妊娠期铁缺乏和缺铁性贫血对母胎影响的研究进展

妊娠期铁缺乏(Iron Deficiency,ID)和缺铁性贫血(Iron Deficiency Anemia,IDA)是近年产科研究的热点之一。本文综述了近年来国内外文献,概括妊娠期铁缺乏和缺铁性贫血的流行现状,探讨铁缺乏和缺铁性贫血对孕妇和妊娠结局的影响,以及近年来动物实验中铁缺乏和缺铁性贫血对子代的影响。     

口服铁剂改善妊娠缺铁性贫血效果及铁储备状态的研究

目的:探讨口服铁剂改善孕期贫血及铁储备状态的作用。方法:选择144例妊娠贫血孕妇(贫血组,口服多糖铁复合物胶囊150 mg/次,2次/天)、100例正常孕妇(预防组,口服多糖铁复合物胶囊150 mg/次,1次/天)和50例正常孕妇(对照组,膳食补铁),测定血红蛋白(Hb)、红细胞计数(RBC)、血清铁蛋白(SF)、血清铁(SI)。结果:贫血组和预防组Hb和RBC呈现早-中期下降(P<0.05)、中-晚期上升(P<0.05)的变化,对照组各孕周Hb、RBC呈逐渐下降趋势(P<0.05)。整个孕周3组孕妇SF均呈进行性下降(P<0.01)。3组孕妇SI早-中期下降较为明显(P<0.01)。结论:单纯膳食补铁不能满足孕期对铁的需求。孕期铁储备处于持续消耗状态。需重视孕早期及孕中期铁剂补充。     

妊娠妇女补充核黄素、VA对缺铁性贫血影响

目的 探讨补充核黄素、维生素A(VA)对妊娠妇女缺铁性贫血的影响.方法 将贫血孕妇分为补铁组、补铁 核黄素组、补铁 VA组、补铁 核黄素 VA组.补充上述营养素60 d,观察补充前后血红蛋白、血清铁蛋白、血清转铁蛋白受体的变化情况.结果 单独补铁、补铁 核黄素、补铁 VA、补铁 核黄素 VA均能显著提高妊娠妇女血红蛋白水平;补铁 VA组的血清铁蛋白明显高于补铁组(P<0.05);补铁 核黄素 VA组的血清铁蛋白明显高于补铁组、补铁 核黄素组、补铁 VA组(P<0.05),血清转铁蛋白受体显著低于补铁组、补铁 核黄素组、补铁 VA组(P<0.05).结论 单独补铁、补铁 核黄素、补铁 VA对改善缺铁性贫血均有明显效果,但铁、核黄素、VA等3种营养素同时补充,效果最好.     

Iron deficiency without anemia causes maternal hypothyroxinemia in pregnant rats

Because of increased total red blood cell mass and the demands of the fetus, iron requirements are greater during pregnancy than at most other times. Previous experiments in nonpregnant women have shown that iron deficiency (ID) can reduce circulating thyroxine and triiodothyronine levels; therefore, we hypothesized that ID before pregnancy can reduce thyroid hormone levels in maternal circulation and in the thyroid gland during pregnancy. In the present study, 2 types of rat models with ID were established using diets with different iron concentrations. Levels of thyroid hormone, hemoglobin, serum iron, liver iron, serum ferritin, serum transferrin receptor, and serum thyroid-stimulating hormone as well as thyroid peroxidase activity were measured throughout pregnancy, and thyroid structure was analyzed. Both mild ID with anemia and ID without anemia resulted in maternal hypothyroxinemia from midgestation to the end of the pregnancy. Thyroid peroxidase activity significantly decreased, even before the reduction of liver iron concentrations in ID groups. Iron deficiency reduced the size of follicular cavities but did not destroy the follicular structure. Linear regressions were performed to compare total levels of maternal serum thyroxine to indices of iron status for individual dams. This is the first rat study to report our results stating that ID can cause maternal hypothyroxinemia during early pregnancy.     

