健康孕妇孕晚期全血游离肉碱与母婴心脏结构和功能的关系  

Free carnitine levels in peripheral blood of healthy pregnant women in third trimester and their relationship with maternal and fetal cardiac function and structure

作　　者：丁文虹[1] 崔刚[2] 丁翔[3] 付蒙[3] 王丽红 宋金荣 上官文 韩玲[1] Ding Wenhong;Cui Gang;Ding Xiang;Fu Meng;Wang Lihong;Song Jinrong;Shangguan Wen;Han Ling(Pediatric Cardiovascular Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Drug Clinical Trial and Research Center,China-Japan Friendship Hospital,Beijing 100029,China;Department of Obstetrics and Gynecology,Beijing Haidian Maternal&Child Health Hospital,Beijing 100080,China;Department of Obstetrics and Gynecology,Beijing Miyun District Maternal and Child Health Hospital,Beijing 101500,China;Department of Ultrasonography,Beijing Miyun District Maternal and Child Health Hospital,Beijing 101500,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,100029 [2]中日友好医院药物临床试验研究中心,北京100029 [3]北京市海淀区妇幼保健院妇产科,100080 [4]北京市密云区妇幼保健院妇产科,100150 [5]北京市密云区妇幼保健院超声科,100150

出　　处：《中华围产医学杂志》2021年第2期97-104,共8页Chinese Journal of Perinatal Medicine

摘　　要：目的研究健康孕妇孕晚期全血游离肉碱及氨基酸水平及其与母胎、新生儿心脏结构及功能的关系。方法前瞻性选择2017年6月至2018年2月在北京市2家区级妇幼保健院(城区1家和远郊区1家)进行常规产前检查并分娩的单胎妊娠孕妇,于孕(18±1)周时行唐氏综合征筛查,孕(35±1)周时采用液相色谱-串联质谱技术检测孕妇全血及尿氨基酸、游离肉碱水平,同时行母亲及胎儿心脏超声检查,分娩后行新生儿心脏超声评估心脏结构、心功能。同时收集孕妇文化程度、初婚年龄、妊娠年龄、孕次、孕早期口服叶酸史等产前因素。采用t检验、方差分析、χ^(2)检验、Kolmogorov-Smirnov检验、Pearson相关检验、Kappa检验进行统计学分析。结果最终493对资料完整的孕妇及其新生儿纳入统计分析。孕妇孕晚期血游离肉碱水平为5.09~59.17μmol/L(参考值10.00~50.00μmol/L),平均(13.03±3.87)μmol/L;心脏超声未见结构异常,左室舒张末期内径为(45.70±3.08)mm,左室收缩末期内径为(29.17±3.12)mm,左室射血分数均≥55%;孕晚期胎儿心脏超声未检出心脏畸形。493例新生儿出生体重为(3340±313)g,<2500 g共5例(1.0%),其母亲血游离肉碱水平为(13.25±2.17)μmol/L(10.46~19.21μmol/L);出生体重>4000 g新生儿共15例(3.0%),其母亲血游离肉碱水平为(12.64±2.50)μmol/L(8.78~17.73μmol/L),2组差异无统计学意义(t=0.42,P>0.05)。493例新生儿左室舒张末期内径平均为(17.21±1.27)mm,左室收缩末期内径平均为(11.03±1.30)mm。其中64例(13.0%)新生儿左室射血分数<60%,其母血游离肉碱水平为(12.93±2.78)μmol/L(7.34~22.13μmol/L);59例(12.0%)新生儿左室射血分数>75%,其母血游离肉碱水平为(13.09±3.24)μmol/L(8.66~27.49μmol/L),2组差异无统计学意义(t=-0.29,P>0.05)。以血游离肉碱水平四分位数分4组,不同血游离肉碱水平组间孕妇、新生儿左室舒张末期内径及左室射血分数差异均无统计学意义(Objective To investigate the levels of periphreal blood free carnitine and amino acids in healthy pregnant women in the third trimester and their association with maternal,fetal,and neonatal cardiac function and structure.Methods This prospective descriptive study included healthy singleton pregnancies who underwent routine obstetric examination and delivered in two district maternal and child health hospitals(one in the urban and one in the suburb an area)in Beijing from June 2017 to February 2018.All recruiters had serology Down's syndrome screening test at(18±1)gestational weeks.Besides measurement of amino acids and free carnitine levels in whole blood and urine samples by liquid chromatography-tandem mass spectrometry,all cases underwent maternal and fetal echocardiography at(35±1)weeks of gestation.And neonatal echocardiography was performed after delivery to assess the heart function and structure.Antenatal factors were also collected,including maternal education background,age at first marriage and conception,gravidity,and folic acid supplement in early pregnancy.Statistical analysis was performed using t-test,ANOVA,Chi-square test,Pearson correlation coefficient,and Kappa test.Results A total of 493 mother-neonate dyads were enrolled in this study.Blood free carnitine levels in the healthy pregnant women in the third trimester ranged from 5.09 to 59.17μmol/L(reference value:10.00-50.00μmol/L)with an average value of(13.03±3.87)μmol/L.None was found with structural abnormalities by cardiac ultrasound,showing an average left ventricular end diastolic diameter(LVEDD)and end systolic diameter(LVESD)of(45.70±3.08)mm and(29.17±3.12)mm,respectively,and left ventricular ejection fraction(LVEF)of all cases were over 55%.No cardiac malformation was detected by the third-trimester fetal echocardiography.The average birth weight of the 493 newborns was(3340±313)g.Those whose birth weight<2500 g and>4000 g were accounted for 1.0%(5 cases)and 3.0%(15 cases)with the average maternal blood free carnitine level

关 键 词：孕妇 全血游离肉碱 心脏功能 

分 类 号：R715.3[医药卫生—妇产科学]