孕妇血清叶酸和同型半胱氨酸水平对胎儿结局的影响
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摘要
目的探讨妊娠期妇女血清叶酸(FA)和同型半胱氨酸(Hcy)水平与发生胎儿不良结局的相关性。方法选取2016年12月-2017年12月于本院进行定期产前检查的孕妇400例,其中发生不良胎儿结局(先天畸形、胎儿生长受限、早产、自然流产、死胎)的孕妇45例为观察组,正常胎儿结局的孕妇355例为对照组,健康非孕妇女50例为正常组。采用酶循环法和电化学发光法检测Hcy与FA含量,对比3组妊娠期Hcy与FA血清水平,通过非条件Logistic回归分析统计发生不良胎儿结局的相关危险因素。结果正常组、对照组孕早期、中期、晚期、产后的孕妇血浆Hcy、FA含量比较,差异无统计学意义(P>0.05);观察组同型半胱氨酸水平高于其余2组,而叶酸水平均低于另外2组(P<0.05)。主要导致的先天畸形疾病为先天性心脏病、神经管缺陷和唇腭裂。结论正常妊娠各个阶段Hcy、FA含量与健康非孕妇女差异无统计学意义,实验组各个阶段Hcy、FA含量明显高于对照组。孕妇血清Hcy水平升高、FA水平降低、高龄是发生胎儿不良结局的危险因素。
Objective To investigate the correlation between serum folic acid(FA) and homocysteine(Hcy) levels in pregnant women with fetal adverse outcomes. Methods 400 pregnant women were selected for regular prenatal examination in our hospital from December 2016 to December 2017. Among them, 45 pregnant women with adverse fetal outcomes(congenital malformations, fetal growth restriction, premature birth, spontaneous abortion and stillbirth) were selected as the observation group. 355 pregnant women with normal fetal outcomes were selected as the control group. 50 healthy non-pregnant women were selected as the normal group. The contents of Hcy and FA were detected by enzyme-linked immunoassay and electrochemiluminescence. The serum levels of Hcy and FA were compared in three groups, and the unconditioned logistic regression analysis was used to count the risk factors for adverse fetal outcomes. Results There was no statistical significance on the difference in plasma Hcy and FA contents between the normal group and the control group in early, middle, and late stage of pregnancy(P>0.05). Homocysteine levels of the two groups were higher than the other two groups, and folic acid levels were lower than the other two groups(P<0.05). The main causes of congenital malformation were congenital heart disease, neural tube defects and cleft lip and palate. Conclusion There was no statistical significance on the difference in Hcy, FA contents between pregnant group and healthy non-pregnant group at all stages of normal pregnancy, and the contents of Hcy and FA in the observation group were significantly higher than that in the control group. Elevated levels of serum Hcy, reduced FA levels, and advanced age in pregnant women were risk factors for fetal adverse outcomes.
Objective To investigate the correlation between serum folic acid(FA) and homocysteine(Hcy) levels in pregnant women with fetal adverse outcomes. Methods 400 pregnant women were selected for regular prenatal examination in our hospital from December 2016 to December 2017. Among them, 45 pregnant women with adverse fetal outcomes(congenital malformations, fetal growth restriction, premature birth, spontaneous abortion and stillbirth) were selected as the observation group. 355 pregnant women with normal fetal outcomes were selected as the control group. 50 healthy non-pregnant women were selected as the normal group. The contents of Hcy and FA were detected by enzyme-linked immunoassay and electrochemiluminescence. The serum levels of Hcy and FA were compared in three groups, and the unconditioned logistic regression analysis was used to count the risk factors for adverse fetal outcomes. Results There was no statistical significance on the difference in plasma Hcy and FA contents between the normal group and the control group in early, middle, and late stage of pregnancy(P>0.05). Homocysteine levels of the two groups were higher than the other two groups, and folic acid levels were lower than the other two groups(P<0.05). The main causes of congenital malformation were congenital heart disease, neural tube defects and cleft lip and palate. Conclusion There was no statistical significance on the difference in Hcy, FA contents between pregnant group and healthy non-pregnant group at all stages of normal pregnancy, and the contents of Hcy and FA in the observation group were significantly higher than that in the control group. Elevated levels of serum Hcy, reduced FA levels, and advanced age in pregnant women were risk factors for fetal adverse outcomes.