Iron status of pregnant Indian women from an area of active iron supplementation

ObjectiveThe aim of this study was to investigate the iron status of pregnant tribal women from Ramtek, Nagpur, Maharashtra, India using a combination of indices.MethodsA community-based observational study was conducted to assess iron status using a convenience sample of pregnant Indian tribal women from Ramtek. Pregnant women were recruited at 13 to 22 wk gestation (first visit; n = 211) and followed to 29 to 42 wk gestation (second visit; n = 177) of pregnancy. Sociodemographic and anthropometric data; iron supplement intake; and blood samples for estimating hemoglobin (Hb), serum ferritin (SF), soluble transferrin receptor (sTfR), and C-reactive protein (CRP) were obtained.ResultsThe mean (SD) Hb concentration at recruitment was 106 (15) g/L and 106 (14) g/L at the second visit; 41% of the women at recruitment and 55% at second visit were anemic (14% higher, P < 0.001). No women at recruitment and 3.7% at second visit had SF concentration < 15 ng/mL; and 3.3% at recruitment and 3.9% at the second visit had sTfR > 4.4 ng/mL (0.6% higher, P = 0.179). Almost 62% and 71% of pregnant women used iron supplements at both visits, respectively. Iron supplement intake > 7 d in the preceding month improved the Hb concentration by 3.23 g/L and reduced sTfR concentration by 13%; women who were breastfeeding at the time of recruitment had 11% higher SF concentration.ConclusionsThe iron indices suggest that pregnant tribal women of central India, although anemic, had good iron status. Use of iron supplements > 7 d in the preceding month improved iron status; however, non–iron-deficiency anemia persisted in this group.     

补充铁剂对上海育龄妇女缺铁性贫血改善效果研究

目的了解缺铁性贫血育龄妇女补充铁剂的效果,探讨维持育龄妇女正常铁营养状况的总铁摄入量。方法招募贫血的育龄妇女74名,年龄21～45岁,按血红蛋白随机分成干预组和对照组,每日分别口服一包铁营养包(主要成分为焦磷酸铁和富马酸亚铁,含铁元素8mg)和安慰剂,连续服用6个月观察效果。干预前、3个月及6个月后两组均进行缺铁性贫血相关指标检查、膳食频率调查及24 h膳食回顾调查。结果干预6个月后干预组血红蛋白和血清铁蛋白均显著高于对照组(P<0.01),干预组和对照组血红蛋白值达标人数分别为15人(44.1%)和5人(14.3%),P<0.01;血清铁蛋白达标人数分别为11人(35.5%)和4人(12.1%),P<0.05。膳食铁的平均摄入量为14.0mg/d。总铁摄入量(膳食铁加补充的铁)与血红蛋白值的改变呈正相关(r=0.57,P﹤0.01)。膳食纤维摄入多和月经量多则是危险因素(P<0.05)。结论连续6个月每日补充8mg铁能有效改善育龄妇女缺铁性贫血,育龄妇女每日摄入23.2mg铁可维持正常铁储存状况。     

孕妇缺铁性贫血发生情况及影响因素分析

目的 探析孕妇缺铁性贫血（IDA）发生情况及影响因素。方法 以2019年3月至2020年2月首次在株洲市某医院建立生育档案的孕妇为调查对象进行问卷调查、血红蛋白（Hb）和血清铁蛋白（SF）水平检测,采用描述流行病学分析方法进行分析,并采用单、多因素分析方法对IDA发生影响因素进行分析。结果 本研究共调查1 624名孕妇,年龄21~43岁,平均（28.72 ± 4.69）岁。文化程度以中专或高中为主,占50.00%。家庭年收入以8~19万元为主,占45.07%。初产妇占55.36%,检出孕期IDA 176例,发生率为10.84%。多因素Logistic回归分析结果显示孕妇年龄30~34、35~39、40~44岁（OR=4.998、10.455、7.745）、家庭年收入<8万元（OR=2.134）、孕中期及孕晚期（OR=1.728、4.315）、居住地为郊区（OR=3.027）、经产妇（OR=6.197）、流产次数1~2、≥3次（OR=2.139、12.203）、饮食习惯不正常（OR=2.055）、铁剂补充≤每周1次（OR=14.939）的孕妇发生IDA的风险较大,中专或高中以上文化程度（OR=0.277、0.570）孕妇发生IDA风险较小。结论 株洲市孕妇IDA发生情况较为普遍,孕妇发生IDA可受年龄、孕周、文化程度、家庭经济、居住环境、流产、分娩史,孕期膳食结构及铁剂补充情况等诸多因素影响,需加强孕妇妊娠保健教育,保证母婴健康。     

