摘要
目的分析目前南京地区孕妇的维生素D状况,并评价其与产后出血发生的关系。方法选择2012年3月至2015年2月期间在我院产科进行孕检的2 794例孕妇为研究对象,采集受试孕妇外周血5 m L,低温离心分离,于-80°C冰箱保存,并同时收集其基本信息及后续分娩方式。采用酶联免疫法测定25(OH)D浓度,运用条件Logistic回归分析25(OH)D水平与产后出血发生的关联程度。结果 2 794例孕妇中,1 752例(62.7%)孕妇的血清25(OH)D<50 nmol/L,处于维生素缺乏状态;血清25(OH)D水平的中位数和四分位间距为43.80 nmol/L和35.60~58.40 nmol/L;不同年龄段的孕妇其血清25(OH)D水平比较差异有统计学意义(P<0.05),年龄<25岁的孕妇其血清25(OH)D水平低于25~32岁和>32岁的孕妇;有不良孕产史的孕妇,其血清25(OH)D水平高于无不良孕产史的孕妇(P<0.05);且不同季节检测的25(OH)D水平差异有统计学意义(P<0.01),其中夏秋季检测的25(OH)D水平相对较高[45.65 nmol/L(36.78~59.43 nmol/L)、45.50 nmol/L(36.88~61.43 nmol/L)],而春冬季相对较低[(40.40 nmol/L(33.65~54.80 nmol/L)、42.80 nmol/L(35.60~55.75 nmol/L)];在产后出血的孕妇中,高龄、高BMI、经产妇、不良孕产史、子宫肌瘤、疾病史和低维生素D可能为产后出血的危险因素;关联分析及亚组分析结果显示,相对于血清25(OH)D水平处于50~75 nmol/L的孕妇,血清25(OH)D水平<50 nmol/L和>75 nmol/L的孕妇并未显著增加产后出血的风险。维生素D缺乏(<50 nmol/L)在子宫肌瘤和无疾病史的孕妇中,可显著增加产后出血的风险(OR=5.96和1.29;95%CI=1.98~17.92和1.01~1.63)。结论南京孕晚期妇女存在维生素D水平不足或缺乏状况,维生素D不足或缺乏未能显著增加产后出血的风险,而低水平的血清25(OH)D在子宫肌瘤和无疾病史的孕妇中,可能增加产后出血的风险。
Objective To analyze the status of vitamin D in pregnant women in Nanjing, and to evaluate the relationship between vitamin D level and the occurrence of postpartum hemorrhage. Methods A total of 2 794 pregnant women who underwent pregnancy test in our hospital from March 2012 to February 2015 were selected as research objects. Peripheral blood(5 m L) were collected from the test pregnant women, and then centrifuged at low temperature and stored at-80 °C until assayed. The subjects' basic information and delivery mode were collected. The serum 25-hydroxy vitamin D(25(OH)D) levels was measured by enzyme linked immunosorbent assay. The relationship between 25(OH)D level and postpartum haemorrhage were analyzed by logistic regression. Results Among 2 794 cases, there were 1 752cases(62.7%) of 25(OH)D<50 nmol/L, in a vitamin deficiency state. The median and range interquartile of serum25(OH)D level were 43.80 nmol/L and 35.60~58.40 nmol/L. There were significant differences in the serum 25(OH)D level between pregnant women of different age periods(P<0.05), with the serum 25(OH)D level of age <25 years group significantly lower than that of 25~32 years group and >32 years group. Pregnant women with history of adverse pregnancy had higher 25(OH)D levels than those without history of adverse pregnancy(P<0.05). The 25(OH)D levels also showed statistically significant difference in different detection seasons(P<0.01), and the 25(OH)D levels were relatively higher in summer and autumn and relatively lower in spring and winter, which were 45.65 nmol/L(36.78~59.43 nmol/L), 45.50 nmol/L(36.88~61.43 nmol/L), 40.40 nmol/L(33.65~54.80 nmol/L, 42.80 nmol/L(35.60~55.75 nmol/L), respectively. Advanced age, obesity, high body mass index(BMI), pregnancy history, abnormal pregnancy history, uterine fibroids, disease history, and lower Vitamin D may be the risk factors for the subsequent postpartum haemorrhage. Correlation analysis and subgroup analysis showed that, compared with that in pregnant women with 25(OH)D level of 50~75 nmol
出处
《海南医学》
CAS
2016年第21期3520-3524,共5页
Hainan Medical Journal
基金
南京医科大学医学科技发展基金重点项目(编号:2014NJMUZD048)
江苏省南京市卫生局一般课题(编号:YKK13139)
关键词
25羟维生素D
维生素D缺乏
产后出血
相关性
25-hydroxy vitamin D(25(OH)D)
Vitamin D deficiency
Postpartum haemorrhage
Relationship
