孕期Hcy水平与胎儿先天性心脏病的关系及相关影响因素分析
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摘要
目的探究孕期同型半胱氨酸(Hcy)水平与胎儿先天性心脏病(CHD)的关系以及胎儿CHD相关影响因素分析。方法选取2014年10月～2017年10月期间产前筛查发现胎儿CHD的56例孕妇为CHD组,选择同期产前筛选发现胎儿非CHD的56例孕妇为非CHD组,测定两组孕妇Hcy水平,并分析孕妇孕期Hcy水平与胎儿CHD的关系。同时,收集两组的孕妇的临床资料,采用单因素和多因素Logistic回归分析法对胎儿CHD的危险因素进行分析。结果 CHD组孕妇Hcy水平显著高于非CHD组,其差异有统计学意义(P<0.05)。两组孕妇在孕妇年龄、父亲年龄、产次、并发症、遗传因素、孕早期剧吐、被动吸烟、丈夫酗酒等情况比较差异无统计学意义(P>0.05);CHD组孕妇孕期用药、长期高频率使用手机电脑、接触有毒化学物质、孕期营养不良发生率显著高于非CHD组,差异有统计学意义(P<0.05),CHD组孕妇孕早期合理服用叶酸发生率显著低于非CHD组,差异有统计学意义(P<0.05)。进一步采用多因素Logistic回归分析对单因素分析中比较差异具有统计意义的变量(孕期用药、长期高频率使用手机电脑、孕早期合理服用叶酸、接触有毒化学物质、孕期营养不良以及孕妇Hcy水平)进行分析,分析显示孕妇Hcy水平、长期高频率使用手机电脑是胎儿发生CHD的危险因素,而孕早期合理服用叶酸是胎儿发生CHD的保护因素。结论孕妇在早期需要合理服用叶酸,避免长期高频率使用手机电脑,注重孕期营养物质的补充;同时,孕妇Hcy水平是胎儿发生CHD的高危因素,具有一定的临床预测价值。
Objective:To investigate the relationship between the level of homocysteine(Hcy)during pregnancy and the congenital heart disease(CHD)and the factors affecting fetal CHD. Methods:A total of 56 pregnant women who were found to have fetal CHD during prenatal screening from October 2014 to October 2017 were selected as CHD group. 56 pregnant women with non-CHD were selected as non-CHD group during the same period. Level and analyze the relationship between Hcy levels during pregnancy and fetal CHD. At the same time,the clinical data of the two groups of pregnant women were collected,and the risk factors of fetal CHD were analyzed by single factor and multivariate logistic regression analysis. Results:The Hcy level of pregnant women in CHD group was significantly higher than that in non-CHD group(P<0.05). There were no significant differences in the age of pregnant women,father's age,parity,complications,genetic factors,early pregnancy,passive smoking,and husband's alcohol abuse(P>0.05). The pregnant women in the CHD group were given medication for a long time. The high frequency of using mobile computers,exposure to toxic chemicals,the incidence of malnutrition during pregnancy was significantly higher than that of non-CHD group,the difference was statistically significant(P<0.05). The incidence of folic acid in pregnant women in CHD group was significantly lower than that in non-CHD group. The difference was statistically significant(P<0.05). Further multivariate logistic regression analysis was used to analyze the statistically significant variables in the single factor analysis(pregnancy medication,long-term high-frequency use of mobile computers,reasonable use of folic acid in early pregnancy,exposure to toxic chemicals,malnutrition during pregnancy,and Hcy levels in pregnant women). Analysis,analysis shows that pregnant women Hcy level,long-term high frequency use of mobile computers is a risk factor for fetal CHD,and the reasonable use of folic acid in the first trimester is a protective factor for fetal CHD. Conclusion:Pregnant women need to take folic acid reasonably in the early stage to avoid long-term high-frequency use of mobile computers,and pay attention to the supplement of nutrients during pregnancy. At the same time,the Hcy level of pregnant women is a high risk factor for fetal CHD,and has certain clinical predictive value.
