舟山海岛地区孕妇妊娠期血红蛋白含量与血压的关系
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摘要
目的探讨舟山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月期间在浙江省舟山市妇幼保健院进行围产保健的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与血压之间的关系。结果孕早、中、晚期贫血发生率分别为7.74%、25.45%和15.76%;多元线性回归显示,孕期血红蛋白水平对孕早、中、晚期收缩压均有影响,并且呈现出越早期血红蛋白水平对各期的收缩压影响明显。早期的血红蛋白水平的影响最大(β=0.10,P<0.001),中期无统计学关联,晚期的影响其次(β=0.04,P=0.027)。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。结论妊娠期血红蛋白水平对孕早、中、晚期血压均有明显的影响,定期测量孕期血红蛋白水平,可以更好地改善孕产妇健康状况。
Objective To investigate the relationship between hemoglobin and blood pressure of pregnant women in Zhoushan islands, so as to provide scientific evidence for the etiological study of gestational hypertension. Methods A retrospective study was conducted among 1 383 pregnant women who received perinatal care in Zhoushan Maternal and Child Health Hospital of Zhejiang Province from January 2017 to June 2018. Pregnant women were monitored for hemoglobin content and blood pressure in the early, middle and late pregnancy. The multivariate linear regression was used to analyze the relationship between hemoglobin content and blood pressure in different pregnancy. Results The incidence of anemia in early, middle and late pregnancy was 7.74%, 25.45% and 15.76% respectively. The multivariate linear regression showed that hemoglobin levels during pregnancy had effects on systolic blood pressure in early, middle and late pregnancy, and the earlier hemoglobin levels were monitored, the more obvious the effect on systolic blood pressure was.With the increase of hemoglobin level, systolic blood pressure increased, such as the effect of hemoglobin on systolic blood pressure in early pregnancy, mid-pregnancy and late pregnancy. Hemoglobin of first trimster had the greatest effect(β=0.10, P<0.001), Hemoglobin of second trimester had no obvious effect, and that of third trimester had the second effect(β=0.04, P=0.027).Hemoglobin levels and diastolic blood pressure levels were similar to their relationship with systolic blood pressure. Conclusions Hemoglobin levels during pregnancy have significant effects on systolic and diastolic blood pressure in first, second and third trimsters of pregnancy. Regular measurement of hemoglobin levels during pregnancy can improve the health of pregnant women.
Objective To investigate the relationship between hemoglobin and blood pressure of pregnant women in Zhoushan islands, so as to provide scientific evidence for the etiological study of gestational hypertension. Methods A retrospective study was conducted among 1 383 pregnant women who received perinatal care in Zhoushan Maternal and Child Health Hospital of Zhejiang Province from January 2017 to June 2018. Pregnant women were monitored for hemoglobin content and blood pressure in the early, middle and late pregnancy. The multivariate linear regression was used to analyze the relationship between hemoglobin content and blood pressure in different pregnancy. Results The incidence of anemia in early, middle and late pregnancy was 7.74%, 25.45% and 15.76% respectively. The multivariate linear regression showed that hemoglobin levels during pregnancy had effects on systolic blood pressure in early, middle and late pregnancy, and the earlier hemoglobin levels were monitored, the more obvious the effect on systolic blood pressure was.With the increase of hemoglobin level, systolic blood pressure increased, such as the effect of hemoglobin on systolic blood pressure in early pregnancy, mid-pregnancy and late pregnancy. Hemoglobin of first trimster had the greatest effect(β=0.10, P<0.001), Hemoglobin of second trimester had no obvious effect, and that of third trimester had the second effect(β=0.04, P=0.027).Hemoglobin levels and diastolic blood pressure levels were similar to their relationship with systolic blood pressure. Conclusions Hemoglobin levels during pregnancy have significant effects on systolic and diastolic blood pressure in first, second and third trimsters of pregnancy. Regular measurement of hemoglobin levels during pregnancy can improve the health of pregnant women.
引文
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[11] 姚立岩,柏学民,张毓洪,等.妊高征危险因素调查分析 [J].中国妇幼保健,2004,19(10):116-117.DOI:10.3969/j.issn.1001-4411.2004.20.070.Yao LY,Bai XM,Zhang YH,et al.Investigation and analysis of the risk factors in women with pregnancy-induced hypertension syndrome [J].Maternal and Child Health Care of China,2004,19(10):116-117.DOI:10.3969/j.issn.1001-4411.2004.20.070.
[12] Cabrales P,Han G,Nacharaju P,et al.Reversal of hemoglobin-induced vasoconstriction with sustained release of nitric oxide [J].Am J Physiol Heart Circ Physiol,2011,300(1):H49-H56.DOI:10.1152/ajpheart.00665.2010.
