3.05f1,低于靜止型組及對照組：輕型組MCV低于靜止型組及對照組,高于中間型組；整個孕期輕型組、中間型組孕婦MCV值呈增加趨勢、靜止型組MCV值呈下降趨勢,對照組MCV值孕中期上升、孕晚期下降。 (3)中間型組孕婦孕早期、孕中期和孕晚期MCH結(jié)果分別為20.85±2.56pg、20.03 ±2.67pg、19.91±1.88pg,低于輕型組、靜止型組及對照組；輕型組低于靜止型組及對照組；整個孕期中間型組、輕型組、靜止型組MCH值均呈下降趨勢,對照組MCH值于孕中期上升、孕晚期下降,孕晚期值低于孕早期。(4)中間型組孕婦孕早期、孕中期和孕晚期SF結(jié)果分別為120.01±42.33ng/ml、63.36±28.14ng/ml、41.38±20.94ng/ml；中間型組及輕型組孕婦孕早期SF水平高于靜止型組及對照組；中間型組與輕型組、靜止型組與對照組孕早期SF水平、四組孕婦孕中期及孕晚期SF水平無明顯差別；孕期SF下降程度為：中間型組最大,輕型組次之,靜止型組及對照組最小。(5)四組孕婦剖宮產(chǎn)原因比較：中間型組孕婦分娩時胎兒窘迫發(fā)生率最高,其余三組間無明顯差別。 (6)中間型組孕婦分娩新生兒的出生體重為2941.65±634.25g,低于靜止型組、輕型組及對照組；輕型組孕婦分娩新生兒的出生體重低于靜止型組及對照組；四組孕婦新生兒1 min Apgar評分無明顯差別。結(jié)論：(1)輕型及中間型地中海貧血孕婦孕期血紅蛋白值低于靜止型地貧孕婦及正常孕婦,孕婦孕期血紅蛋白值均會下降,且地中海貧血基因缺失越多,貧血程度越重,血紅蛋白下降程度越大。(2)輕型及中間型α地貧孕婦孕期MCV值上升,MCH值下降,但均低于正常值,臨床上應(yīng)重視MCV及MCH值,避免漏診地中海貧血。(3)輕型及中間型α地貧孕婦孕早期時血清鐵蛋白值高,孕婦隨著孕周進展,鐵消耗增加,部分患者孕晚期時會表現(xiàn)為缺鐵狀態(tài),可加重貧血。(4)靜止α地貧孕婦孕期血常規(guī)、血清鐵蛋白與正常孕婦無明顯差別,臨床上應(yīng)注意靜止型地中海貧血的鑒別診斷,避免漏診。(5)女性妊娠期貧血會影響妊娠結(jié)局,妊娠期女性應(yīng)按時產(chǎn)檢,定期監(jiān)測相關(guān)指標(biāo),及時糾正貧血,減少不良妊娠結(jié)局發(fā)生。
[Abstract]:Objective: To investigate the changes of Hb, mean red blood cell volume (MCV), mean erythrocyte hemoglobin (MCH), serum ferritin (SF) level and pregnancy outcome in pregnant women with different types of alpha thalassemia, and to provide a basis for pregnancy health care for pregnant women of different types of alpha thalassemia. Methods: 10 from July 2013 to 2014. 35 cases of intermediate alpha poor pregnant women (intermediate group) in our hospital were randomly selected in the same period, 35 cases of light alpha poor pregnant women (light group), 35 cases of static alpha poor pregnant women (static group), 35 healthy pregnant women (control group) in the early pregnancy (13 weeks of pregnancy), middle pregnancy (14 to 27 weeks of pregnancy), and late pregnancy (pregnancy 28 to childbirth) monitoring. Group Hb, MCV, MCH and SF values, to understand the changes of the above indexes during pregnancy in four groups of pregnant women and to observe the outcome of pregnancy. Results: (1) the Hb values in the middle group were 103 + 14.45g/L, 94.38 + 16.34g/L, 80.38 + 18.54g/L, respectively, lower than the static group, the light group and the control group, and the early pregnancy, the middle pregnancy and the gestational night in the light group. The value of Hb was lower than that of the static group and the control group. The decrease amplitude of Hb in pregnant women in the middle group was 11.21 + 2.03g/L, higher than that in the static group, the light group and the control group; the light group was higher than the static group and the control group. (2) the intermediate group was 70.13 + 3.92fl, 70.45 + 4.27fl and 72.43 + 3.05f1 in the middle group of pregnant women in the early pregnancy, the middle of the pregnancy and the third trimester. The static group and the control group: the light group MCV was lower than the static group and the control group, which was higher than the middle type group. The MCV value of the pregnant women in the light group and the middle type group increased, the MCV value of the static group decreased, the MCV value of the control group rose in the middle period of pregnancy, and the late pregnancy decreased. (3) the MCH results in the early pregnancy, the middle pregnancy and the late trimester of pregnancy in the middle and middle type group were divided. 20.85 + 2.56pg, 20.03 + 2.67pg, 19.91 + 1.88pg, lower than the light group, the static group and the control group; the light group was lower than the static group and the control group. The MCH value of the middle stage group, the light group and the static group decreased, the MCH value of the control group rose in the middle of pregnancy, the late pregnancy was lower and the late pregnancy was lower than that in the early pregnancy. (4) intermediate group. The SF results in the early pregnancy, mid pregnancy and late trimester of pregnant women were 120.01 + 42.33ng/ml, 63.36 + 28.14ng/ml and 41.38 + 20.94ng/ml respectively. The SF level in the middle group and the light group was higher than that of the static group and the control group. The middle group and the light group, the static group and the control group were SF level in the early pregnancy, and the four groups of pregnant women and the SF level in the late trimester of pregnancy. There was no significant difference in the degree of SF decline during pregnancy: the largest in the middle group, the light group, the static group and the control group. (5) the reasons for cesarean section in the four groups were compared: the middle group had the highest rate of fetal distress during childbirth, and there was no significant difference between the other three groups. (6) the birth weight of the newborns in the middle type pregnant women was 2941.65 +. 634.25g, lower than the static group, the light group and the control group, the birth weight of the newborn babies in the light group was lower than that of the static group and the control group. The 1 min Apgar score of the four groups of pregnant women had no significant difference. Conclusion: (1) the value of the serum erythrocyte of pregnant women with mild and intermediate thalassemia was lower than that of the static poor pregnant women and the normal pregnant women. The value of hemoglobin in pregnant women will decrease, and the more gene deletion of thalassemia, the greater the degree of anemia and the greater the decrease of hemoglobin. (2) the MCV value of pregnant women in light and intermediate type alpha poor pregnant women increase, MCH values decrease, but they are lower than normal values. The value of MCV and MCH should be paid more attention to to avoid missed diagnosis of thalassemia. (3) light and intermediate alpha The serum ferritin value of pregnant women in the early stage of pregnancy is high. With the progress of pregnancy and the increase of iron consumption in pregnant women, some patients will appear iron deficiency during the late pregnancy. (4) there is no significant difference between the serum ferritin and normal pregnant women, and the differential diagnosis of static thalassemia should be paid attention to. No missed diagnosis. (5) female pregnancy anemia will affect pregnancy outcome, pregnancy women should be timely examination, regular monitoring of relevant indicators, timely correction of anemia, and reduce the outcome of bad pregnancy.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R714.254

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