孕妇营养状况与枯萎卵妊娠关系的研究
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摘要
枯萎卵妊娠是临床早期妊娠中常见的疾病。随着人们优生优育意识的提高,计划生育工作的广泛开展及B超技术的日益普及,越来越多的枯萎卵妊娠被临床检出并有增加趋势,且枯萎卵妊娠的发生给孕妇及其家庭造成了很大的心理负担。目前枯萎卵妊娠的研究存在很多问题:1)目前国内绝大部分关于胚胎停育研究中,研究对象的选择包括了胚胎死亡型和枯萎卵型胚胎停育,定义不明确,导致多种病例选择偏倚。2)到目前为止,几乎没有关于胚胎停育和营养状况的研究。3)目前几乎没有关于枯萎卵具体病理形态学表现的研究。
目的:1)研究枯萎卵妊娠发生的流行病学特点,从宏观的角度了解枯萎卵妊娠的发生特点,为进行深入的病因研究,制定合理的预防措施提供线索。2)探讨营养状况与胚胎停育枯萎卵型妊娠的关系,初步建立判别函数,为早期诊断和预防措施的制定奠定基础。3)利用定性研究的调查方法,深入调查当地群众的饮食行为习惯,为制定操作性强且适宜于当地的饮食行为干预方案奠定基础。
方法:根据一定的现场选择标准,选定山西省出生缺陷较高的吕梁地区四个县的四个医院作为研究现场,采用病例对照研究对80对孕周匹配的枯萎卵组和正常组孕妇进行流行病学调查,且对其中的30对孕妇测定叶酸,VB12、同型半胱氨酸,S-腺苷同型半胱氨酸和55种矿物质。其中叶酸和VB12是采用化学发光免疫测定,采用荧光偏振免疫法测定同型半胱氨酸水平,以及利用电感耦合等离子体质谱法测定55种元素水平。采用卡方检验、配对T检验,多变量数据的统计分析和判别分析方法对研究结果进行分析。
饮食行为干预的定性调查研究现场为以确定的研究现场中的两个县,研究对象为这两个县中的四个村80名妇女。每个县两个村,每个村通过一定的选择标准选定10名育龄妇女。采用的定性调查方法包括结构式观察法、结构化个人访谈、专题小组讨论、农村参与式调查和实地观察。调查工具为从美国疾病控制中心引进的食物频率调查问卷和结构式访谈提纲。
结果:1)枯萎卵妊娠的胎囊内只有囊液,没有胚胎组织。妊娠囊外没有绒毛组织或绒毛组织较稀疏。病理组织HE染色的结果显示,枯萎卵妊娠中绒毛膜组织中绒毛细胞较少,且粘液变性严重。
2)枯萎卵妊娠发生数占总不良妊娠结局例数的比例平均为40%,枯萎卵妊娠与妊娠早期其他形式自然流产的比值为6;枯萎卵妊娠与神经管畸形发生例数的比值为1.5;枯萎卵妊娠与其他畸形发生例数的比值为1.7。
3)流行病学调查资料分析显示,枯萎卵组和正常组孕妇在孕妇年龄、丈夫年龄、孕妇和丈夫的文化程度方面、接触有毒有害物质情况、吸烟、饮酒和饮食行为方面都没有差别。但枯萎卵组孕妇中外省市人所占比例多于正常组孕妇,且枯萎卵组孕妇的既往怀孕次数、流产次数、死胎死产次数、和生育过智力低下儿次数多于正常组孕妇。进一步的调查显示两组孕妇在“亲属中是否有智力低下儿”、“先天畸形儿生育史”和“亲属中是否有先天畸形儿生育史”的分布方面没有统计学差异。
4)血样和尿样中维生素和矿物质水平的检测结果显示,枯萎卵组孕妇的叶酸,钒,钛,锂,镉,锶,铷,磷、钠、钾和硼的水平低于正常组孕妇;VB12、同型半胱氨酸和锗水平高于正常组孕妇;两组孕妇的S-腺苷同型半胱氨酸水平没有差异。
5)饮食行为干预调查研究结果分析显示,当地主食主要为面条和馒头。蔬菜主要为土豆和白菜。当地妇女主食的摄入量高于中国营养学会膳食宝塔的推荐量,新鲜蔬菜,水果、动物食品和豆类奶类等食用量都低于推荐量,尤其是动物食品、豆类和奶类的食用量只为推荐量的三分之一或低于三分之一。饮食行为不科学的原因主要为经济收入低,不足以买多种食物,以及不知道何为科学的饮食行为。
结论:孕妇较低的叶酸,钛,锂,镉,锶,铷,磷、钠、钾和硼的水平,和较高的同型半胱氨酸和锗水平,与枯萎卵妊娠的发生有关。饮食行为干预调查研究结果提示当地饮食单调,饮食行为习惯不科学。且当地村民接受符合当地实际情况,操作性较强的饮食行为干预措施。
Recently,with the improvemnent of eugenics consciousness and wide use of ultrasound scan,more and more anembryonic pregnancies have been found.Many pregnant women and their family were burdened with anembryonic pregnancy.
