孕妇血清叶酸、同型半胱氨酸水平与胎儿神经管畸形危险性研究_临床医学论文.docVIP

孕妇血清叶酸、同型半胱氨酸水平与胎儿神经管畸形危险性研究_临床医学论文 孕妇血清叶酸、同型半胱氨酸水平与胎儿神经管畸形危险性研究_临床医学论文 作者：高宝英 吴丽华 刘清爱 【摘要】 目的 了解孕妇血清叶酸和同型半胱氨酸(homocysteine，Hcy)水平与胎儿神经管畸形(neural tube defects，NTDs)的关系。 方法 采用病例对照研究设计，以NTDs高发的山西省5个县作为研究现场，研究对象为此现场9所医院内进行产前检查或分娩并同意参与此研究的孕妇。病例组指经B超诊断为孕NTDs胎儿并通过终止妊娠确诊的孕妇及活/死产NTDs胎儿的孕妇。对照组指在同一医院随机选择的当地正常孕妇。检测所有研究对象血清叶酸和Hcy水平，比较病例组和对照组血清叶酸和Hcy水平差异。分别以对照组血清叶酸和Hcy水平的第10和90百分位数作为界值，比较不同水平组NTDs的发病风险。 结果 收集到符合要求的病例113例，对照148例。病例组和对照组血清叶酸水平分别为10.5(4.4～24.5)nmol/L、12.9(6.3～32.7)nmol/L，2组比较，差异有统计学意义(P=0.001)，2组血清Hcy浓度比较，差异无统计学意义(Pgt;0.05);病例分型后发现，妊娠无脑儿及脊柱裂的孕妇血清叶酸水平低于对照组，差异有统计学意义(0.05)，妊娠脑膨出的孕妇血清叶酸平均值低于对照组，但差异无统计学意义(Pgt;0.05)，妊娠无脑儿的孕妇血清Hcy水平高于对照组，差异有统计学意义(0.05);低叶酸水平孕妇妊娠NTDs的危险性显著增加(OR=2.4;95% CI 1.1～5.6)。 结论 在NTDs高发区，孕妇低水平叶酸是妊娠NTDs的独立危险因素;血清叶酸与Hcy相比是对NTDs胎儿的发生更有预测意义的指标。 【关键词】 叶酸;同型半胱氨酸;神经管畸形 　　【Abstract】 Objective To explore the relationship between serum folate and homocysteine (Hcy) during pregnancy and the risk of neural tube defects (NTDs). Methods Our research was a case-control study. We recruited pregnant women from 9 hospitals in 5 counties in Shanxi province, where NTDs prevalence was high. All subjects received prenatal healthcare or delivered in participating hospitals and agreed to participate. Women who were diagnosed with NTD by ultrasound scans and who electively terminated an NTD affected fetus, and who had live birth or stillborn with an NTD were ascertained as case women. Women who had a live born infant with no identified structural malformation after one year of follow up were ascertained as control women. We compared differences in serum folate and Hcy levels between the case and control group and compared NTD risk between different subgroups of serum or Hcy divided by 10th percentile cutoff value in the control group and 90th cutoff value of serum Hcy in the case group. Results We recruited 113 NTD affected pregnant women and 148 controls. Serum folate level was significantly lower (P=0.001) in the case group (10.5 nmol/L) than in the control group (12.9 nm