孕期针对性补充叶酸对血清HCY水平的影响
Effect of targeted supplementation of folic acid during pregnancy on serum homocysteine levels of women

目的:探讨不同遗传体征的孕妇口服不同剂量的叶酸对血清同型半胱氨酸(homocysteine,HCY)水平的影响。方法:选取定期围产保健的早孕期孕妇1 432人,采集口腔黏膜上皮细胞,用Taqman-MGB探针检测5,10-亚甲基四氢叶酸还原酶(MTHFR)C677T、A1298C和甲蛋氨酸合成还原酶(MTRR)A66G三个位点,判断叶酸利用能力。根据叶酸利用能力分为未发现风险组、低度风险组、中度风险组、高度风险组,其中未发现风险组根据叶酸补充剂量分为0.4 mg叶酸组和未干预组,低、中、高度风险组根据叶酸补充剂量分为:0.4 mg叶酸组和0.8 mg叶酸组,检测早、中、晚孕期研究对象外周血血清HCY水平。结果:未发现风险组中服用0.4 mg叶酸的孕妇血清HCY在早、中、晚孕期均低于未干预孕妇(P<0.05)。低度风险组中,服用0.4 mg叶酸和服用0.8 mg叶酸的孕妇早、中、晚孕期血清HCY水平差异无统计学意义(P>0.05)。中、高风险组中,服用0.4 mg叶酸的孕妇早、中、晚孕期血清HCY均高于服用0.8 mg叶酸的孕妇(P<0.05)。未发现风险组和低风险组补充0.4 mg叶酸和中、高风险组补充0.8 mg叶酸的孕妇血清HCY在孕期均呈降低趋势。结论:不同遗传体征孕妇针对性补充叶酸可使孕期血清HCY水平相对稳定,预防妊娠后期HCY浓度的升高,进而改善妊娠结局。
Aim: To investigate the effects of different doses of folic acid supplementation on the serum homocysteine levels of pregnant women with different genetic characteristics.Methods: A total of 1 432 pregnant women who received regular perinatal care were selected. Oral mucosal epithelial cells were collected from these women. The Taqman-MGB probe was used to examine the C677T and A1298C loci in the 5,10-methylenetetrahydrofolate reductase(MTHFR)gene and the A66G locus in the methionine synthase reductase(MTRR)gene. Based on their folic acid utilization ability, the included women were allocated into no-risk, low-risk, moderate-risk, and high-risk groups. Based on the dosage of folic acid supplementation, the no-risk group was further divided into non-intervention group and 0.4 folic acid mg group, and the low-risk, moderate-risk, and high-risk groups were further divided into 0.4 mg and 0.8 mg folic acid groups. The level of homocysteine in the peripheral blood of the study subjects during early, mid-, and late pregnancy was examined.Results: In no-risk group, the pregnant women with 0.4 mg folic acid supplementation had lower serum level of homocysteine during early, mid-, and late pregnancy than those not intervented(P<0.05); in low-risk group, there was no significant difference in serum homocysteine level between the pregnant women with 0.4 mg folic acid supplementation and 0.8 mg folic acid supplementation during early, mid-, and late pregnancy(P>0.05); in moderate-risk group and high-risk group, during early, mid-, and late pregnancy, the serum homocysteine level in the pregnant women with 0.4 mg folic acid supplementation was significantly higher compared with those with 0.8 mg folic acid supplementation(P<0.05). The serum homocysteine level of the pregnant women with 0.4 mg folic acid supplementation in no-risk group and low-risk group as well as those with 0.8 mg folic acid supplementation in moderate-risk group and high-risk group