孕妇血清叶酸、维生素B12和同型半胱氨酸水平与胎儿神经管畸形相关性研究  

Correlation between fetus with neural tube defects and level of serum folic acid,vitamin B12 and homocysteine in pregnant women

作　　者：陈益明[1] 王美英[1] 梅瑾 顾琳媛 王芳[1] 褚雪莲 黄芳[1] 林黎春 

机构地区：[1]杭州市余杭区妇幼保健院,311100 [2]杭州市妇幼保健院

出　　处：《中国优生与遗传杂志》2014年第7期107-109,共3页Chinese Journal of Birth Health & Heredity

基　　金：浙江省医药卫生科技计划基金资助(编号:2012KYB173)

摘　　要：目的比较胎儿神经管畸形（neural tube defects,NTDs）孕妇和正常孕妇血清叶酸（Folate,Fol）、维生素B12（Vitamin B12,B12）和同型半胱氨酸（homocysteine,Hcy）水平,以了解三种物质的代谢水平与胎儿NTDs的关系。方法根据有无胎儿NTDs将研究对象分为病例组（n=47）和对照组（n=43）,两组共90例。病例组指经B超诊断为孕NTDs胎儿并通过终止妊娠确诊活产或死产NTDs胎儿的孕妇。对照组指经B超诊断胎儿发育正常,并经随访确认所分娩婴儿正常的孕妇中随机抽取43例。检测两组孕妇血清标本Fol、B12和Hcy水平,并比较两组孕妇血清Fol、B12和Hcy水平差异。结果病例组和对照组血清Hcy水平分别为9.31±4.19（8.08~10.54）μmol/L和7.75±1.95（7.15~8.35）μmol/L,两组经独立样本t检验比较,差异有统计学意义（t=2.189,P=0.031）;两组血清Fol和B12水平比较,差异均无统计学意义（P〉0.05）。单因素Logistic回归分析从6个变量中遴选出1个危险因素,Hcy OR=2.021（95%CI：1.167~3.500）,是子代发生NTDs的危险因素;多因素Logistic回归分析结果显示,随着孕妇血清Hcy水平的升高,其发生胎儿NTDs发病风险增加。结论中孕期妇女血清高水平Hcy是妊娠NTDs的独立危险因素,随着孕妇血清Hcy水平的升高,其发生胎儿NTDs发病风险增加。Objective： By comparing the levels of Folate （Fol） , Vitamin B12 （B12） and homocysteine （Hcy） between pregnant women with neural tube defects （NTDs） and healthy pregnant women, and to investigate the relation between fetus with NTDs and the upper three substances. Methods： All cases were divided into case group （n=47） and control group （n=43） by whether there being NTDs. By diagnosing with ultrasound scans, pregnant women with NTDs infants who electively terminated an NTD affected fetus being with live or stillborn were ascertained as case group, and pregnant women who had a live born infant with no identified structural malformation after follow-up were ascertained as control group. After detecting the levels of Folic acid, Vitamin B12 and homocysteine to 90 case of subjects, and then to compare their levels between case group and control group. Results： The levels of Hcy in case and the control group were g. 31_-＋4.19 （8.08~10.54） ~tmol/L and 7. 75_＋l. 95 （7.15~8.35） ~tmol/L respectively, through comparing with the upper test results by independent-Sample T Test, they had significant difference （t=-2. 189, P=0.031） , but there were all no significant differences between the levels of Fol and B12 in the case group and the control group （P all 〉0.05） . By means of simple Logistic regression, one risky factor was found from six variables, with Hcy OR being 2. 021 （95%CI- 1.167--3.500） , which was a risky factor of NTDs to the next generation. The multiple conditional Logistic regression showed that they will get a higher risk of NTDs infancts with the increasing of serum Hcy level in pregnant women. Conclusion.- High level of serum Hcy during mid-term pregnancy is an independent risk factor for NTDs. They will get a higher risk of NTDs infants with the increasing of serum Hcy level in pregnant women.

关 键 词：叶酸 维生素B12 同型半胱氨酸 神经管畸形 

分 类 号：R714.53[医药卫生—妇产科学]