正常妊娠妇女血清同型半胱氨酸水平调查

目的观察正常妊娠妇女血清同型半胱氨酸(Hcy)水平,为确定妊娠妇女Hcy水平的参考区间提供临床依据。方法采用循环酶法测定942例正常妊娠妇女血清Hcy水平,并收集其产检资料,追踪其分娩结局。根据测定Hcy时妊娠妇女的妊娠周期分为早、中和晚孕3组,各组例数分别为98例、202例和642例。结果正常妊娠妇女血清Hcy水平为(7.25±2.90)μmol/L,95%参考区间为1.57~12.93μmol/L。早孕组Hcy水平为(6.87±2.78)μmol/L,第75百分位数(P75)为7.53μmol/L;中孕组为(6.43±2.90)μmol/L,P75为7.21μmol/L;晚孕组为(7.54±2.86)μmol/L,P75为8.32μmol/L;3组之间差异有统计学意义(F=12.03,P=0.000)。两两比较显示早孕组与中孕组之间差异无统计学意义(t=0.99,P=0.321),中孕组与晚孕组之间差异有统计学意义(t=4.77,P=0.000)。晚孕组Hcy水平较中孕组平均升高(1.11±0.23)μmol/L[P=0.000;95%可信区间(CI)为0.65~1.56μmol/L]。线性相关分析显示Hcy水平与妊娠妇女年龄、检测孕周呈正相关(r值分别为0.14、0.15,P=0.000);将早、中和晚孕3组分别进行线性相关分析,仅晚孕组Hcy水平与检测孕周呈正相关(r=0.10,P=0.009)。多因素分析显示年龄、服用叶酸和Hcy检测孕周是影响孕妇Hcy水平的因素(F=16.59,P=0.000)。结论正常妊娠妇女血清Hcy水平妊娠早期为6.87μmol/L、中期为6.43μmol/L、晚期为7.54μmol/L;如妊娠早期Hcy水平7.53μmol/L(P75)、中期7.21μmol/L(P75)、晚期8.32μmol/L(P75)可能提示高Hcy血症。

The serum homocysteine concentrations among women with normal pregnancy

Objective To observe the maternal homocysteine（ Hcy） concentrations during normal pregnancy,and to establish the reference interval of Hcy among women with normal pregnancy. Methods A total of 942 normal pregnant women were enrolled. The relative data were collected,and they were followed up until delivery. The Hcy was detected during the first（ 98 pregnant women）,second（ 202 pregnant women） or third（ 642 pregnant women） trimesters of pregnancy by enzymatic cycling assay. Results The serum Hcy concentrations among women with normal pregnancy were（ 7. 25 ± 2. 90） μmol /L（ 95% reference interval 1. 57-12. 93 μmol /L）,including（ 6. 87 ± 2. 78） μmol /L in the first trimester [the 75 th percentile（ P75） 7. 53 μmol/L],（ 6. 43 ± 2. 90） μmol/L in the second trimester（ P757. 21 μmol /L） and（ 7. 54 ± 2. 86） μmol /L in the third trimester（ P758. 32 μmol /L）. There was statistical significance among the 3 groups（ F = 12. 03,P = 0. 000）. There was statistical significance between the first trimester group with the second trimester group（ t = 0. 99,P = 0. 321） and between the second trimester group with the third trimester group（ t =4.77,P =0.000）. The Hcy concentration in the third trimester increased as（ 1.11 ±0.23） μmol/L for that in the second trimester [P = 0. 000,95% confidence interval（ CI）（ 0. 65-1. 56） μmol /L]. Linearity correlation analysis showed that there was positive correlation of Hcy concentration with age and gestational weeks（ r = 0. 14 and 0. 15,P =0. 000）. There was positive correlation of Hcy concentration in the third trimester with gestational weeks（ r = 0. 10,P =0. 009）. Multiple factor analysis showed that age,taking folic acid and gestational weeks were main factors for Hcy concentration（ F = 16. 59,P = 0. 000）. Conclusions The serum Hcy concentrations among women with normal pregnancy are 6. 87 μmol /L in the first trimester,6. 43 μmol /L in the second trimester and 7. 54 μmol /L in the third trimes