妊娠期Hcy和凝血相关指标与胎儿生长发育的临床研究

Clinical research on relationship between homocysteine level and indicators of coagulation in gestation period with fetal growth and development

目的通过监测妊娠妇女孕早、中、晚期血同型半胱氨酸(Hcy)和凝血功能相关指标,了解其各期指标水平的变化及Hcy水平与胎儿生长发育之间的关系。方法选2013年1月至2014年10月在浙江省温州市中医院产科初诊建卡至住院分娩的孕产妇50例作为研究组,另选取103例门诊体检非孕育龄妇女为对照组。测定研究组早、中、晚孕期及对照组Hcy、血浆凝血酶原时间(PT)、纤维蛋白原(Fg)、D-二聚体水平(D-dimer),并记录产妇分娩时的孕周和新生儿的体重;同时按照新生儿体重分为3组进行Hcy水平比较。结果孕妇组早、晚孕期D—dimer、Hcy水平均显著高于对照组(t值分别为5.84、22.38、6.58、4.21,均P<0.05)。妊娠妇女孕中期、晚期的Hcy水平与胎儿出生体重与孕周呈负相关(r值分别为-0.38、-0.40、-0.44、-0.48,均P<0.05)。结论娠中晚期D-dimer、Hcy、Fg水平关系着胎儿生长发育,动态监测D—dimer、Hcy、Fg水平,及时对妊娠妇女进行饮食和治疗干预,促进胎儿生长发育尤为重要。

Objective To know changes in homocysteine （Hcy） levels and indicators of coagulation function at different periods and relations between those indicators and Hcy levels with fetal growth and development by monitoring Hcy levels and indicators of coagulation function of pregnant women in early, middle and late pregnancy. Methods A total of 50 cases of pregnant women opening accounts after preliminary diagnosis and delivered their babies at Wenzhou Hospital of Traditional Chinese Medicine in Zhejiang Province from January 2013 to October 2014 were chosen as research group. Another 103 women of non-pregnant childbearing age receiving physical examinations at outpatient department were chosen as control group. Hcy levels, prothrombin time （PT）, fibrinogen （Fg） and D-dimer （D-D） levels were measured in pregnant women in early, middle and late pregnancy and women in the control group. Besides, gestational week of puerperas during delivery and neonatal weight were recorded. Newborn babies were divided into 3 groups according to their weight to compare Hcy levels. Results As for pregnant women in early and late pregnancy, their D-D levels and Hcy levels were significantly higher those in the control group （ t value was 5.84, 22.38, 6.58 and 4.21 respectively, all P 〈 0.05 ）. Hcy levels of pregnant women in middle and late period were negatively correlated to neonatal weight and gestational week （ r value was - 0.38, - 0.40, - 0. 44 and - 0.48, respectively, all P 〈 0.05 ）. Conclusion D-D, Hcy and Fg levels of the women in middle and late pregnancy are related to fetal growth and development. Dynamic monitoring of D-D, Hcy and Fg levels in pregnant women and timely interventions of diet and treatment are particularly important to the promotion of fetal growth and development.