叶酸代谢障碍与复发性流产相关性研究进展

Research Progress on the Relationship between Folate Metabolism Disorder and Recurrent Spontaneous Abortion

复发性流产的定义不同国家和地区在流产次数及流产孕周等内容上仍未达成统一的标准,其病因错综复杂,是近几年的研究热点,随着研究不断深入,目前已明确多方面致病因素,但仍有多数患者的病因尚未明确,给临床诊疗带来极大的困难。叶酸作为一碳单位的载体,是核酸合成和DNA修复的重要物质,其代谢异常可通过干扰DNA的甲基化和合成、影响同型半胱氨酸水平导致相关疾病的发生,而叶酸代谢通路受相关酶活性的调节,关键酶基因存在遗传多态性,其通过改变酶活性影响叶酸代谢过程;近期越来越多研究证实叶酸代谢异常可引起复发性流产发生风险增加,而通过叶酸干预可改善妊娠结局,降低复发性流产的发生率,但其作用机制尚存争议。综述叶酸代谢障碍与复发性流产的相关性研究进展,为复发性流产的诊疗提供帮助。

For the definition of recurrent spontaneous abortion,different countries and regions have not reached a unified standard in terms of the number of abortions and gestational weeks of abortion.Its etiology is complex,which has been a hot topic for research in recent years.With the deepening of research,many pathogenic factors have been identified,but the etiology of many patients is still unclear,which brings great difficulties to clinical diagnosis and treatment.As a carrier of one carbon unit,folic acid is an important material for nucleic acid synthesis and DNA repair.Its metabolism abnormality can lead to related diseases by interfering with DNA methylation and synthesis,affecting homocysteine level.The folate metabolic pathway is regulated by related enzyme activities,and there are genetic polymorphisms in key enzyme genes,which affect the process of folic acid metabolism by changing the enzyme activity.Recently,more and more studies have confirmed that abnormal folic acid metabolism can increase the risk of recurrent spontaneous abortion,and folic acid intervention can improve the pregnancy outcome and reduce the incidence of recurrent abortion,but the mechanism is still controversial.This article reviews the research progress on the correlation between folic acid metabolism disorder and recurrent spontaneous abortion,and to provide help for the diagnosis and treatment of recurrent spontaneous abortion.