基于MTHFR和PAI-1基因多态性的精准药学服务对妊娠期高血压的预防效果

Preventive effect of precise pharmaceutical care based on MTHFR and PAI-1 gene polymorphisms on pregnancy induced hypertension

目的 探究临床药师精准药学服务(基于MTHFR和PAI-1基因多态性,协助临床医师为孕妇制定个体化叶酸剂量及疗程)对妊娠期高血压的预防效果。方法 从2020年10月至2022年1月就诊孕妇中筛选自愿进行MTHFR和PAI-1基因多态性检测60例作为观察组,选择同期进行定期产检未接受MTHFR和PAI-1基因多态性检测的孕妇60例作为对照组。对照组患者予以常规药学服务,观察组患者在对照组基础上实施精准药学服务(根据MTHFR和PAI-1基因多态性选择个体化叶酸剂量及疗程等)。比较2组孕妇孕中、晚期血压,孕晚期尿蛋白及血清同型半胱氨酸(Hcy)水平,以及各阶段叶酸服用依从性。结果 观察组孕晚期无孕妇收缩压>140mmHg和/或舒张压>90 mmHg,对照组5例有上述情况;观察组孕妇孕晚期收缩压、舒张压及血清Hcy水平均低于对照组(P <0.05);观察组叶酸服用依从性MMAS评分8分孕妇占比多于对照组(93.33%vs 45.00%,P <0.05);观察组孕晚期尿蛋白阳性发生率低于对照组(8.33%vs 20.00%,P <0.05)。结论 基于MTHFR和PAI-1基因多态性选择个体化叶酸剂量及疗程的精准药学服务可以有效预防妊娠期高血压的发生。

AIM To explore the use of MTHFR and PAI-1 gene polymorphisms to assist clinical physicians in developing personalized folic acid doses and treatment courses for pregnant women,and to study the preventive effect of precise pharmaceutical services provided by clinical pharmacists on gestational hypertension.METHODS From October 2020 to January 2022,60 pregnant women who voluntarily underwent MTHFR and PAI-1 gene polymorphism testing were selected as the observation group,while 60 pregnant women who did not undergo MTHFR and PAI-1 gene polymorphism testing during regular prenatal examinations were selected as the control group.The patients in control group were provided with routine pharmaceutical services,while the patients in observation group were provided with precision pharmaceutical services on the basis of the control group(personalized folic acid doses and treatment courses were selected according to MTHFR and PAI-1 gene polymorphisms).The blood pressure,urinary protein,serum homocysteine(Hcy) levels,and folate adherence of 2 groups of pregnant women in the middle and late stages of pregnancy were compared.RESULTS There were no pregnant women in the observation group with systolic blood pressure 140 mmHg and/or diastolic blood pressure 90 mmHg in the third trimester of pregnancy,while 5 patients in the control group had the same situation.The systolic blood pressure,diastolic blood pressure,and serum Hcy levels of pregnant women in the observation group were lower than those in the control group(P<0.05).The observation group had an MMAS score of 8 for compliance with folic acid administration,with more pregnant women than the control group(93.30% vs 45.00%,P<0.05).The incidence of urinary protein positivity in the observation group during late pregnancy was lower than that in the control group(8.33% vs 20.00%,P<0.05).CONCLUSION Accurate pharmaceutical care based on MTHFR and PAI-1 gene polymorphism sexual selection of individual folic acid dosage and course of treatment can effectively prevent the occurrence of gestational hypertension.