同型半胱氨酸代谢异常与不明原因反复性自然流产相关性研究

The correlation study on the homocysteine metabolic abnormality and unexplained repeated spontaneous abortion

目的 探讨同型半胱氨酸 ( Hcy)代谢异常对不明原因反复性自然流产( URSA)的发生及与叶酸、维生素 B12 缺乏和抗心磷脂抗体 ( ACA)的关系。 方法 非孕期 URSA患者 57例 ,非孕期正常妇女 50例为对照组。采用高压液相色谱法测空腹血清总 Hcy,放射免疫法测血清叶酸、维生素 B12 ,酶链免疫法测 ACA的 Ig G、Ig M。 结果 ( 1 ) URSA组血清 Hcy水平显著高于对照组 ( P<0 .0 1 ) ;血清叶酸、维生素 B12 水平显著低于对照组 ;血清 Hcy水平与年龄明显相关 ,叶酸、维生素 B12 水平与年龄无相关性 ,三者与城乡、流产次数、流产时期及原发性或继发性流产均无明显关联。URSA患者血清 Hcy水平与血清叶酸、维生素 B12 浓度均呈负相关。 ( 2 ) URSA组 ACA阳性率显著高于对照组。URSA患者中 ACA( +)组 Hcy水平显著高于 ACA( -)组 ( P<0 .0 1 ) ;ACA与高 Hcy血症有一定的协同作用。 结论 高同型半胱氨酸血症 ( HHM)和低叶酸状态均系 URSA发生的独立危险因素。叶酸和维生素 B12 缺乏 ,是血清 Hcy增高的主要原因之一。 ACA也是 URSA的独立危险因素。 ACA与 HHM相互影响 ,可能存在协同作用。

Objective: To study the effect of metabolic abnormality of homocysteine (Hcy) on unexplained repeated spontaneous abortion (URSA), and the cooperative effect of anticardiolipin antibody (ACA) in URSA. Methods: 57 patients with URSA history and 50 healthy women without pregnancy were studied .The Hcy in the sera was measured with highpressure liquid chromatography (HPLC); folic acid and vitamin B 12 were detected by radioimmunoassay; ACA was detected by ELISA. Results: (1)The level of serum Hcy in URSA group was significantly higher than that in control group( P <0.01). (2)The levels of folic acid and vitamin B 12 in URSA group were significantly lower than those in control group. The levels of serum folic acid and vitamin B 12 were not correlated with age, area, number of misscarrige and abortion period. The level of serum Hcy was correlated negatively with serum folic acid and vitamin B 12 .(3)ACA positive rate in URSA was significantly higher than that in control group. The level of Hcy in URSA with ACA(+) group was significantly higher than that in ACA(-) group. Conclusion: Hyperhomocysteinemia, low folic acid state,and ACA positive are all the independent risk factors for URSA. Lacking of folic acid and vitamin B 12 is one of the important causes of hyperhomocysteinemia. The level of Hcy is related to ACA status. ACA and hyperhomocysteinemia may have synergistic effect in the occurrence of URSA.