There are some issues in studies about anembryonic pregnancy:first,the objects of many studies were consisted of women with anembryonic pregnancy and dead embryo pregnancy,which caused diagnosis bias.Second,there are few studies on the association of nutrients status of pregnant women with anembryonic pregnancy. Third,the pathomorphology of anembryonic pregnancy were hardly reported.
Objective:1) To study the epidemiology characteristic of anembryonic pregnancy and give some advice to future prevention of anembryonic pregnancy.
2) To study the association of nutrients status of pregnant women with the risk of anembryonic pregnancy and establish the discirminant function,which can be helpful for future diagnosis and prevention of anembryonic pregnancy.
3) To provide information for future intervention of diet behavior by qualitative investigation which was used to investigate the diet behavior of the local villager.
Methods:Four hospitals in four districts with high prevalence of birth defects in Shanxi were selected by standard selection principal.Case control study was used in our study.Eighty pairs of pregnant women with anembryonic and normal pregnancy were paired by gestation weeks and were administered epidemiological questionaire. Thirty pairs of pregnant women from whole sample were selected and their level of folate,VB12,homocysteine,S-adenosylhomocysteine(SAH) and 55 elements were measured.Serum folate level of the objects was analyzed by a method of paramagnetic-particle,the level of homocysteine was by a fluorescence Polarization immunoassay(FPIA),the level of SAH was by Enzyme Linked ImmunoSorbent Assay(Elisa),and 55 elements were measured simultaneously by inductively coupled plasma mass spectrometry(ICP-MS).The test results were analyzed by X~2 analysis, paired T-test,Multivariate data analysis and discirminant analysis.
The objects of intervention investigation of diet behavior were 80 women selected from four counties in two districts selected from the four fields mentioned above.According to the standard principle,two counties were selected from every district and 10 women were selected from every country.Structure investigation, structure personal interview,focus group discussion,Particular Rural Appraisal(PRA) and field research were used to collection information.The tools of intervention investigation of diet behavior were questionnaire of food frequency introduced from Center of disease control and prevention and interview outline.
Results:1) There is no embryonic tissue in gestation sac without or with little villous tissue in anembryonic pregnancy.And villous cells were sparsity in villous tissue of anembryonic pregnancy through staining technique of haematoxylin and eosin and were serious mucinous degeneration.
2) The proportion of anembryonic pregnancy in the total of adverse pregnancy outcome was averagely 40%,the ratio of the number of women with anembryonic pregnancy to the number of women with other kinds of spontaneous abortion was 6 to 1;the ratio of women with anembryonic pregnancy to the number of women with neural tube defects was 1.5 to 1;and the ratio ofanembryonic pregnancy to other birth defects was 1.7 to 1.
3) There is no significant difference between anembryonic and normal pregnancy in aspect of age of women and husband,education level of women and husband,exposure of all kinds of poison,smoking,drinking,and diet behavior.
However,the frequency of pregnancy,abortion,stillbirth and the proportion of nonresident women in women with anembryonic pregnancy were more than those in women with normal pregnancy.Further analysis showed that the history of birth defect in relative were no difference between anembryonic and normal pregnancy.
4) The test results showed that the level of folate,V,Ti,Li,Cd,Sr,Rb,P,Na, K,and B in women with anembryonic pregnancy were significantly lower than those of normal pregnancy women;the level of VB_(12) and homocysteine in women with anembryonic pregnancy were significantly higher than those of the normal,and the women with anembryonic and normal pregnancy women were not different in the level of SAH.
5) The results of intervention investigation of diet behavior showed that the majority of food of local village was flour,potato and Chinese cabbage.In local country,the intake of flour of women of child-bearing age was higher than the recommendation in dietary pagoda by the Nutrition Society of China.The intake of fresh vegetables,fruit and meat in local village were lower than the recommendation, and especially,the intake of animal food,pulses and milk were equal to or lower than one third of the recommendation,respectively.The reasons for unscientific diet behavior in local women were not only that they are too poor to afford buying many kinds of food,but also that the local women didn't know how to be balanced diet.
