摘要
【目的】分析高海拔地区藏族孕产妇妊娠晚期全血细胞计数(CBC)、糖化血红蛋白(GHbA1c)及甲状腺功能的相关性。【方法】回顾性分析2021年1月1日至2021年12月31日在西藏自治区昌都市察雅县人民医院住院分娩的妊娠≥28周藏族单胎妊娠孕产妇临床资料,共纳入研究对象374例。研究对象均在入院时分娩前完成CBC、GHbA1c及总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、促甲状腺激素(TSH)的检测。根据研究对象长期居住地的海拔高度将其分为三组:A组海拔高度<3500 m;B组海拔高度3500~4000 m;C组海拔高度>4000 m。分析高海拔地区藏族孕产妇妊娠晚期经海拔校正前后的贫血率,不同海拔高度妊娠晚期CBC、GHbA1c及甲状腺功能水平及其相关性。【结果】①该地区妊娠晚期实测血红蛋白(HB)水平为120.0(108.0~130.0)g/L,贫血率27.8%(104/374),海拔校正后HB水平为93.0(80.0~104.0)g/L,贫血率为84.3%(315/374);②三组对比,实测HB水平随海拔升高有上升趋势,但差异无统计学意义(P>0.05),实测贫血率比较差异无统计学意义(P>0.05);经海拔校正后HB水平随海拔升高呈下降趋势,贫血率随海拔升高呈上升趋势,差异有统计学意义(P<0.001);③三组对比,红细胞计数(RBC)、平均红细胞血红蛋白浓度(MCHC)随海拔升高呈上升趋势,TSH随海拔升高呈下降趋势,差异有统计学意义(P<0.05);④实测HB、MCHC水平与TT4呈正相关,GHbA1c与TT4呈负相关,与血小板计数(PLT)呈正相关,相关性分析有统计学意义(P<0.05)。【结论】高海拔地区藏族孕产妇妊娠晚期实测HB水平随海拔升高上升趋势不明显,海拔校正后贫血率大增。随海拔升高TSH呈下降趋势,海拔高度可能对妊娠晚期甲状腺相关激素有影响。妊娠晚期实测贫血与低T4水平相关,低T4水平、高PLT与GHbA1c升高有关,妊娠晚期实测HB、PLT及T4水平有望成为GDM的预测因子。
【Objective】To analyze the correlation between complete blood count(CBC),glycosylated hemoglobin(GHbA1c)and thyroid function in late pregnancy on Tibetan Plateau.【Methods】A retrospective analysis was performed on374 patients of single pregnancies who had delivered in the department of Obstetrics and Gynecology,Chaya People′s Hospital,Changdu City,Tibet Autonomous Region,between January 1,2021 and December 31,2021. All subjects completed CBC,GHbA1c and total triiodothyronine(TT3),total thyroxine(TT4),thyroid stimulating hormone(TSH)before delivery. According to the altitude of long-term residence,they were divided into three groups:the altitude of group A is <3500 m;the altitude of group B is 3 500~4 000 m;and the altitude of group C is >4 000 m. The anemia of Tibetan pregnant women in late pregnancy before and after adjustment,the levels of CBC,GHbA1c and thyroid function in different altitudes,and their correlations were analyzed.【Results】(1) The mean actual hemoglobin(HB)was 120.0(108.0~130.0)g/L,and the prevalence of anemia was 27.8%(104/374). After adjustment,the mean HB was 93.0(80.0~104.0)g/L,and the prevalence of anemia was 84.3 %(315/374);(2) Actual HB levels increased with the rise of altitude,but the difference was not statistically significant(P>0.05),and there was no difference among the three groups in the prevalence of anemia.After adjustment,HB levels showed a downward trends,while the prevalence of anemia increased with the rise altitude,and the difference was statistically significant(P<0.001).(3) Red blood cell count(RBC)and mean erythrocyte hemoglobin concentration(MCHC)increased,while TSH decreased with the rise of altitude,and the difference was statistically significant(P<0.05).(4) The actual HB and MCHC were positively correlated with TT4,GHbA1c was negatively correlated with TT4,and positively correlated with Platelet count(PLT);spearman correlation analysis showed statistical significance(P<0.05).【Conclusions】The actual HB of Tibetan Plateau pregnant women in late pregnancy does not increase significantly with the rise of altitude. The prevalence of anemia increases significantly after adjustment according to the altitude. TSH decreases with the rise of altitude,and the altitude may have an effect on thyroid function in late pregnancy. Actual anemia in late pregnancy is associated with low T4,and low T4 and high PLT might be associated with increased GHbA1c. Actual HB,PLT and T4 in late pregnancy are expected to be predictors of thyroid disease and GDM.
作者
崔金晖
李萍
陈晓宇
刘强
梁亚婷
达瓦卓嘎
尼玛
范建辉
CUI Jin-hui;LI Ping;CHEN Xiao-yu;LIU Qiang;LIANG Ya-ting;DAWA Zhuoga;NI Ma;FAN Jian-hui(Department of Obstetrics,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China;Department of Obstetrics and Gynecology,Chaya People's Hospital,Changdu City,Tibet Autonomous Region,Changdu 854300,China)
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2022年第6期1020-1027,共8页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省医学科研基金(A2021049)。
