Study On The Association Of G6PD Enzyme Activity With BMI,Blood Pressure And HBV Susceptibility Among Pre-pregnant Reproductive-age Females In Shenzhen

Background:Based on the field of the National Free Pre-Conception Health Checkup Project(NFPCP)in Shenzhen,We collected Glucose-6-phosphate Dehydrogenase(G6PD)enzyme screening and other laboratory test results from 21 laboratories which undertook NFPCP serologic testing of 10 districts in Shenzhen,and investigated the quality control methods in the laboratories and practical problems arising during the course of NFPCP.The distribution of G6PD deficiency among reproductive age female population was analyzed,and the correlation analysis was conducted between G6PD deficiency and Body Mass Index(BMI),blood pressure,and susceptibility of HBV infection.Method:In order to understand the laboratory condition of G6PD enzyme activity screening and other serum test methods among reproductive age female in Shenzhen,and labora-tory quality control method and practical problems arising during the course of the NFPCP,4 medical organizations(Baoan District,Longgang District,Nanshan District and Luohu District)which undertook NFPCP serologic test in Shenzhen were selected to have interviews with us.We designed questionnaire based on the results of the inter-views,and used the questionnaire to collect the test methods,reagents,and medical refer-ences of G6PD enzyme activity screening and other serum test items such as hemoglo-bin,creatinine,HBV,serum glucose and etc.in the 21 laboratories in 10 districts of Shenzhen from 1st Jan 2013 to 31st Dec 2015.The medical references were used to categorize the data during association analysis.We used 112 076 reproductive age female aged 20 to 49 as our study object,who joined NFPCP test in the 21 laboratories in 10 districts of Shenzhen from 1st Jan 2013 to 31st Dec 2015.Other data were collected from NFPCP in a standardized process.We used descriptive analysis method to investigate the distribution of G6PD deficiency among reproductive age female in Shenzhen.Multinominal logistic regression and sub-group analysis were used to analyze the relation between G6PD deficiency and BMI,blood pressure,and susceptibility of HBV infection respectively.Results:1.NFPCP was standardized management in Shenzhen.Data collection,data entry process was clear,laboratory quality control method was strictly executed.The test methods,instruments,reagents,and medical references of G6PD enzyme screening and other serum test were different among different laboratories.The results of serum test should be categorized before analysis.2.The mean age of reproductive age female was 28.39�4.29(67.25%female aged 20-29)from 2013 to 2015 in Shenzhen.95.74%of the females were Han people,78.91%had more than high school degree,63.2%were agriculture account,44.83%were migrant population;G6PD deficiency prevalence was 1.90%,the prevalence of G6PD deficiency among people with south household registration is more than people with north house-hold registration.The differences were statistically significant(P<0.001).3.After multiple factors adjusted,the model showed that to compare with G6PD normal reproductive age female,G6PD deficiency reproductive age females had 32.00%higher risk of underweight(BMI<18.5)[aOR:1.32(95%CI:1.11?1.54)];while the associ-ation between G6PD deficiency and overweight and obesity(BMI ? 24.0)didn't have statistical significance[aOR:0.90(95%CI:0.73?1.12)].Subgroup analysis results were consistent.4.After adjusting by multiple factors,to compare with G6PD normal reproductive aged females,G6PD deficiency reproductive age female had 23%higher risk of elevated blood pressure[aOR:1.23(95%CI:1.03?1.47)](120mmHg? systolic blood pressure<130mmHg and diastolic blood pressure<80mmHg,2017 the American Heart Association guideline),and the risk of hypertension(systolic blood pressure ? 130mmHg or diast-olic blood pressure ?80mmHg)was 14%higher[aOR:1.14(95%CI:1.00-1.30)].The further researches found that the reproductive aged females with G6PD deficiency had higher risk at systolic blood)140mmHg[aOR:1.15(95%CI:1.00-1.33)].while repro-ductive aged females with G6PD deficiency didn't have statistical significance on slightly elevate at systolic blood pressure(80-89mmHg)[aOR:1.07(95%CI:0.94-1.22)]and diastolic blood pressure? 140mmHg[aOR:0.91(95%CI:0.61-1.34)].Subgroup analysis results were consistent.5.In this study,we divided the research object into hepatitis B virus(HBV)infected group[HBsAg(+)],susceptible control group[HBsAg(-)HBsAb(-)HBeAg(-)HBeAb(-)HBcAb(-)]and immunized control group[HBsAg(-)HBsAb(+)HBeAg(-)HBeAb(-)HBcAb(-)].Multivariable adjusted model showed,comparing HBV infected group with susceptible group,the G6PD normal reproductive aged female had 82%higher risk of HBV infected[aOR:1.82(95%CI:1.47-2.24)],while comparing HBV infected group with immunized control group,G6PD deficient reproductive aged female had 55%higher risk of HBV infection[aOR:1.55(95%CI:1.30-1.85)].Further study on whether G6PD deficiency was associated with elevated Alanine transaminase(ALT)in HBV infected people showed that either in the population among objects between HBV infected group and susceptible control group or in population among objects between HBV infected group and immunized control group,to compare with G6PD normal and non-HBV infected reproductive aged female,only G6PD deficiency female was not significantly on elevated ALT(ALT ?45U/L),while only HBV infected reproductive aged female was 1.91 times higher risk on elevated ALT[aOR:2.91(95%CI:2.57?3.28)]and 2.66 times higher[aOR:3.66(95%CI:(3.30-4.06)],the G6PD deficiency combined with HBV infected reproductive aged female had 3.27 higher risk[aOR:4.27(95%CI:2.75-6.61)]and 4.38 higher risk[aOR:5.38(95%CI:(3.48-8.30)].Subgroup analysis results were consistent.Conclusions:In Shenzhen,the prevalence of G6PD deficiency in people with south household registration was higher than in people with north household registration.G6PD defic-iency could be the risk factor of underweight,elevated blood pressure and hypertension and HBV infection in reproductive aged female.G6PD deficiency could aggravate the ALT in HBV infected reproductive aged female.G6PD deficient people should take action to lower the risk on underweight,elevated blood pressure,HBV infection and impairment of liver function during the pre-pregnancy and pregnancy periods to improve the maternal and child health condition.