坦桑尼亚农村地区妊娠期贫血：与微量营养素状况及感染的关联

Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections.

作者信息

Hinderaker S G, Olsen B E, Lie R T, Bergsjø P B, Gasheka P, Bondevik G T, Ulvik R, Kvåle G

机构信息

Centre for International Health, University of Bergen, Norway.

出版信息

Eur J Clin Nutr. 2002 Mar;56(3):192-9. doi: 10.1038/sj.ejcn.1601300.

DOI:10.1038/sj.ejcn.1601300

PMID:11960293

Abstract

OBJECTIVE

We studied the association between anemia in pregnancy and characteristics related to nutrition and infections.

DESIGN

Cross-sectional study.

SETTING

Four antenatal clinics in rural northern Tanzania.

SUBJECTS/METHODS: A total of 2547 women were screened for hemoglobin (Hb) and malaria plasmodia in capillary blood and for infections in urine. According to their Hb, they were assigned to one of five groups and selected accordingly, Hb<70 g/l (n=10), Hb=70-89 g/l (n=61), Hb=90-109 g/l (n=86), Hb=110-149 g/l (n=105) and Hb> or =150 g/l (n=50). The 312 selected subjects had venous blood drawn, were interviewed, and their arm circumference was measured. The sera were analyzed for ferritin, iron, total iron binding capacity (TIBC), cobalamin, folate, vitamin A, C-reactive protein (CRP), and lactate dehydrogenase (LD). Transferrin saturation (TFsat) was calculated. Urine was examined by dipsticks for nitrite.

MAIN OUTCOME MEASURES

Unadjusted and adjusted odds ratio (OR and AOR) of anemia with Hb<90 g/l.

RESULTS

Anemia (Hb<90 g/l) was associated with iron deficiency (low s-ferritin; AOR 3.4). The association with vitamin deficiencies were significant in unadjusted analysis (low s-folate; OR 3.1, low s-vitamin A; OR 2.6). Anemia was also associated with markers of infections (elevated s-CRP; AOR 3.5, urine nitrite positive; AOR 2.4) and hemolysis (elevated s-LD; AOR 10.1). A malaria positive blood slide was associated with anemia in unadjusted analysis (OR 2.7). An arm circumference less than 25 cm was associated with anemia (AOR 4.0). The associations with less severe anemia (Hb 90-109 g/l) were similar, but weaker.

CONCLUSIONS

Anemia in pregnancy was associated with markers of infections and nutritional deficiencies. This should be taken into account in the management of anemia at antenatal clinics.

SPONSORSHIP

The study was supported by the Norwegian Research Council (NFR) and the Centre for International Health, University of Bergen.

摘要

目的

我们研究了孕期贫血与营养及感染相关特征之间的关联。

设计

横断面研究。

地点

坦桑尼亚北部农村的四家产前诊所。

研究对象/方法：对2547名妇女进行了毛细血管血血红蛋白（Hb）和疟原虫筛查以及尿液感染筛查。根据她们的Hb水平，将其分为五组之一并相应选取，Hb<70 g/l（n = 10），Hb = 70 - 89 g/l（n = 61），Hb = 90 - 109 g/l（n = 86），Hb = 110 - 149 g/l（n = 105）和Hb≥150 g/l（n = 50）。选取的312名研究对象采集静脉血、接受访谈并测量上臂围。分析血清中的铁蛋白、铁、总铁结合力（TIBC）、钴胺素、叶酸、维生素A、C反应蛋白（CRP）和乳酸脱氢酶（LD）。计算转铁蛋白饱和度（TFsat）。用试纸检测尿液中的亚硝酸盐。

主要观察指标

Hb<90 g/l的贫血的未调整和调整后的优势比（OR和AOR）。

结果

贫血（Hb<90 g/l）与缺铁（低血清铁蛋白；AOR 3.4）相关。在未调整分析中，与维生素缺乏的关联显著（低血清叶酸；OR 3.1，低血清维生素A；OR 2.6）。贫血还与感染标志物（血清CRP升高；AOR 3.5，尿液亚硝酸盐阳性；AOR 2.4）和溶血（血清LD升高；AOR 10.1）相关。在未调整分析中，疟原虫血涂片阳性与贫血相关（OR 2.7）。上臂围小于25 cm与贫血相关（AOR 4.0）。与轻度贫血（Hb 90 - 109 g/l）的关联相似，但较弱。