母亲KAP模式干预对婴幼儿缺铁性贫血的影响研究

摘要:目的　了解母亲KAP（知识、态度、行为）对缺铁性贫血婴幼儿的影响,为防治婴幼儿缺铁性贫血提供理论依据。方法　对2013年3月-2014年8月武汉市儿保门诊首次进行规范化健康体检的1858例6月龄至36月龄婴幼儿抽取血红蛋白检测并对其母亲进行问卷调查,了解母亲KAP水平,予以教育指导及知识、态度、行为干预后再次进行KAP问卷调查。结果　婴幼儿缺铁性贫血发生率31.3％。母亲中普遍存在缺铁性贫血知识欠缺,对铁缺乏及其引起的疾病等知识贫乏,喂养行为不科学,尤其在母乳喂养、合理添加辅食、系统学习科学育儿知识等方面掌握明显不足,造成婴幼儿缺铁性贫血的发生。而对母亲进行喂养方式、食物提供及健康教育指导后,婴幼儿缺铁性贫血情况明显改善,婴幼儿缺铁性贫血发生率17.5％。结论　应开展多层面的婴幼儿缺铁性贫血知识专项宣传,提高母亲对贫血的认知水平,从饮食理念、饮食行为、饮食态度等方面改善母亲的喂养习惯,并要求其长期保持,以此逐步地养成其良好的饮食习惯,降低婴幼儿缺铁性贫血发生率。     

Reducing iron deficiency anemia in Bolivian school children: Calcium and iron combined versus iron supplementation alone

ObjectiveThe aim of this study was to determine the effect of combined calcium and iron versus single iron supplementation on iron status in Bolivian schoolchildren.MethodsChildren ages 6 to 10 y old (N = 195), were randomly assigned to receive either 700 mg Ca (as calcium carbonate) plus 30 mg Fe (as ferrous sulfate) (Ca + Fe group) or 30 mg Fe (as ferrous sulfate) (Fe group). The doses were administered daily, from Monday to Friday, between meals at school over 3 mo. Iron status was assessed at baseline and after intervention. Additionally, overall nutritional status was assessed by anthropometry and an estimation of dietary intake.ResultsAt baseline, the prevalence of anemia in the Ca + Fe group and the Fe group were 15% and 21.5%, respectively. After 3 mo follow-up, the prevalence of iron deficiency anemia dropped significantly (P < 0.001) to 3% in both groups (χ² = NS). Iron dietary intake was within recommended levels, but calcium intake only covered 39% of the Recommended Daily Intake.ConclusionCombined calcium and iron supplementation is equally as effective as single iron supplementation in reducing the prevalence of iron deficiency anemia in Bolivian school children.     

幽门螺旋杆菌根治治疗与缺铁性贫血的相关性研究

目的：研究幽门螺旋杆菌（HP）感染与缺铁性贫血（IDA）的相关性,探讨HP根治对IDA治疗效果的影响。方法：选择健康体检志愿者584名,对其进行IDA及HP感染构成情况分析,将其中确诊的61例IDA合并HP感染患者随机分为观察组（31例）和对照组（30例）,观察组给予铁剂联合抗HP治疗,对照组单纯给予铁剂治疗,比较两组患者治疗效果。结果：584名志愿者中IDA合并HP感染患者61例;IDA患者HP感染率为55．96％,明显高于非IDA人群的20．21％;HP感染者IDA患病率为38．85％,明显高于HP阴性者的11．24％;HP感染与IDA发病具有显著的相关性（X2=15．3403,P〈0．001）。观察组抗HP治疗药物停用4周后,HP根治29例,根治率93．55％。两组患者治疗后IDA指标均有不同程度改善,其中观察组治疗后1个月、3个月均较治疗前显著上升（t=3．974,t=4．802,t=5．221;P〈0．01）;对照组治疗后1个月仅1项指标较治疗前显著上升（,=5．383,P〈0．01）,治疗后3个月虽然各项指标较治疗前显著上升（t=4．446,t=3．741,t=8．221;P〈0．01）,但显著低于同期观察组（t=4．201,t=6．664,t=3．847;P〈0．01）。结论：HP感染与IDA密切相关,根治HP感染对改善IDA治疗效果具有重要意义。     

