叶酸补充与代谢循环对育龄女性红细胞叶酸水平的影响  

Impact of folic acid supplementation and metabolic cycle on red blood cell folate concentration in women of reproductive age

作　　者：顾玲琪 陈万杰 李海娟 平鹏 顾锦华[1,2,4] GU Lingqi;CHEN Wanjie;LI Haijuan;PING Peng;GU Jinhua(Department of Pharmacy,Affiliated Maternity and Child Health Hospital of Nantong University,Jiangsu Nantong 226018,China;School of Pharmacy,Nantong University,Jiangsu Nantong 226001,China;School of Information Science and Technology,Nantong University,Jiangsu Nantong 226001,China;Nantong Institute of Genetics and Reproductive Medicine,Jiangsu Nantong 226007,China)

机构地区：[1]南通大学附属妇幼保健院药学部,江苏南通226018 [2]南通大学药学院,江苏南通226001 [3]南通大学信息科学技术学院,江苏南通226001 [4]南通市遗传与生殖医学研究所,江苏南通226007

出　　处：《中国医院药学杂志》2025年第7期792-798,共7页Chinese Journal of Hospital Pharmacy

基　　金：江苏卫生创新团队项目(编号:CX2023006);南通大学临床医学专项(编号:2024LY056);南通市科技计划项目(编号:MSZ2022097);南通市重点人才项目(编号:NTS2022003);国家自然科学基金项目(编号:52202496)。

摘　　要：目的:探索影响育龄女性红细胞叶酸水平的关键因素。方法:本研究为一项横断面研究,纳入2023年6月至2023年12月间在南通大学附属妇幼保健院进行健康检查的419例育龄女性作为研究对象,所有参与者应用高效液相色谱-串联质谱检测代谢循环中关键物质。通过多因素校正单因素线性回归模型分析各因素与红细胞叶酸之间的关联性,各自变量以四分位数(第一分位数作为参考)纳入模型,并以年龄、体质量指数(body mass index,BMI)、是否补充叶酸、补充剂品种、每日剂量、围受孕期状态、饮食情况、孕次、流产次数和生育次数校正分析结果。结果:所有参与者平均红细胞叶酸浓度为631.09 nmol·L^(-1),77.1%的女性红细胞叶酸浓度低于906 nmol·L^(-1)。多元线性回归模型的筛选中,维生素B6、同型半胱氨酸(homocysteine,HCY)和叶酸补充时间与红细胞叶酸水平之间有统计学关联(P<0.05)。多因素模型显示,HCY[Q4vs.Q1:–18.09%(–30.53%,–3.43%)]与红细胞叶酸浓度存在显著负相关,叶酸补充时间[Q4vs.Q1:58.73%(30.21%,93.50%)]红细胞叶酸浓度存在显著正相关。曲线拟合显示,HCY浓度与红细胞叶酸浓度呈线性负相关,HCY高于6.5μmol·L^(-1)时红细胞叶酸变化率随之下降(P_(overall)=0.019,P_(nonlinear)>0.05);叶酸补充时间与红细胞叶酸浓度呈非线性相关,叶酸补充50 d后红细胞叶酸浓度变化率显著升高(P_(overall)<0.01,P_(nonlinear)<0.01)。剂量-效应曲线显示,叶酸补充超过100 d后红细胞叶酸浓度达到最佳预防界值。结论:叶酸补充时间和HCY水平是红细胞叶酸浓度的主要影响因素。育龄女性叶酸水平普遍不足,应根据受孕计划提前补充叶酸,有条件的可检查HCY和红细胞叶酸水平,优化补充方案。OBJECTIVE To explore the key factors affecting the red blood cell folate(RBCF)concentration in women of reproductive age.METHODS This was a cross-sectional study involving 419 women of reproductive age receiving physical examinations in Affiliated Maternity and Child Health Care Hospital of Nantong University from June 2023 to December 2023.High-performance liquid chromatography tandem mass spectrometry(HPLC-MS/MS)was performed to detect key substances in the metabolic cycle.Variables obtained from the univariate linear regression model were adjusted in a multivariate model to identify the correlation between each variable and RBCF concentration.With the reference of the first quartile,independent variables were included in the model as quartiles.Analysis results were adjusted for age,body mass index(BMI),folic acid supplementation,types of supplements,daily dosage,preconception status,dietary conditions,number of pregnancies,number of miscarriages,and number of births.RESULTS The average RBCF concentration of all participants was 631.09 nmol·L^(–1),with 77.1%of women having RBCF levels below 906 nmol·L^(–1).In the multiple linear regression model,vitamin B6,homocysteine(HCY),and folic acid supplementation duration were significantly associated with RBCF concentration(P<0.05).The multivariate analysis showed that HCY was negatively correlated with RBCF concentration(Q4 vs.Q1:–18.09%[–30.53%,–3.43%]),and folic acid supplementation duration was positively correlated with RBCF concentration(Q4 vs.Q1:58.73%[30.21%,93.50%]).Curve fitting showed a linear negative correlation between HCY and RBCF concentration,with the rate of change in RBCF concentration decreasing as HCY concentration exceeding 6.5μmol·L^(–1)(P_(overall)=0.019,P_(nonlinear)>0.05).There was a significant nonlinear correlation between folic acid supplementation duration and RBCF concentration,with a marked increase in the rate of change of RBCF concentration after 50 days of supplementation(P_(overall)<0.001,P_(nonlinear)<0.001).The dose

关 键 词：叶酸 一碳代谢 高效液相色谱-串联质谱 红细胞叶酸 

分 类 号：R98[医药卫生—药品]