引文
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[11] Jiang CT,Zhang H,Zhang WZ.Homocysteine promotes vascular smooth muscle cell migration by induction of the adipokine resistin[J].Am J Physiol Cell Physiol,2009,297(6):c1466-c1476.
[12] 张亚男.血清脂联素与血浆同型半胱氨酸检测在急性脑梗死中的价值[J].医学检验,2012,19(12):75-76.
[13] 邵雪峰.孕妇叶酸和同型半胱氨酸对胎儿生长发育的影响[J].检验医学与临床,2008,5(5):286-287.
[14] 杨冬梅,李敏清,庞丽红,等.孕前及孕早期补充小剂量叶酸对孕妇及胎儿的意义[J].广西医科大学学报,2016,33(1):96-97.
[15] Zhang XM,Huang GW,Tian ZH,et al.Effects of folic acid on invitro astrocytic differentiation of neural stem cells from neonatalrats[J].Neural Regen Res,2009,4(8):613-617.
[16] Wang J,Cui Y,Ge J,et al.Folic acid supplementation attenuates hyperhomocy steinemia-induced preeclampsia-like symptoms in rats[J].Neural Regen Res,2012,7(25):1954-1959.
[2] Salih MA,Murshid WR,Seidahmed MZ.Epidemiology,prenatal management,and prevention of neural tube defects[J].Saudimed J,2014,35:15-28.
[3] 速存梅,叶汉风,王珏,等.育龄妇女血清和红细胞叶酸水平与不良妊娠结局的相关性分析[J].中国妇幼保健,2015,30(2):241-243.
[4] 蔡卫华,张国华,岑赛宁,等.胎儿生长受限与孕妇红细胞叶酸缺乏的相关性研究[J].中国妇幼保健,2008,23(9):1243-1244.
[5] Callaway L,Colditz PB,Fisk NM.Folic acid supplementation and spontaneous preterm birth:Adding grist to the mill?[J].PLoS Med,2009,6(5):e1000077.
[6] Jessica A.Grieger,Vicki L.A review of the impact of dietary intakes in human pregnancy on infant birth weight[J].Nutrients,2015,7(1):153-178.
[7] Comes T,LiMner U,Tennekoon K,et al.Homoeysteine in small-for-gestational gae and appropriale-for-gestationalagel preterm neonates from mothers receiving folic acid supplementation[J].Clin Chem Lab Med,2010,48(8):1157-1161.
[8] 府伟灵,徐克前.临床生物化学检验[M].5版.北京:人民卫生出版社,2013:383-384.
[9] Ross ME.Gene-environment interactions,folate metabolism and the embryonic nervous system[J].Syst Biol Med,2011,2(4):471-480.
[10] 杨梦婕,骆斯莹,熊晶,等.同型半胱氨酸水平与早期妊娠流产相关性分析[J].医学临床研究,2014,31(11):2116-2118.
[11] Jiang CT,Zhang H,Zhang WZ.Homocysteine promotes vascular smooth muscle cell migration by induction of the adipokine resistin[J].Am J Physiol Cell Physiol,2009,297(6):c1466-c1476.
[12] 张亚男.血清脂联素与血浆同型半胱氨酸检测在急性脑梗死中的价值[J].医学检验,2012,19(12):75-76.
[13] 邵雪峰.孕妇叶酸和同型半胱氨酸对胎儿生长发育的影响[J].检验医学与临床,2008,5(5):286-287.
[14] 杨冬梅,李敏清,庞丽红,等.孕前及孕早期补充小剂量叶酸对孕妇及胎儿的意义[J].广西医科大学学报,2016,33(1):96-97.
[15] Zhang XM,Huang GW,Tian ZH,et al.Effects of folic acid on invitro astrocytic differentiation of neural stem cells from neonatalrats[J].Neural Regen Res,2009,4(8):613-617.
[16] Wang J,Cui Y,Ge J,et al.Folic acid supplementation attenuates hyperhomocy steinemia-induced preeclampsia-like symptoms in rats[J].Neural Regen Res,2012,7(25):1954-1959.