孕期Hcy水平与胎儿先天性心脏病的关系及相关影响因素分析

Relationship between Hcy level during pregnancy and fetal congenital heart disease and related influencing factors

目的探究孕期同型半胱氨酸(Hcy)水平与胎儿先天性心脏病(CHD)的关系以及胎儿CHD相关影响因素分析。方法选取2014年10月～2017年10月期间产前筛查发现胎儿CHD的56例孕妇为CHD组,选择同期产前筛选发现胎儿非CHD的56例孕妇为非CHD组,测定两组孕妇Hcy水平,并分析孕妇孕期Hcy水平与胎儿CHD的关系。同时,收集两组的孕妇的临床资料,采用单因素和多因素Logistic回归分析法对胎儿CHD的危险因素进行分析。结果 CHD组孕妇Hcy水平显著高于非CHD组,其差异有统计学意义(P<0.05)。两组孕妇在孕妇年龄、父亲年龄、产次、并发症、遗传因素、孕早期剧吐、被动吸烟、丈夫酗酒等情况比较差异无统计学意义(P>0.05);CHD组孕妇孕期用药、长期高频率使用手机电脑、接触有毒化学物质、孕期营养不良发生率显著高于非CHD组,差异有统计学意义(P<0.05),CHD组孕妇孕早期合理服用叶酸发生率显著低于非CHD组,差异有统计学意义(P<0.05)。进一步采用多因素Logistic回归分析对单因素分析中比较差异具有统计意义的变量(孕期用药、长期高频率使用手机电脑、孕早期合理服用叶酸、接触有毒化学物质、孕期营养不良以及孕妇Hcy水平)进行分析,分析显示孕妇Hcy水平、长期高频率使用手机电脑是胎儿发生CHD的危险因素,而孕早期合理服用叶酸是胎儿发生CHD的保护因素。结论孕妇在早期需要合理服用叶酸,避免长期高频率使用手机电脑,注重孕期营养物质的补充;同时,孕妇Hcy水平是胎儿发生CHD的高危因素,具有一定的临床预测价值。

Objective:To investigate the relationship between the level of homocysteine(Hcy)during pregnancy and the congenital heart disease(CHD)and the factors affecting fetal CHD. Methods:A total of 56 pregnant women who were found to have fetal CHD during prenatal screening from October 2014 to October 2017 were selected as CHD group. 56 pregnant women with non-CHD were selected as non-CHD group during the same period. Level and analyze the relationship between Hcy levels during pregnancy and fetal CHD. At the same time,the clinical data of the two groups of pregnant women were collected,and the risk factors of fetal CHD were analyzed by single factor and multivariate logistic regression analysis. Results:The Hcy level of pregnant women in CHD group was significantly higher than that in non-CHD group(P<0.05). There were no significant differences in the age of pregnant women,father’s age,parity,complications,genetic factors,early pregnancy,passive smoking,and husband’s alcohol abuse(P>0.05). The pregnant women in the CHD group were given medication for a long time. The high frequency of using mobile computers,exposure to toxic chemicals,the incidence of malnutrition during pregnancy was significantly higher than that of non-CHD group,the difference was statistically significant(P<0.05). The incidence of folic acid in pregnant women in CHD group was significantly lower than that in non-CHD group. The difference was statistically significant(P<0.05). Further multivariate logistic regression analysis was used to analyze the statistically significant variables in the single factor analysis(pregnancy medication,long-term high-frequency use of mobile computers,reasonable use of folic acid in early pregnancy,exposure to toxic chemicals,malnutrition during pregnancy,and Hcy levels in pregnant women). Analysis,analysis shows that pregnant women Hcy level,long-term high frequency use of mobile computers is a risk factor for fetal CHD,and the reasonable use of folic acid in the first trimester is a protective factor for fetal CHD. Conclusion:Pregnant women need to take folic acid reasonably in the early stage to avoid long-term high-frequency use of mobile computers,and pay attention to the supplement of nutrients during pregnancy. At the same time,the Hcy level of pregnant women is a high risk factor for fetal CHD,and has certain clinical predictive value.