Conclusion:The lower level of folate,V,Ti,Li,Cd,Sr,Rb,P,Na,K,and B together with the higher level of homocysteine and Ge were associated the risk of anembryonic pregnancy.The intervention investigation of diet behavior showed the diet behavior of the local child-bearing women was unscientific and the local women look forward to the practical intervention measure of diet behavior.
目的:1)研究枯萎卵妊娠发生的流行病学特点,从宏观的角度了解枯萎卵妊娠的发生特点,为进行深入的病因研究,制定合理的预防措施提供线索。2)探讨营养状况与胚胎停育枯萎卵型妊娠的关系,初步建立判别函数,为早期诊断和预防措施的制定奠定基础。3)利用定性研究的调查方法,深入调查当地群众的饮食行为习惯,为制定操作性强且适宜于当地的饮食行为干预方案奠定基础。
方法:根据一定的现场选择标准,选定山西省出生缺陷较高的吕梁地区四个县的四个医院作为研究现场,采用病例对照研究对80对孕周匹配的枯萎卵组和正常组孕妇进行流行病学调查,且对其中的30对孕妇测定叶酸,VB12、同型半胱氨酸,S-腺苷同型半胱氨酸和55种矿物质。其中叶酸和VB12是采用化学发光免疫测定,采用荧光偏振免疫法测定同型半胱氨酸水平,以及利用电感耦合等离子体质谱法测定55种元素水平。采用卡方检验、配对T检验,多变量数据的统计分析和判别分析方法对研究结果进行分析。
饮食行为干预的定性调查研究现场为以确定的研究现场中的两个县,研究对象为这两个县中的四个村80名妇女。每个县两个村,每个村通过一定的选择标准选定10名育龄妇女。采用的定性调查方法包括结构式观察法、结构化个人访谈、专题小组讨论、农村参与式调查和实地观察。调查工具为从美国疾病控制中心引进的食物频率调查问卷和结构式访谈提纲。
结果:1)枯萎卵妊娠的胎囊内只有囊液,没有胚胎组织。妊娠囊外没有绒毛组织或绒毛组织较稀疏。病理组织HE染色的结果显示,枯萎卵妊娠中绒毛膜组织中绒毛细胞较少,且粘液变性严重。
2)枯萎卵妊娠发生数占总不良妊娠结局例数的比例平均为40%,枯萎卵妊娠与妊娠早期其他形式自然流产的比值为6;枯萎卵妊娠与神经管畸形发生例数的比值为1.5;枯萎卵妊娠与其他畸形发生例数的比值为1.7。
3)流行病学调查资料分析显示,枯萎卵组和正常组孕妇在孕妇年龄、丈夫年龄、孕妇和丈夫的文化程度方面、接触有毒有害物质情况、吸烟、饮酒和饮食行为方面都没有差别。但枯萎卵组孕妇中外省市人所占比例多于正常组孕妇,且枯萎卵组孕妇的既往怀孕次数、流产次数、死胎死产次数、和生育过智力低下儿次数多于正常组孕妇。进一步的调查显示两组孕妇在“亲属中是否有智力低下儿”、“先天畸形儿生育史”和“亲属中是否有先天畸形儿生育史”的分布方面没有统计学差异。
4)血样和尿样中维生素和矿物质水平的检测结果显示,枯萎卵组孕妇的叶酸,钒,钛,锂,镉,锶,铷,磷、钠、钾和硼的水平低于正常组孕妇;VB12、同型半胱氨酸和锗水平高于正常组孕妇;两组孕妇的S-腺苷同型半胱氨酸水平没有差异。
5)饮食行为干预调查研究结果分析显示,当地主食主要为面条和馒头。蔬菜主要为土豆和白菜。当地妇女主食的摄入量高于中国营养学会膳食宝塔的推荐量,新鲜蔬菜,水果、动物食品和豆类奶类等食用量都低于推荐量,尤其是动物食品、豆类和奶类的食用量只为推荐量的三分之一或低于三分之一。饮食行为不科学的原因主要为经济收入低,不足以买多种食物,以及不知道何为科学的饮食行为。
结论:孕妇较低的叶酸,钛,锂,镉,锶,铷,磷、钠、钾和硼的水平,和较高的同型半胱氨酸和锗水平,与枯萎卵妊娠的发生有关。饮食行为干预调查研究结果提示当地饮食单调,饮食行为习惯不科学。且当地村民接受符合当地实际情况,操作性较强的饮食行为干预措施。
Recently,with the improvemnent of eugenics consciousness and wide use of ultrasound scan,more and more anembryonic pregnancies have been found.Many pregnant women and their family were burdened with anembryonic pregnancy.
