血清同型半胱氨酸水平在反复自然流产中的临床价值

doi:10.3969/j.issn.1673-8640.2017.06.008

摘要/Abstract

摘要：

目的探讨血清同型半胱氨酸（Hcy）水平与反复自然流产（RSA）发生的关系,分析引起高Hcy血症的原因。方法选取有≥2次自然流产史的非妊娠妇女197例作为RSA组,将所有RSA患者根据B超妇科检查和实验室检测分为无病理异常组（146例）和有病理异常组（51例）;选取进行产前检查的正常妊娠妇女83名作为妊娠组,以进行健康体检的非妊娠妇女60名作为正常对照组。RSA组检测血清Hcy、叶酸（FA）和维生素B₁₂（Vit B₁₂）水平,妊娠组及正常对照组仅检测血清Hcy水平。将研究对象按年龄分为≥30岁者和<30岁者。结果无论有无病理异常,RSA组血清Hcy水平均高于正常对照组（P<0.05）和妊娠组（P<0.001）。RSA患者有无病理异常组或不同病理异常组间血清Hcy水平差异均无统计学意义（P>0.05）。RSA组中≥30岁者血清Hcy水平明显低于<30岁者（P=0.03）。RSA组≥30岁者和<30岁者血清Hcy水平均高于妊娠组同年龄者（P<0.001）。RSA组<30岁者血清Hcy水平高于正常对照组同年龄者（P<0.05）,而2个组≥30岁者之间血清Hcy水平差异无统计学意义（P>0.05）。在146例无病理异常的RSA患者中,Hcy升高、FA降低、Vit B₁₂降低的比例分别为9.59%、14.38%、4.11%,高Hcy组中低FA的发生率明显高于Hcy正常组（P<0.001）,Hcy与FA、Vit B₁₂均呈负相关（r值分别为-0.599、-0.503,P<0.05）。不同流产次数（2、3和≥4次）的RSA患者之间血清Hcy、FA和Vit B₁₂水平差异均无统计学意义（P>0.05）。结论高Hcy血症可能是RSA发生的危险因素,FA缺乏是造成RSA患者血清Hcy升高的主要原因之一。

关键词: 同型半胱氨酸, 叶酸, 维生素B12, 反复自然流产

Abstract:

Objective To investigate the relationship between serum homocysteine （Hcy） level and recurrent spontaneous abortion （RSA）,and to analyze the causes for hyperhomocysteinemia. Methods A total of 197 non-pregnant patients with RSA for ≥2 times were enrolled,and they were classified into non-pathologic disease group （146 cases）and pathologic disease group （51 cases）according to the results of B ultrasound and related determinations. A total of 83 healthy pregnant women were enrolled as pregnant group,and 60 healthy non-pregnant women were enrolled as healthy control group. Serum levels of Hcy,folic acid （FA） and vitamin B₁₂ （Vit B₁₂） in RSA group were determined,and pregnant and healthy control groups were determined only for serum Hcy level. Results Serum Hcy level in RSA group was higher than those in pregnant group （P<0.001）and healthy control group （P<0.05）. There was no statistical significance for serum Hcy level in RSA group with and without pathologic diseases （P>0.05）. Serum Hcy level was lower in ≥30-year-old RSA group than that in <30-year-old RSA group （P=0.03）. Serum Hcy levels in ≥30-year-old and <30-year-old RSA groups were higher than that in age-matched pregnant group（P<0.001）. Serum Hcy level was higher in <30-year-old RSA group than that in age-matched healthy control group （P<0.05）,whereas there was no statistical significance between the 2 groups aged ≥30-year-old （P>0.05）. In non-pathologic disease group,there were 9.59% patients with increasing Hcy level,14.38% with decreasing FA level and 4.11% with decreasing Vit B₁₂ level. The incidence rate of low FA level was higher in group with high Hcy level than that with normal Hcy level （P<0.001）. There was negative correlation of Hcy with FA and Vit B₁₂ （r=-0.599 and -0.503,P<0.05）. No statistical significance was observed in serum Hcy,FA and Vit B₁₂ levels among RSA patients with different times of abortion（2,3 and ≥4 times）（P>0.05）. Conclusions RSA might be correlated with hyperhomocysteinemia,which may be caused by the deficiency of FA.

Key words: Homocysteine, Folic acid, Vitamin B12, Recurrent spontaneous abortion

中图分类号:

R446.1

刘媛, 孙文琴, 陆文汇, 张军, 陈慧芬. 血清同型半胱氨酸水平在反复自然流产中的临床价值[J]. 检验医学, 2017, 32(6): 481-485.

LIU Yuan, SUN Wenqin, LU Wenhui, ZHANG Jun, CHEN Huifen. Serum homocysteine level in patients with recurrent spontaneous abortion[J]. Laboratory Medicine, 2017, 32(6): 481-485.

