ABNORMAL IRON DISTRIBUTION IN INFANTS OF DIABETIC MOTHERS - SPECTRUM AND MATERNAL ANTECEDENTS
ABNORMAL IRON DISTRIBUTION IN INFANTS OF DIABETIC MOTHERS - SPECTRUM AND MATERNAL ANTECEDENTS
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DOI：
10.1016/s0022-3476(05)81097-2
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发表时间：
1990-09-01
影响因子：
5.1
通讯作者：
WIDNESS, JA
中科院分区：
文献类型：
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作者：
GEORGIEFF, MK;LANDON, MB;WIDNESS, JA
由于慢性低氧血症导致血清和储存池中的铁重新分配到不断扩大的红细胞团中，并且由于糖尿病母亲的婴儿在子宫内经常出现低氧血症并且出生时红细胞增多症的患病率很高，因此我们研究了 43 名糖尿病母亲足月婴儿的铁分布。 24 名婴儿的体型适合胎龄； 19 例大于胎龄。出生时，28 名婴儿 (65%) 的血清铁含量异常； 8 名仅铁蛋白浓度降低（第 1 阶段），9 名铁蛋白降低且总铁结合力值增加（第 2 阶段），11 名有这些血清结果加上游离红细胞原卟啉浓度升高（第 3 阶段）。体型大于胎龄的低血糖婴儿 (n = 14) 铁含量异常的发生率高于胎龄正常且体型正常的婴儿 (n = 20; 93% vs 50%; p = 0.009)。逐渐异常的铁谱与较高的糖基化胎儿血红蛋白值、较大程度的巨大儿、血红蛋白和促红细胞生成素浓度增加以及红细胞/储存铁比率增加相关。促红细胞生成素浓度与血清铁值呈线性负相关（n = 32，r = -0.54；p = 0.003）。患有糖尿病的母亲所生的铁值异常的婴儿的红细胞和储存铁池总量显着较低，特别是确诊患有糖尿病血管病变的女性所生的婴儿。我们推测这些发现可能是由于慢性低氧血症导致代偿性血红蛋白合成过程中胎儿铁利用率增加以及妊娠晚期糖尿病并发铁转移减少所致。
Because chronic hypoxemia causes a redistributiion of iron from serum and storage pools into an expanding erythrocyte mass, and because infants of diabetic mothers are often hypoxemic in utero and have a high prevalence of polycythemia at birth, we studied iron distribution in 43 term infants of diabetic mothers. Twenty-four infants were at an appropriate size for gestational age; 19 were large for gestational age. At birth, 28 infants (65%) had abnormal serum iron profiles; eight had decreased ferritin concentrations only (stage 1), nine had decreased ferritin and increased total iron-binding capacity values (stage 2), and 11 had these serum findings plus elevated free erythrocyte protoporphyrin concentration (stage 3). The hypoglycemic infants who were large for gestational age (n = 14) had a higher prevalence of abnormal iron profiles than euglycemic infants who were appropriate in size for gestational age (n = 20; 93% vs 50%; p = 0.009). Progressively abnormal iron profiles were associated with higher glycosylated fetal hemoglobin values, greater degree of macrosomia, increased hemoglobin and erythropoietin concentrations, and increased erythrocyte/storage iron ratios. Erythropoietin concentrations were inversely linearly correlated with serum iron values (n = 32, r = -0.54; p = 0.003). The combined erythrocyte and storage iron pools were significantly lower in infants with abnormal iron values whose mothers were diabetic, particularly in infants of women with confirmed diabetic vasculopathy. We speculate that these findings are likely due to increased fetal iron utilization during compensatory hemoglobin synthesis in response to chronic hypoxemia and reduced iron transfer during late gestation complicated by diabetes.