There are some issues in studies about anembryonic pregnancy:first,the objects of many studies were consisted of women with anembryonic pregnancy and dead embryo pregnancy,which caused diagnosis bias.Second,there are few studies on the association of nutrients status of pregnant women with anembryonic pregnancy. Third,the pathomorphology of anembryonic pregnancy were hardly reported.
Objective:1) To study the epidemiology characteristic of anembryonic pregnancy and give some advice to future prevention of anembryonic pregnancy.
2) To study the association of nutrients status of pregnant women with the risk of anembryonic pregnancy and establish the discirminant function,which can be helpful for future diagnosis and prevention of anembryonic pregnancy.
3) To provide information for future intervention of diet behavior by qualitative investigation which was used to investigate the diet behavior of the local villager.
Methods:Four hospitals in four districts with high prevalence of birth defects in Shanxi were selected by standard selection principal.Case control study was used in our study.Eighty pairs of pregnant women with anembryonic and normal pregnancy were paired by gestation weeks and were administered epidemiological questionaire. Thirty pairs of pregnant women from whole sample were selected and their level of folate,VB12,homocysteine,S-adenosylhomocysteine(SAH) and 55 elements were measured.Serum folate level of the objects was analyzed by a method of paramagnetic-particle,the level of homocysteine was by a fluorescence Polarization immunoassay(FPIA),the level of SAH was by Enzyme Linked ImmunoSorbent Assay(Elisa),and 55 elements were measured simultaneously by inductively coupled plasma mass spectrometry(ICP-MS).The test results were analyzed by X~2 analysis, paired T-test,Multivariate data analysis and discirminant analysis.
The objects of intervention investigation of diet behavior were 80 women selected from four counties in two districts selected from the four fields mentioned above.According to the standard principle,two counties were selected from every district and 10 women were selected from every country.Structure investigation, structure personal interview,focus group discussion,Particular Rural Appraisal(PRA) and field research were used to collection information.The tools of intervention investigation of diet behavior were questionnaire of food frequency introduced from Center of disease control and prevention and interview outline.
Results:1) There is no embryonic tissue in gestation sac without or with little villous tissue in anembryonic pregnancy.And villous cells were sparsity in villous tissue of anembryonic pregnancy through staining technique of haematoxylin and eosin and were serious mucinous degeneration.
2) The proportion of anembryonic pregnancy in the total of adverse pregnancy outcome was averagely 40%,the ratio of the number of women with anembryonic pregnancy to the number of women with other kinds of spontaneous abortion was 6 to 1;the ratio of women with anembryonic pregnancy to the number of women with neural tube defects was 1.5 to 1;and the ratio ofanembryonic pregnancy to other birth defects was 1.7 to 1.
3) There is no significant difference between anembryonic and normal pregnancy in aspect of age of women and husband,education level of women and husband,exposure of all kinds of poison,smoking,drinking,and diet behavior.
However,the frequency of pregnancy,abortion,stillbirth and the proportion of nonresident women in women with anembryonic pregnancy were more than those in women with normal pregnancy.Further analysis showed that the history of birth defect in relative were no difference between anembryonic and normal pregnancy.
4) The test results showed that the level of folate,V,Ti,Li,Cd,Sr,Rb,P,Na, K,and B in women with anembryonic pregnancy were significantly lower than those of normal pregnancy women;the level of VB_(12) and homocysteine in women with anembryonic pregnancy were significantly higher than those of the normal,and the women with anembryonic and normal pregnancy women were not different in the level of SAH.
5) The results of intervention investigation of diet behavior showed that the majority of food of local village was flour,potato and Chinese cabbage.In local country,the intake of flour of women of child-bearing age was higher than the recommendation in dietary pagoda by the Nutrition Society of China.The intake of fresh vegetables,fruit and meat in local village were lower than the recommendation, and especially,the intake of animal food,pulses and milk were equal to or lower than one third of the recommendation,respectively.The reasons for unscientific diet behavior in local women were not only that they are too poor to afford buying many kinds of food,but also that the local women didn't know how to be balanced diet.
Conclusion:The lower level of folate,V,Ti,Li,Cd,Sr,Rb,P,Na,K,and B together with the higher level of homocysteine and Ge were associated the risk of anembryonic pregnancy.The intervention investigation of diet behavior showed the diet behavior of the local child-bearing women was unscientific and the local women look forward to the practical intervention measure of diet behavior.
引文
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