妊娠女性不同时期非稳态负荷状况及其影响因素研究  

Status and Influencing Factors of Allostatic Load in Pregnant Women at Different Trimesters

作　　者：袁德慧 李玉红[1] 熊敏 俞敏 马瑞亮 杨方方 俞巧稚 王明欢 YUAN Dehui;LI Yuhong;XIONG Min;YU Min;MA Ruiliang;YANG Fangfang;YU Qiaozhi;WANG Minghuan(School of Nursing,Anhui Medical University,Hefei 230601,China;Jin'an Maternal and Child Health Care Hospital,Lu'an 237009,China;Department of Obstetrics and Gynecology,901 Hospital,Joint Logistic Support Force of the Chinese People's Liberation Army,Hefei 230071,China)

机构地区：[1]安徽医科大学护理学院,安徽省合肥市230601 [2]安徽省六安市金安区妇幼保健院,237009 [3]中国人民解放军联勤保障部队第901医院妇产科,安徽省合肥市230071

出　　处：《中国全科医学》2023年第32期4057-4063,共7页Chinese General Practice

基　　金：安徽省自然科学基金面上项目(2108085MG242);安徽医科大学护理学院研究生青苗计划培育项目(hlqm2021014)。

摘　　要：背景非稳态负荷(AL)作为评价慢性压力的客观指标,与不良妊娠结局有关。目前,纵向研究分析妊娠女性AL影响因素的研究较少。目的探讨妊娠女性不同时期AL状况及其影响因素。方法本研究为前瞻性研究,采用方便抽样法,于2021年11月—2022年11月对在中国人民解放军联勤保障部队第901医院和六安市金安区妇幼保健院产科门诊建档的152例妊娠早期(≤14周)、中期(23~27周)和晚期(30~34周)女性进行问卷调查、体格检查和实验室检查。采用爱丁堡产后抑郁量表(EPDS)评估妊娠期抑郁情绪。参考既往研究,采用代谢系统、心血管系统、免疫系统的相关评估指标计算AL总分,并将AL总分≥3分作为妊娠女性不同时期高AL的判定标准。采用多因素Logistic回归分析探究妊娠早期、中期和晚期AL的影响因素。结果在152例妊娠女性中,妊娠早期、中期和晚期女性平均AL总分分别为(2.06±1.68)、(2.07±1.84)、(2.07±1.68)分。在妊娠早期、中期和晚期分别有52例(34.2%)、54例(35.5%)和50例(32.9%)处于高AL状态(AL总分≥3分)。多因素Logistic回归分析结果显示,职业{商业服务业员工[OR=0.229,95%CI(0.062,0.845),P=0.027]、办事人员[OR=0.164,95%CI(0.051,0.528),P=0.002]、专业技术人员[OR=0.278,95%CI(0.099,0.784),P=0.015]}、失业[OR=5.516,95%CI(1.044,29.144),P=0.044]、抑郁情绪[OR=6.241,95%CI(1.403,27.757),P=0.016]是妊娠早期女性AL的影响因素。年龄[OR=1.098,95%CI(1.002,1.202),P=0.045]和妊娠早期AL[OR=9.965,95%CI(4.402,22.561),P<0.001]是妊娠中期女性AL的影响因素。妊娠晚期夜间睡眠时长[≥9 h/d:OR=0.176,95%CI(0.044,0.703),P=0.014]、妊娠早期AL[OR=4.697,95%CI(1.852,11.908),P<0.001]和妊娠中期AL[OR=9.426,95%CI(3.728,23.834),P<0.001]是妊娠晚期女性AL的影响因素。结论超过30%的女性在妊娠不同阶段处于高AL水平,且其影响因素也不尽相同,职业、失业情况、抑郁情绪是妊娠早期女性AL的影响因�Background As an objective index to evaluate chronic stress,allostatic load(AL)is associated with adverse pregnancy outcomes.At present,there are few longitudinal studies to analyze the influencing factors of AL among pregnant women.Objective To investigate the status of AL and its influencing factors in pregnant women at different trimesters.Methods This study was designed as a prospective study.Questionnaire survey,physical examination and laboratory examination were administered to 152 women in the first(≤14 weeks),second(23-27 weeks)and third(30-34 weeks)trimesters of pregnancy collected in the obstetrics outpatient clinics of the 901 Hospital,Joint Logistic Support Force of the Chinese People's Liberation Army,Jin'an Maternal and Child Health Care Hospital from November 2021 to November 2022 by using convenience sampling method.The Edinburgh Postpartum Depression Scale(EPDS)was used to assess the depression during pregnancy.Referring to previous studies,the relevant assessment indexes of metabolic system,cardiovascular system,and immune system were used to calculate the total score of AL,and AL≥3 score was used as a criterion for determining high AL level at different trimesters of pregnancy.Multivariate Logistic regression analysis was used to explore the influencing factors of AL in the first,second and third trimesters.Results Among 152 pregnant women,the mean total AL score was(2.06±1.68),(2.07±1.84)and(2.07±1.68)in the first,second and third trimesters;52(34.2%),54(35.5%)and 50(32.9%)women were in high level of AL(total score of AL≥3)in the first,second and third trimesters.The results of multivariate Logistic regression analysis showed that occupations{business service employees〔OR=0.229,95%CI(0.062,0.845),P=0.027〕,office staff〔OR=0.164,95%CI(0.051,0.528),P=0.002〕,professional and technical personnel〔OR=0.278,95%CI(0.099,0.784),P=0.015〕},unemployment〔OR=5.516,95%CI(1.044,29.144),P=0.044〕and depression〔OR=6.241,95%CI(1.403,27.757),P=0.016〕were the influencing factors of AL i

关 键 词：妊娠 慢性应激 非稳态负荷 心理困扰 生物标志物 影响因素分析 

分 类 号：R395.6[哲学宗教—心理学] R339.2[医药卫生—医学心理学]