Objective:To investigate the relationship between the level of homocysteine(Hcy)during pregnancy and the congenital heart disease(CHD)and the factors affecting fetal CHD. Methods:A total of 56 pregnant women who were found to have fetal CHD during prenatal screening from October 2014 to October 2017 were selected as CHD group. 56 pregnant women with non-CHD were selected as non-CHD group during the same period. Level and analyze the relationship between Hcy levels during pregnancy and fetal CHD. At the same time,the clinical data of the two groups of pregnant women were collected,and the risk factors of fetal CHD were analyzed by single factor and multivariate logistic regression analysis. Results:The Hcy level of pregnant women in CHD group was significantly higher than that in non-CHD group(P<0.05). There were no significant differences in the age of pregnant women,father's age,parity,complications,genetic factors,early pregnancy,passive smoking,and husband's alcohol abuse(P>0.05). The pregnant women in the CHD group were given medication for a long time. The high frequency of using mobile computers,exposure to toxic chemicals,the incidence of malnutrition during pregnancy was significantly higher than that of non-CHD group,the difference was statistically significant(P<0.05). The incidence of folic acid in pregnant women in CHD group was significantly lower than that in non-CHD group. The difference was statistically significant(P<0.05). Further multivariate logistic regression analysis was used to analyze the statistically significant variables in the single factor analysis(pregnancy medication,long-term high-frequency use of mobile computers,reasonable use of folic acid in early pregnancy,exposure to toxic chemicals,malnutrition during pregnancy,and Hcy levels in pregnant women). Analysis,analysis shows that pregnant women Hcy level,long-term high frequency use of mobile computers is a risk factor for fetal CHD,and the reasonable use of folic acid in the first trimester is a protective factor for fetal CHD. Conclusion:Pregnant women need to take folic acid reasonably in the early stage to avoid long-term high-frequency use of mobile computers,and pay attention to the supplement of nutrients during pregnancy. At the same time,the Hcy level of pregnant women is a high risk factor for fetal CHD,and has certain clinical predictive value.
引文
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[10] Zhen Liu,Jing Wang,Shanling Liu,et al. Copy number variations of GATA4 and NKX2-5 in Chinese fetuses with congenital heart disease[J].Pediatrics International,2014,57(2):234.
[11] Wang X,Li P,Chen S,et al. Influence of genes and the environment in familial congenital heart defects.[J].Molecular Medicine Reports,2014,9(2):695.
[12]张欢,张颖.产前超声在胎儿先天性心脏病筛查中的应用及危险因素分析[J].中国妇幼保健,2017,32(6):1245-1247.
[13] Evans W,Castillo W,Rollins R,et al. Moving Towards Universal Prenatal Detection of Critical Congenital Heart Disease in Southern Nevada:A Community-Wide Program[J].Pediatric Cardiology,2015,36(2):281-8.
[14]李小鹏,颜琼娴,谭支良.孕期营养不良影响子代生长发育的表观遗传机制[J].基因组学与应用生物学,2016,35(3):520-527.
[15] Zhang Y F,Zeng X L,Zhao E F,et al. Diagnostic Value of Fetal Echocardiography for Congenital Heart Disease:A Systematic Review and Meta-Analysis[J].Medicine,2015,94(42):e1759.
[2]王婕,王凤,桂永浩.孕前糖尿病致先天性心脏病的机制研究进展[J].中国当代儿科杂志,2017,19(12):1297-1300.
[3]王春香,王庆华,陈光元,等.孕妇血浆同型半胱氨酸水平对胎儿的影响[J].中国妇幼保健,2012,27(36):5900-5902.
[4]石春红,严倩,姜凌.孕妇血清叶酸、同型半胱氨酸的水平与胎儿先天性心脏病的相关性[J].山东医药,2015,55(37):71-72.
[5]Chen X,Zhao S,Yang X. OC12.03:A national survey of fetal congenital heart diseases in China[J].Journal of the American College of Cardiology,2015,46(S1):26-26.
[6]赵光临,代礼,谢建生,等.深圳市先天性心脏病流行病学特征研究[J].中国妇幼保健,2013,28(22):3633-3636.
[7]陈益明,王美英,梅瑾,等.孕妇血清叶酸、维生素B12和同型半胱氨酸水平与胎儿神经管畸形相关性研究[J].中国优生与遗传杂志,2014,(7):107-109.
[8]陈益明,顾琳媛,王芳,等.孕妇血清Fol、VB12和Hcy水平与胎儿CHD相关性研究[J].中国妇幼健康研究,2014,25(6):966-968.
[9]高宝英,吴丽华,刘清爱.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[J].中国生育健康杂志,2009,20(4):1438.
[10] Zhen Liu,Jing Wang,Shanling Liu,et al. Copy number variations of GATA4 and NKX2-5 in Chinese fetuses with congenital heart disease[J].Pediatrics International,2014,57(2):234.
[11] Wang X,Li P,Chen S,et al. Influence of genes and the environment in familial congenital heart defects.[J].Molecular Medicine Reports,2014,9(2):695.
[12]张欢,张颖.产前超声在胎儿先天性心脏病筛查中的应用及危险因素分析[J].中国妇幼保健,2017,32(6):1245-1247.
[13] Evans W,Castillo W,Rollins R,et al. Moving Towards Universal Prenatal Detection of Critical Congenital Heart Disease in Southern Nevada:A Community-Wide Program[J].Pediatric Cardiology,2015,36(2):281-8.
[14]李小鹏,颜琼娴,谭支良.孕期营养不良影响子代生长发育的表观遗传机制[J].基因组学与应用生物学,2016,35(3):520-527.
[15] Zhang Y F,Zeng X L,Zhao E F,et al. Diagnostic Value of Fetal Echocardiography for Congenital Heart Disease:A Systematic Review and Meta-Analysis[J].Medicine,2015,94(42):e1759.