亚甲基四氢叶酸还原酶基因多态性对异位妊娠MTX保守治疗影响相关性分析

Effects of Methylenetetrahydrofolate Reductase Gene Polymorphism on MTX Conservative Treatment in Ectopic Pregnancy

目的 研究苏州地区汉族妇女亚甲基四氢叶酸还原酶C677T基因多态性与小剂量MTX肌注保守治疗异位妊娠后相关不良反应是否存在相关性,为临床合理用药提供参考.方法 收集2016年1月-2018年6月住院治疗的低剂量MTX肌注异位妊娠患者211例,采集血样提取DNA,检测MTHFR 677位点基因型,同时对比收集门诊妊娠期妇女MTHFR C677T基因型共3686例.对比治疗组MTX治疗后皮疹、黏膜损伤、肝功能损害、胃肠道反应及外周血细胞下降等不良反应发生例数与C677T基因多态性相关性.结果 治疗组CC基因型64例(30.33%),CT基因型107例(50.71%),TT基因型41例(19.43%).MTHFR 677TT基因型患者在皮疹、肝功能损害及黏膜损伤副反应发生率高于MTHFR 677CC及CT型患者(P<0.05),在胃肠道反应及外周血细胞降低方面其副反应差异无统计学意义(P>0.05).结论 推测MTHFR基因多态性与MTX保守治疗异位妊娠后发生毒副反应程度有相关性,MTHFR 677TT型基因型患者在小剂量保守治疗异位妊娠时可能更易发生毒副反应,临床可根据基因型做好解救措施及副反应对症治疗措施.

Objective To study the correlation between polymorphism of methylenetetrahydrofolate reductase(MTHFR)C677T gene and related adverse reactions after conservative ectopic pregnancy with intramuscular injection of low-dose MTX in Han Chinese women in Suzhou area,so as to provide reference for clinical rational drug use.Methods By collecting a total of 211 patients with low-dose MTX intramuscular injection of ectopic pregnancy who were hospitalized between January 2016 and June 2018,blood samples were collected to extract DNA,and the genotype of MTHFR 677 was detected.Meanwhile,a total of 3686 patients with MTHFR C677T genotype were compared and collected.In the treatment group,the relationship between the number of cases of adverse reactions such as the rash,mucositis,hematological toxicity,hepatic and gastrointestinal toxicities after MTX treatment and the polymorphism of C677T gene was compared.Results In the treatment group,there were 64 cases of CC genotype(30.33%),107 cases of CT genotype(50.71%),and 41 cases of TT genotype(19.43%).TT genotype patients had higher incidence of adverse reactions in the rash,mucositis and hepatic toxicities(P<0.05).No statistically significant difference in adverse reactions in gastrointestinal toxicities and hematological toxicity(P>0.05).Conclusion It is speculated that MTHFR gene polymorphism is correlated with the degree of toxic and side effects after conservative treatment of ectopic pregnancy with MTX.Patients with TT genotype may be more prone to toxic and side effects during low-dose conservative treatment of ectopic pregnancy,and clinical rescue measures and symptomatic treatment measures for side effects can be made according to the genotype.