不同口服铁剂治疗儿童缺铁性贫血安全性的网络Meta分析

目的 应用网络Meta分析评价8种口服铁剂治疗儿童缺铁性贫血安全性。方法 检索收集2015年7月之前国内外发表有关口服铁剂与儿童缺铁性贫血文献。采用Microsoft Excel 2013软件加载NetMetaXL宏命令调用WinBUGS 1.4.3软件选择随机效应模型进行统计分析,系统评价8种口服铁剂之间的OR值及优劣顺序。结果 纳入文献31篇,3 417例缺铁性贫血儿童。与右旋糖酐铁相比,硫酸亚铁、铁叶绿素钠、琥珀酸亚铁、葡萄糖酸亚铁、多维铁复合物、多糖铁复合物、富马酸亚铁的OR值及95% CI分别为0.00（0.00~0.03）、0.03（0.00~0.39）、0.02（0.00~0.23）、0.01（0.00~0.07）、0.01（0.00~0.11）、0.02（0.00~0.19）、0.01（0.00~0.12）。右旋糖酐铁发生不良反应风险最小（SUCRA=0.999 4）,而硫酸亚铁的风险最高（SUCRA=0.034 1）。结论 硫酸亚铁发生不良反应的风险较高,临床医生和患者在选择硫酸亚铁治疗儿童IDA时需慎重。     

营养干预对儿童缺铁性贫血的干预效果评价

目的探讨营养干预对儿童缺铁性贫血（IDA）的干预效果。方法选取2012年1—12月在南京医科大学附属淮安第一医院门诊确诊的3~6岁的IDA患儿160例,根据＂不平衡指数最小的原则＂随机分为对照组和观察组,每组80例,对照组采取常规药物治疗,观察组采取常规药物治疗加营养干预,干预10个月后评价营养干预对儿童缺铁性贫血的干预效果。结果干预前,观察组患儿家属IDA病因（73.8%）、临床表现（66.3%）等相关知识知晓率与对照组相比差异无统计学意义;观察组患儿轻度贫血（77.5%）、中度贫血（22.5%）与对照组相比差异无统计学意义（P〉0.05）;观察组患儿经常吃铁强化制品（63.8%）、经常吃肉蛋鱼类等动物制品（76.3%）等饮食行为应答率与对照组相比差异无统计学意义（P〉0.05）。干预后观察组患儿家属对IDA病因（96.3%）、临床表现（97.5%）、危害（96.3%）、治疗（97.5%）、预防（93.8%）、定期复查的重要性（97.5%）相关知识知晓率均高于自身干预前及干预后对照组（P〈0.01）。观察组患儿轻度贫血（7.5%）、中度贫血（1.3%）的患病率均低于自身干预前及对照组（P〈0.01）。观察组患儿经常吃铁强化制品（91.3%）、经常吃肉蛋鱼类等动物制品（93.8%）、经常吃新鲜蔬菜（92.5%）、经常吃新鲜水果（96.3%）、经常吃豆类及豆制品（91.3%）和经常吃奶类及奶制品（97.5%）饮食行为应答率均高于自身干预前及对照组（P〈0.01）。结论营养干预能改善儿童缺铁性贫血。     

Issues in prevention of iron deficiency anemia in India

Iron deficiency anemia (IDA) continues to be major public health problem in India. It is estimated that about 20% of maternal deaths are directly related to anemia and another 50% of maternal deaths are associated with it. The question, therefore, is why, despite being the first country to launch the National Nutritional Anemia Prophylaxis Programme in 1970, the problem of IDA remains so widespread. As is to be expected, the economic implications of IDA are also massive. The issues of control of IDA in India are multiple. Inadequate dietary intake of iron, defective iron absorption, increased iron requirements due to repeated pregnancies and lactation, poor iron reserves at birth, timing of umbilical cord clamping, timing and type of complementary food introduction, frequency of infections in children, and excessive physiological blood loss during adolescence and pregnancy are some of the causes responsible for the high prevalence of anemia in India. In addition, there are other multiple programmatic and organizational issues. This review, therefore, is an attempt to examine the current burden of anemia in India, its epidemiology, and the various issues regarding its prevention and control, as well as to offer some innovative approaches to deal with this major health problem.     

婴幼儿缺铁性贫血对认知功能的影响及干预研究

目的 通过总结婴幼儿缺铁性贫血对认知功能产生近期和远期影响以及影响机制和干预措施,发现贫血影响婴幼儿的关键期,为提出更高效的干预措施提供科学依据。方法 使用“anemia”、“infants”、“iron deficiency”、“cognition”和“贫血”、“铁缺乏”以及“认知功能”等为关键词,通过PubMed和中国知网（CNKI）进行文献检索,共收集38篇相关文献,用描述性研究对婴幼儿缺铁性贫血对认知功能的影响及干预措施进行综述。结果 婴幼儿缺铁性贫血对认知功能的影响具有持续性及不可逆性以及对认知功能影响存在关键期,目前对婴幼儿缺铁性贫血的干预措施。结论 孕期补铁、延迟期待结扎以及婴幼儿补铁可以改善缺铁性贫血对认知功能的影响。     

