地中海贫血对孕妇妊娠结局影响的Meta分析

Effects of thalassaemia on pregnancy outcome: A Meta-analysis

摘要:

目的： 综合评价地中海贫血对孕妇妊娠结局的影响，旨为临床决策提供依据。方法：检索Medline，Elsevier，Cochrane Library，ISI web of knowledge、EMBase、中国期刊全文数据库（CNKI）、维普中文科技期刊数据库（VIP）、万方数据库、中国生物医学文献数据库（CBM）从1980年1月至2014年10月发表的关于地中海贫血与孕妇妊娠结局的队列研究，经文献筛选和数据提取后采用RevMan5.2软件进行Meta分析，采用亚组分析的方法分析异质性的来源，采用漏斗图分析发表偏倚。结果：地中海贫血是孕妇剖宫产、早产发生的危险因素 (RR=1.35, 95%CI[1.19,1.54]，P=0.00；RR=2.06，95%CI[1.29,3.28]，P=0.00)，但不是新生儿低体质量发生的危险因素（RR=1.56，95%CI[0.98,2.49]，P=0.06）。经亚组分析后，α地中海贫血不是孕妇剖宫产、早产、新生儿低体质量发生的危险因素（RR=1.32，95%CI[0.92,1.91]，P=0.14；RR=1.21，95%CI[0.51,2.86]，P=0.67；RR=1.27,95%CI[0.52,3.10]，P=0.59）；β地中海贫血是剖宫产、新生儿低体质量发生的危险因素，且发生风险分别是正常孕妇的1.54倍和2.31倍（RR=1.54，95%CI[1.20,1.97]，P=0.00；RR=2.31，95%CI[1.04,5.14]，P=0.04），但β地中海贫血不是孕妇早产发生的危险因素（RR=2.53，95%CI[0.78,8.18]，P=0.12）。结论：地中海贫血是孕妇剖宫产、早产发生的危险因素，β地中海贫血为剖宫产、新生儿低体质量发生的危险因素。

Abstract:

Objective: To comprehensively evaluate the influence of thalassaemia pregnancy outcomes on pregnant woman, and to provide basis for making clinical decision. Methods: Mediterranean anemia and pregnancy outcomes of pregnant women cohort study from January 1980 to October 2014 were collected. The databases of Chinese Biomedical Literature Database, CNKI database, WanFang, VIP, Medline, ISI Web of knowledge, Elsevier, EMBase and the Cochrane library were retrieved. RevMan5.2 software was used to improve the comprehensive quantitative analysis; subgroup analysis methods were adopted to analyze the source of the heterogeneity, and the funnel chart analysis publication bias was used. Results: The Mediterranean anemia was a risk factor for pregnant women with cesarean section and premature birth(RR=1.35, 95%CI[1.19,1.54]，P=0.00; RR=2.06，95%CI[1.29,3.28]，P=0.00)， not a risk factor for neonatal low weight（RR=1.56，95%CI[0.98,2.49]，P=0.06）. Based on subgroup analysis, alpha thalassaemia was not a risk factor for pregnant women with cesarean section, premature birth and low weight（RR=1.32，95%CI[0.92,1.91]，P=0.14;RR=1.21,95%CI[0.51,2.86],P=0.67；RR=1.27,95%CI[0.52,3.10]，P=0.59）. Beta thalassaemia was not a risk factor for preterm delivery of pregnant women（RR=2.53，95%CI[0.78,8.18]，P=0.12）. Beta thalassaemia was a risk factor for low cesarean section and neonatal weight, and risk are respectively 1.54 times and 2.31 times higher than normal pregnant women（RR=1.54，95%CI[1.20,1.97]，P=0.00；RR=2.31，95%CI[1.04,5.14]，P=0.04）.Conclusion: Thalassaemia is a risk factor for pregnant with cutting palace and preterm delivery, and beta thalassaemia is a risk factor for low cesarean section and neonatal weight.