不同孕期微量元素水平对胎儿生长受限的预测作用

doi:10.12114/j.issn.1007-9572.2020.00.446

摘要/Abstract

摘要： 背景　胎儿生长受限（FGR）是围生期较严重的并发症之一，可导致胎儿多个系统发育不良，甚至死亡，近年来研究发现，微量元素缺乏可能与FGR相关。目的　评估不同孕期微量元素铁、锌、铜和碘水平对FGR发生风险的预测作用。方法　选取2016年7月—2018年6月在湖北民族大学附属民大医院进行产前检查且妊娠8周内的326例孕妇作为研究对象。分别于孕早期（妊娠≤13周）、孕中期（妊娠14~27周）和孕晚期（妊娠≥28周）检测孕妇血液样本中铁、锌、铜水平和尿液样本中碘水平并计算微量元素缺乏率。参照《妇产科学》的诊断标准评估是否为FGR。比较不同孕期铁、锌、铜、碘水平及缺乏率，比较FGR孕妇与非FGR孕妇铁、锌、铜、碘水平；绘制微量元素水平预测FGR的受试者工作特征（ROC）曲线，并计算ROC曲线下面积（AUC）。结果　孕中期和孕晚期孕妇铁、碘水平低于孕早期（P<0.05）；孕晚期锌、铜水平低于孕早期（P<0.05）；孕中期的铁、锌、铜、碘水平均高于孕晚期（P<0.05）。孕中期和孕晚期铁、碘缺乏率高于孕早期（P<0.05）；孕中期和孕晚期锌缺乏率低于孕早期（P<0.05）；孕中期的铁、锌、碘缺乏率均低于孕晚期（P<0.05）。FGR孕妇不同孕期铁、碘水平低于非FGR孕妇（P<0.05）；FGR孕妇孕晚期铜水平低于非FGR孕妇（P<0.05）。孕晚期铁、锌、铜、碘联合预测FGR的效能较好，AUC（95%CI）为0.829（0.753，0.905），截断值为0.094，灵敏度84.4%，特异度72.1%。结论　孕晚期微量元素铁、锌、铜、碘联合检测对FGR发生风险具有较好的预测作用。

关键词: 胎儿生长迟缓, 妊娠, 微量元素, 不同孕期, 预测, 锌, 铁, 铜, 碘

Abstract: Background　Fetal growth restriction（FGR） is one of the most serious complications in the perinatal period，which could lead to disorders in various systems and even cause death in fetuses.Recently，studies have reported that deficiency of microelements may be correlated to FGR risk.Objective　This study aimed to evaluate the values of iron，zinc，copper and iodine levels in the three trimesters of pregnancy in predicting the risk of FGR.Methods　Three hundred and twenty-six pregnant women who received prenatal examination in Minda Hospital Affiliated to Hubei Minzu University from July 2016 to June 2018 were enrolled within the first 8 weeks of pregnancy.The levels of iron，zinc and copper in the venous blood sample and iodine level in the urine sample were detected in the first（≤13 weeks），second（14-27 weeks） and third（≥28 weeks） trimesters of pregnancy，respectively，and prevalence of deficiency of these four microelements was estimated.The average levels and deficiencies of venous iron，zinc and copper and urine iodine were compared across the trimesters，and were also compared between those with FGR（FGR group） and those without FGR（non-FGR group）〔FGR was diagnosed according to the criteria in the Obstetrics and Gynecology（8th Edition） complied by XIE Xing and GOU Wenli〕.ROC curves of the 4 microelements for predicting FGR were plotted with AUC calculated.Results　The average levels of venous iron and urine iodine in the first trimester were higher than those of other two trimesters（P<0.05）.The average levels of venous zinc and copper in the first trimester were higher than those of the third trimester（P<0.05）.The average level of venous iron in the second trimester was higher than that of the third trimester（P<0.05），and so were the average levels of venous zinc and urine iodine（P<0.05）.The average level of venous copper in the second trimester was higher than that of the third trimester（P<0.05）.The prevalence of venous iron and urine iodine deficiencies was elevated but the prevalence of zinc deficiency was decreased in both the second and third trimesters compared with the first trimester（P<0.05）.Besides，the prevalence of iron，zinc，and iodine deficiencies in the second trimester were reduced compared to the third trimester（P<0.05）.Compared with non-FGR group，FGR group showed lower average levels of venous iron and urine iodine across three trimesters（P<0.05）.FGR group also showed lower average level of venous copper in the third trimester（P<0.05）.The combined predictive level of the four microelements in the third trimester for FGR was better，with an AUC（95%CI）of 0.829（0.753，0.905） when the optimal cutoff value was determined as 0.094 with 84.4% sensitivity and 72.1% specificity.Conclusion　Venous iron，copper and zinc in combination with urine iodine in the third trimester of pregnancy had good value in predicting the risk of FGR.

Key words: Fetal growth restriction, Pregnancy, Microelement, Different trimester, Forecasting, Zinc, Iron, Copper, Iodine

刘兆敏,蒲元林,吴慧捷,等. 不同孕期微量元素水平对胎儿生长受限的预测作用[J]. 中国全科医学, 2020, 23(32): 4059-4063. DOI: 10.12114/j.issn.1007-9572.2020.00.446.
LIU Zhaomin,PU Yuanlin,WU Huijie, et al. The Predictive Value of Four Microelements Levels in Different Trimesters for Fetal Growth Restriction　[J]. Chinese General Practice, 2020, 23(32): 4059-4063. DOI: 10.12114/j.issn.1007-9572.2020.00.446.

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