[13] Davis MR,Fitzpatrick CM,Dixon PM,et al.Thrombus-induced endothelial dysfunction:Hemoglobin and fibrin decrease nitric oxide bioactivity without altering eNOS [J].J Surg Res,2004,122(1):121-129.DOI:10.1016/j.jss.2004.07.009.
[14] Brannon PM,Taylor CL.Iron supplementation during pregnancy and infancy:uncertainties and implications for research and policy [J].Nutrients,2017,9(12):1327.DOI:10.3390/nu9121327.
[2] 李玉艳,武俊青,赵瑞,等.母亲妊娠后期和围生理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.DOI:10.16462/j.cnki.zhjbkz.2016.01.009.Li YY,Wu JQ,Zhao R,et al.The relationship between maternal gestational and perinatal factors and blood pressure among adolescents [J].Chin J Dis Control Prev,2016,20(1):34-37,41.DOI:10.16462/j.cnki.zhjbkz.2016.01.009.
[3] 王红菊,魏兆莲,王素芳,等.饮食和生活方式的咨询指导对孕妇体重指数及妊娠结局的影响 [J].中华疾病控制杂志,2014,18(4):301-303.Wang HJ,Wei ZL,Wang SF,et al.The influence of consulting diet and life style systematically on BMI and pregnancy outcomes in women [J].Chin J Dis Control Prev,2014,18(4):301-303.
[4] Jwa SC,Fujiwara T,Yamanobe Y,et al.Changes in maternal hemoglobin during pregnancy and birth outcomes [J].BMC Pregnancy Childbirth,2015,15:80.DOI:10.1186/s12884-015-0516-1.
[5] 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.DOI:10.16439/j.cnki.1673-7245.2008.12.006.Zhong HL,Lu XZ,Chen XM,et al.Relation between hemoglobin and blood pressure [J].Chin J Hypertension,2008,16(12):1111-1114.DOI:10.16439/j.cnki.1673-7245.2008.12.006.
[6] 高宇.孕晚期高浓度血红蛋白与妊娠不良结局的关系 [J].海南医学,2011,22(11):100-101.DOI:10.3969/j.issn.1003-6350.2011.11.044.Gao Y.Association between high hemoglobin level of third trimester of pregnancy and adverse outcome [J].Hainan Medical Journal,2011,22(11):100-101.DOI:10.3969/j.issn.1003-6350.2011.11.044.
[7] 乐杰,谢幸,林仲秋,等.妇产科学-第7版 [M].北京:人民卫生出版社,2008.Le J,Xie X,Lin ZQ,et al.Obstetrics and gynecology-seventh edition [M].Beijing:People’s Health Publishing House,2008.
[8] 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.DOI:10.3784/j.issn.1003-9961.2018.09.016.Pu LY,Wu JH,Huang MX,et al.Study on change trend of blood pressure and related factors in 40 819 pregnant women in Zhoushan,Zhejiang [J].Disease Surveillance,2018,33(9):770-774.DOI:10.3784/j.issn.1003-9961.2018.09.016.
[9] Huisman A,Aarnoudse 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.DOI:10.3109/00016348609158396.
[10] Heilmann L,Rath W,Pollow K.Hemorheological changes in women with severe preeclampsia [J].Clin Hemorheol Microcirc,2004,31(1):49-58.DOI:10.1177/107602960401000116.
[11] 姚立岩,柏学民,张毓洪,等.妊高征危险因素调查分析 [J].中国妇幼保健,2004,19(10):116-117.DOI:10.3969/j.issn.1001-4411.2004.20.070.Yao LY,Bai XM,Zhang YH,et al.Investigation and analysis of the risk factors in women with pregnancy-induced hypertension syndrome [J].Maternal and Child Health Care of China,2004,19(10):116-117.DOI:10.3969/j.issn.1001-4411.2004.20.070.
[12] Cabrales P,Han G,Nacharaju P,et al.Reversal of hemoglobin-induced vasoconstriction with sustained release of nitric oxide [J].Am J Physiol Heart Circ Physiol,2011,300(1):H49-H56.DOI:10.1152/ajpheart.00665.2010.
[13] Davis MR,Fitzpatrick CM,Dixon PM,et al.Thrombus-induced endothelial dysfunction:Hemoglobin and fibrin decrease nitric oxide bioactivity without altering eNOS [J].J Surg Res,2004,122(1):121-129.DOI:10.1016/j.jss.2004.07.009.
[14] Brannon PM,Taylor CL.Iron supplementation during pregnancy and infancy:uncertainties and implications for research and policy [J].Nutrients,2017,9(12):1327.DOI:10.3390/nu9121327.