复方氯化血红素纠正贫血的疗效观察

[目的 ]　观察复方氯化血红素对纠正缺铁性贫血的疗效。　 [方法 ]　随机选取两组各 3 0例贫血者 ,试验组每天服用复方氯化血红素 2片 ,共 3 0d ,对照组服用安慰剂 ,测定服用前后两组血红蛋白、红细胞内原卟啉浓度、血清铁蛋白、平均红细胞血红蛋白浓度 ,并进行统计学分析。　 [结果 ]　试验组试验末血红蛋白量较试验前平均上升 2 1.8g/L ,红细胞内原卟啉浓度较试验前下降 (P <0 .0 5 ) ,血清铁蛋白含量升高 (P <0 .0 5 ) ,红细胞平均血红蛋白浓度升高 (P <0 .0 5 )。　 [结论 ]　复方氯化血红素治疗缺铁性贫血是安全、有效的。     

上海市某社区婴儿缺铁性贫血影响因素研究

[目的] 探讨上海市某社区6月龄婴儿缺铁性贫血发生情况及其影响因素。[方法] 对上海市某社区2007年1月至2009年6月出生的190例6月龄婴儿进行血红蛋白检测与相关因素调查。[结果] 该社区6月龄婴儿缺铁性贫血的患病率为21.58%,经单因素分析与多因素Logistic回归分析,婴儿喂养方式和4~6个月是否添加辅食是婴儿缺铁性贫血的重要影响因素,6个月内纯母乳喂养和4~6个月未添加辅食的OR值分别为3.0和19.8。[结论] 在提倡母乳喂养的同时,应注意合理添加辅食和适时补充铁元素,以减少婴儿缺铁性贫血的发生。     

幽门螺杆菌感染与儿童缺铁性贫血关系的临床研究

目的探讨幽门螺杆菌(Hp)感染与儿童缺铁性贫血(IDA)之间的关系。方法从因再发性腹痛就诊的患儿中,抽取13C呼气试验阳性者26例为观察组,13C呼气试验阴性者22例为对照组。两组分别检测血清铁蛋白(SF)和血常规。结果观察组和对照组比较SF、血红蛋白、红细胞计数、平均红细胞体积和平均血红蛋白浓度差异有统计学意义(P<0.05或<0.01)。白细胞数和血小板数两组差异无统计学意义(P>0.05)。结论Hp感染与儿童IDA发病有关,Hp感染可能是IDA的发病因素之一。     

幽门螺杆菌感染与儿童缺铁性贫血关系的临床研究

目的探讨幽门螺杆菌（Hp）感染与儿意缺铁性贫血（IDA）之间的关系。方法从因再发性腹痛就诊的患儿中。抽^13C呼气试验阳性者26例为观察组，^13C呼气试验阴性者22例为对照组。两组分别检测血清铁蛋白（SF）和血常规。结果观察组和对照组比较SF、血红蛋白、红细胞计数、平均红细胞体积和平均血红蛋白浓度差异有统计学意义（P〈0．05或〈0．01）。白细胞数和血小板数两组差异无统计学意义（P〉0．05）。结论Hp感染与儿童IDA发病有关，Hp感染可能是IDA的发病因素之一。     

婴儿期缺铁性贫血发生率及预防措施分析

目的分析某院儿童保健门诊中婴儿期缺铁性贫血(iron deficiency anemia,IDA)喂养方式及辅食添加的早晚与婴儿期缺铁性贫血的关系,有效的降低其患病率。方法采用整群随机抽样的方法选取该院儿童保健门诊中2009年5月～2010年5月0～1岁婴儿815例,排除疾病因素,通过体格检查,家长问卷,调查其喂养方式及辅食添加的早晚将患儿分为实验组(n=396),是指无论采取何种喂养(母乳或人工或混合)均于4～6个月添加辅食;对照组(n=419),是指无论采取何种喂养(母乳或人工或混合)均于4～6个月未添加辅食。两组统一采用BASIC血细胞全自动分析仪测血常规。结果实验组贫血发生率是19.2%,对照组贫血的发生率是37.5%。差异有统计学意义(P﹤0.01)。结论无论采取何种喂养(母乳或人工或混合)均于4～6个月添加辅食其贫血的发生率低于对照组,因此正确的儿童喂养行为可以有效的预防和减少婴儿期IDA患病率。