孕中期血清叶酸、同型半胱氨酸及维生素A水平联合预测出生缺陷的临床价值

Clinical value of serum folic acid,homocysteine and vitamin A levels to predict birth defects in the second trimester

目的:探讨血清叶酸、血浆同型半胱氨酸(homocysteine,Hcy)及维生素A水平联合预测出生缺陷孕妇方面的价值。方法:选取2017年9月至2019年5月于郑州大学第三附属医院行孕中期产前检查的300例孕妇,其中胎儿结构发育异常并且产前诊断未发现染色体异常的孕妇100例,正常妊娠妇女200例。检测患者的血清学指标,叶酸、Hcy及维生素A水平,分析比较三者对预测出生缺陷的意义。结果:出生缺陷孕妇组叶酸、Hcy及维生素A与正常妊娠组比较,差异有统计学意义(P<0.05),叶酸、维生素A为出生缺陷的保护性因素,Hcy为出生缺陷的危险因素。三者联合检测对出生缺陷的ROC曲线下面积(AUC)最大,为0.747,特异度为79.0%。结论:血清叶酸、Hcy及维生素A对于出生缺陷的联合预测具有更高的临床价值,但最佳预测界值需更大样本量的研究支持。

Objective:To explore the clinical value of serum folic acid,HCY and vitamin A in predicting pregnant women with birth defects.Methods:A total of 300 pregnant women were enrolled from September 2017 to May 2019 at the Third Affiliated Hospital of Zhengzhou university,including 100 cases with abnormal fetal structure but no chromosomal abnormalities found in prenatal diagnosis,and 200 normal cases who underwent prenatal examination.Serum folic acid,Hcy and vitamin A levels were measured to compare the predicting significance for birth defects.Results:The serum levels of folic acid,Hcy and vitamin A in the pregnant women with birth defects were significantly different compared with normal pregnant women(P<0.05).Folic acid and vitamin A were protective factors for birth defects,whereas HCY was a risk factor for birth defects.The area under the ROC curve(AUC)of the combined detection for birth defects was 0.747,and the specificity was 79.0%.Conclusion:Serum folic acid,Hcy,and vitamin A have higher clinical value for the combined prediction of birth defects,but the optimal prediction cut-off value needs to be supported by a study with larger sample size.