Jatavan Phudit, Sekararithi Rattanaporn, Jaiwongkam Thidarat, Kumfu Sirinart, Chattipakorn Nipon, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Cardiac Electrophysiology Research and Training Center (CERT), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Front Med (Lausanne). 2023 Jan 3;9:1015306. doi: 10.3389/fmed.2022.1015306. eCollection 2022.
To compare the levels of Non-transferrin bound iron (NTBI) in fetuses with anemia, using Hb Bart's disease as a study model, and those in unaffected fetuses and to determine the association between fetal cardiac function and the levels of NTBI.
A prospective study was conducted on pregnancies at risk of fetal Hb Bart's disease. All fetuses underwent standard ultrasound examination at 18-22 weeks of gestation for fetal biometry, anomaly screening and fetal cardiac function. After that, 2 ml of fetal blood was taken by cordocentesis to measure NTBI by Labile Plasma Iron (LPI), serum iron, hemoglobin and hematocrit. The NTBI levels of both groups were compared and the correlation between NTBI and fetal cardiac function was determined.
A total of 50 fetuses, including 20 fetuses with Hb Bart's disease and 30 unaffected fetuses were recruited. There was a significant increase in the level of serum iron in the affected group (median: 22.7 vs. 9.7; -value: 0.013) and also a significant increase in NTBI when compared with those of the unaffected fetuses (median 0.11 vs. 0.07; -value: 0.046). In comparisons of fetal cardiac function, myocardial performance (Tei) index of both sides was significantly increased in the affected group (left Tei: = 0.001, Right Tei: = 0.008). Also, isovolumetric contraction time (ICT) was also significantly prolonged (left ICT: = 0.00, right ICT: = 0.000). Fetal LPI levels were significantly correlated inversely with fetal hemoglobin levels ( = 0.030) but not significantly correlated with the fetal serum iron levels ( = 0.138). Fetal LPI levels were also significantly correlated positively with myocardial performance index (Tei) of both sides (right Tei: = 0.000, left Tei: = 0.000) and right ICT ( = 0.013), but not significantly correlated with left ICT ( = 0.554).
Anemia caused by fetal Hb Bart's disease in pre-hydropic stage is significantly associated with fetal cardiac dysfunction and increased fetal serum NTBI levels which are significantly correlated with worsening cardiac dysfunction. Nevertheless, based on the limitations of the present study, further studies including long-term data are required to support a role of fetal anemia as well as increased fetal serum NTBI levels in development of subsequent heart failure or cardiac compromise among the survivors, possibly predisposing to cardiovascular disease in adult life.
以血红蛋白巴特胎儿水肿综合征（Hb Bart's disease）为研究模型，比较贫血胎儿与未受影响胎儿的非转铁蛋白结合铁（NTBI）水平，并确定胎儿心功能与NTBI水平之间的关联。
对有胎儿Hb Bart's disease风险的妊娠进行前瞻性研究。所有胎儿在妊娠18 - 22周时接受标准超声检查，以进行胎儿生物测量、畸形筛查和胎儿心功能检查。之后，通过脐静脉穿刺采集2ml胎儿血液，采用不稳定血浆铁（LPI）、血清铁、血红蛋白和血细胞比容来测量NTBI。比较两组的NTBI水平，并确定NTBI与胎儿心功能之间的相关性。
共纳入50例胎儿，其中20例患有Hb Bart's disease，30例未受影响。与未受影响胎儿相比，患病组血清铁水平显著升高（中位数：22.7对9.7；P值：0.013），NTBI也显著升高（中位数0.11对0.07；P值：0.046）。在胎儿心功能比较中，患病组两侧心肌性能（Tei）指数显著升高（左Tei：P = 0.001，右Tei：P = 0.008）。此外，等容收缩时间（ICT）也显著延长（左ICT：P = 0.00，右ICT：P = 0.000）。胎儿LPI水平与胎儿血红蛋白水平呈显著负相关（P = 0.030），但与胎儿血清铁水平无显著相关性（P = 0.138）。胎儿LPI水平还与两侧心肌性能指数（Tei）以及右ICT呈显著正相关（右Tei：P = 0.000，左Tei：P = 0.000），但与左ICT无显著相关性（P = 0.554）。
胎儿水肿前期由胎儿Hb Bart's disease引起的贫血与胎儿心功能障碍显著相关，且胎儿血清NTBI水平升高，这与心功能障碍恶化显著相关。然而，基于本研究的局限性，需要进一步的研究，包括长期数据，以支持胎儿贫血以及胎儿血清NTBI水平升高在幸存者随后发生心力衰竭或心脏损害中的作用，这可能使成年后易患心血管疾病。