图/表 4

参考文献 19

[1]	段涛,胡丽娜. 妇产科学[M]. 南京:江苏科学技术出版社,2013:66-68.
[2]	JEVE Y B,DAVIES W.Evidence-based management of recurrent miscarriages[J]. J Hum Reprod Sci,2014,7(3):159-169.
[3]	张晓燕,牛秀敏. 同型半胱氨酸与妊娠[J]. 中华妇产科杂志,2003,38(5):316-317.
[4]	张苑华,何淑贞. HCY(同型半胱氨酸)与复发性流产的关系研究[J]. 当代医学,2014,21(4):50-51.
[5]	陈虹,丁杰锋,赵文. Hcy与FA、VitB12在妊高征孕妇的检测和意义[J]. 放射免疫学杂志,2011,24(1):91-92.
[6]	KAUR R,SEKHON B S.Hyperhomocysteinemia:an overview[J]. IJCP,2013,5(1):1-10.
[7]	STEEGERS-THEUNISSEN R P,BOERS G H,BLOM H J,et al. Hyperhomocysteinaemia and recurrent spontaneous abortion or abruptio placentae[J]. Lancet,1992,339(8801):1122-1123.
[8]	NELEN W L,BULTEN J,STEEGERS E A,et al.Maternal homocysteine and chorionic vascularization in recurrent early pregnancy loss[J]. Hum Reprod,2000,15(4):954-960.
[9]	CREUS M,DEULOFEU R,PEÑARRUBIA J,et al. Plasma homocysteine and vitamin B12 serum levels,red blood cell folate concentrations,C677T methylenetetrahydrofolate reductase gene mutation and risk of recurrent miscarriage:a case-control study in Spain[J]. Clin Chem Lab Med,2013,51(3):693-699.
[10]	何健,罗玲,陈智林,等. 血清同型半胱氨酸水平与反复性自然流产关系的探讨[J]. 中国卫生检验杂志,2013,23(15):3095-3097.
[11]	高志峰. 62例习惯性流产女性血清同型半胱氨酸、叶酸、孕酮检测结果分析[J]. 中国医学创新,2015,8(24):141-142.
[12]	李海川,候李俞,谭胡,等. 孕前、孕中及产后同型半胱氨酸水平变化及临床意义[J]. 国际检验医学杂志,2011,32(19):2295-2296.
[13]	MURPHY M M,SCOTT J M,ARIJA V,et al.Maternal homocysteine before conception and throughout pregnancy predicts fetal homocysteine and birth weight[J]. Clin Chem,2004,50(8):1406-1412.
[14]	骆婵珍,万波,吴瑕,等. 正常妊娠妇女血清同型半胱氨酸水平调查[J]. 检验医学,2014,29(7):723-726.
[15]	李晓梅,许燕雪,江森. 同型半胱氨酸代谢异常与不明原因反复性自然流产相关性研究[J]. 生殖医学杂志,2003,12(4):206-210.
[16]	KLEE G G.Cobalamin and folate evaluation:measurement of methylmalonic acid and homocysteine vs vitamin B(12)and folate[J]. Clin Chem,2000,46(8 Pt 2):1277-1283.
[17]	宋绿茵,戚潜辉,余达贤,等. 同型半胱氨酸代谢相关酶基因多态性与习惯性流产关系的研究[J]. 中华围产医学杂志,2005,8(3):160-164.
[18]	杨旭辉,章斐然,任爱国. 叶酸水平与原因不明习惯性流产的关系[J]. 中国生育健康杂志,2009,20(5):266-269.
[19]	NELEN W L,BLOM H J,STEEGERS E A,et al.Homocysteine and folate levels as risk factors for recurrent early pregnancy loss[J]. Obstet Gynecol,2000,95(4):519-524.

组别	例数	Hcy
组别	例数	<30岁	≥30岁
RSA组	197	8.30（6.50~11.18）	7.50（6.30~9.20）
正常对照组	60	7.10（6.20~7.50）^*#	7.40（6.63~7.90）
妊娠组	83	4.80（3.90~5.53）^**#	4.70（3.80~6.40）^**#

组别	例数	Hcy
组别	例数	<30岁	≥30岁
RSA组	197	8.30（6.50~11.18）	7.50（6.30~9.20）
正常对照组	60	7.10（6.20~7.50）^*#	7.40（6.63~7.90）
妊娠组	83	4.80（3.90~5.53）^**#	4.70（3.80~6.40）^**#

组别	例数	FA		Vit B₁₂
组别	例数	降低	正常	降低	正常
高Hcy组	14	11（78.57）	3（21.43）	2（14.29）	12（85.71）
Hcy正常组	132	10（7.58）	122（92.42）	4（3.03）	128（96.97）
χ²值		46.200		1.710
P值		<0.001		0.190

组别	例数	FA		Vit B₁₂
组别	例数	降低	正常	降低	正常
高Hcy组	14	11（78.57）	3（21.43）	2（14.29）	12（85.71）
Hcy正常组	132	10（7.58）	122（92.42）	4（3.03）	128（96.97）
χ²值		46.200		1.710
P值		<0.001		0.190

流产次数	例数	Hcy（μmol/L）	FA（ng/mL）	Vit B₁₂（pg/mL）
2	86	7.80（6.40~9.20）	12.39（8.55~18.56）	392.50（277.00~518.00）
3	40	7.50（6.40~9.80）	12.15（7.83~17.65）	395.00（285.50~503.00）
≥4	20	6.80（6.25~8.80）	11.96（9.51~19.85）	420.50（298.50~591.50）