孕妇血浆同型半胱氨酸水平及影响因素分析

目的 了解孕妇孕期Hcy水平及变化趋势，探讨孕期Hcy水平的影响因素。方法 选择2019年4月-6月在成都市双流区妇幼保健院参加孕期检查并计划在该院分娩的266名孕妇为研究对象，前瞻性随访至生产。通过问卷调查收集相关信息，实验室检测孕早、中、晚血清叶酸和血浆Hcy浓度，以及孕妇MTHFR基因rs1801133和rs1801131位点基因型，采用混合效应模型分析Hcy水平的影响因素。结果 研究对象平均年龄(27.70±3.68)岁，孕妇早、中、晚期血清叶酸中位数分别为20.85、15.30和13.07nmol/L，血浆Hcy平均值分别为6.73、5.35和5.40μmol/L，Hcy水平在孕中期下降后基本保持不变。混合效应模型结果表明，孕妇孕中、晚期Hcy浓度低于孕早期水平，MTHFR rs1801133位点基因型为CT和TT的孕妇相较CC型孕妇Hcy水平更高,叶酸制剂补充周长越久的孕妇Hcy水平更低。结论 应重点关注MTHFR rs1801133基因突变的孕妇，适当延长叶酸制剂补充时长和增大补充剂量以降低孕期Hcy水平。

Plasma homocysteine level and influencing factors in pregnant women

Objective To investigate the level of Hcy in pregnant women and the trend of Hcy during pregnancy, so as to explore the influencing factors of the level of Hcy. Methods A total of 266 pregnant women who were participated in pregnancy examination and planned to give birth in Shuangliu Maternal and Child Health Hospital of Chengdu from April 2019 to June 2019 were enrolled and were prospectively followed up until delivery. Related information was collected through questionnaire. Serum folic acid and plasma homocysteine concentrations were tested in the first, second and third trimester of pregnancy. The Genetic polymorphism of MTHFR rs1801133 and rs1801131 were analyzed. The influencing factors of the level of Hcy were analyzed by mixed effect model.Results The average age of subjects was(27.70±3.68) years old. In the first, second and third trimester of pregnancy, the median concentration of serum folate acid were 20.85 nmol/L, 15.30 nmol/L and 13.07 nmol/L, respectively. The mean concentrations of plasma homocysteine were 6.73 μmol/L, 5.35 μ mol/L and 5.40 μmol/L, respectively. The level of homocysteine was declined in the second trimester of pregnancy and then remained unchanged basically. The results of mixed effect model showed that the plasma homocysteine concentration in the second and third trimester of pregnant women were lower than that in the first trimester. Pregnant women with MTHFR rs1801133 genotype of CT and TT had higher homocysteine concentration than CC type. And pregnant women who took folic acid longer had lower homocysteine concentration. Conclusion More attention should be paid to the pregnant women with MTHFR rs1801133 gene mutation. Prolonging the duration of taking folic acid and increasing dose of supplementation of folic acid could be considered to reduce the homocysteine concentration during pregnancy.