妊娠早期不同水平同型半胱氨酸与自然流产的相关性研究  

Effects of Different Levels of Homocysteineinfirst Trimester on Spontaneous Abortion

作　　者：袁宁[1] 李智[2] 柴三葆[1] 孙健斌 赵心 张晓梅[1] YUAN Ning;LI Zhi;CHAI Sanbao(Peking University International Hospital,Department of Endocrinology,Beijing 102206,China;Peking University International HospitalDepartment of Gynaecology and Obstetrics,Beijing 102206,China)

机构地区：[1]北京大学国际医院内分泌科,北京102206 [2]北京大学国际医院妇产科,北京102206

出　　处：《实用妇产科杂志》2020年第9期700-704,共5页Journal of Practical Obstetrics and Gynecology

基　　金：首都临床特色应用研究与成果推广(编号:Z171100001017126)。

摘　　要：目的:探讨在不同年龄组妊娠妇女中,妊娠早期不同水平同型半胱氨酸(Hcy)暴露对自然流产(SA)的影响,为妊娠妇女SA的早期识别提供临床依据。方法:选择2017年1~11月在北京大学国际医院就诊并建档的妊娠妇女887例为研究对象。SA定义为妊娠在28周前自行终止。根据入组妊娠妇女Hcy水平的四分位数间距分为4组:A组(209例)Hcy<5.7μmol/L;B组(216例)Hcy 5.7~6.4μmol/L;C组(201例)Hcy 6.4~7.2μmol/L;D组(261例)Hcy>7.2μmol/L。比较不同Hcy水平的SA发生情况及不同年龄(<35岁,≥35岁)Hcy水平对SA的影响。结果:妊娠早期健康妊娠妇女Hcy中位数为6.30μmol/L,四分位数间距为5.60~7.25μmol/L。A、B、C和D组SA率分别为6.2%、8.8%、10.0%和11.9%,4组SA率随着Hcy水平升高而呈现升高趋势(P<0.05)。以SA为因变量,进行Logistic回归分析,在调整了体质量指数、产次、不良孕产史、游离甲状腺素和促甲状腺激素后,D组SA风险高于A组(OR 2.603,95%CI 1.246~5.440)。将年龄进行分层后分析:年龄<35岁,D组SA风险高于A组(OR 3.891,95%CI 1.371~11.039);而在年龄≥35岁中,未发现Hcy水平升高是SA发生的高危因素。结论:随着Hcy水平的升高,SA的发生率呈逐渐升高的趋势。在年龄<35岁的妊娠妇女中,Hcy>7.2μmol/L是SA的危险因素。妊娠早期关注Hcy水平可能为早期识别SA提供帮助。Objective:This study explored the effects of different levels of homocysteine(Hcy)in first trimester on spontaneous abortion(SA),providing clinical evidence for early identification of SA.Methods:887 pregnant women who were admitted and documented in Peking University International Hospital from January 2017 to November 2017 were included and divided into four groups accoding to different Hcy levels:group A(n=209):<5.7μmol/L,group B(n=216):5.7-6.4μmol/L,group C(n=201):6.4-7.2μmol/L,group D(n=261):>7.2μmol/L.The occurrence of SA between groups were compared.SA is defined as spontaneous termination of pregnancy before 28 weeks.Results:The median of Hcy in pregnant women in early pregnancy was 6.30μmol/L(IQR 5.60-7.25μmol/L).The rates of SA in the four groups were 6.2%,8.8%,10.0%and 11.9%respectively.The rate of SA showed an raising trend with increasing Hcy level(P<0.05).with SA as dependent variable,Logistic regression analysis showed that the risk of SA in group D was higher than in group A(OR 2.603,95%CI 1.246-5.440)after adjusting other factors such as BMI,etc.The investigators′age stratified analysis showed that the risk of SA in group D was higher than in group A(OR 3.891,95%CI1.371-11.039)in the group(<35 years old).Conclusions:The rate of SA increased with the increasing concentration of the Hcy.Hcy>7.2μmol/L was a risk factor of SA in the group(<35 years old).Attentions to Hcy levels in early pregnancy maybe effective to identify SA.

关 键 词：同型半胱氨酸 妊娠 自然流产 

分 类 号：R714.21[医药卫生—妇产科学]