许冉,潘莹,刘苹苹,申芳芳,白洁宇,孙力,何全中

• 1:新乡医学院第三临床学院妇产科

摘要(Abstract)：

目的探讨外周血叶酸及维生素B12与子痫前期的相关性。方法通过检索中国知网(CNKI)、万方、Pubmed、Medline、Embase、Cochrane Library 6个数据库以及参考文献追溯的方法,收集关于叶酸及维生素B12与子痫前期关系的相关研究。检索时限均为建库至2018年8月28日。依据纳入和排除标准纳入文献。采用Revman5.3对纳入文献的相关数据进行Meta分析。结果共纳入16篇文献,其中中文文献11篇,英文文献5篇,共计子痫前期孕妇1 468例,健康孕妇1 173例。Meta分析结果显示:子痫前期孕妇叶酸水平低于健康孕妇(SMD=-0.74,95%CI[-1.20,-0.28],P=0.002);子痫前期孕妇维生素B12低于健康孕妇(SMD=-0.95,95%CI[-1.32,-0.58],P<0.000 01)。结论叶酸及维生素B12的缺乏与子痫前期的发生密切相关。

关键词(KeyWords)： 子痫前期;叶酸;维生素B12;Meta分析

Abstract:

Keywords:

基金项目(Foundation): 河南省科技攻关计划项目（142102310301)

作者(Author): 许冉,潘莹,刘苹苹,申芳芳,白洁宇,孙力,何全中

DOI: 10.13515/j.cnki.hnjpm.1006-8414.2019.11.001

参考文献(References)：

• [1] Harmon AC,Cornelius DC,Amaral LM,et al.The role of inflammation in the pathology of Preeclampsia[J].Clin Sci(Lond),2016,130(6):409-419.
• [2] Abalos E,Cuesta C,Carroli G,et al.Pre-eclampsia,eclampsia and adverse maternal and perinatal outcomes:a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health[J].BJOG:an international journal of obstetrics and gynaecology,2014,121(Supp l 1):14-24.
• [3]谢幸，孔北华，段涛.妇产科学[M].第9版，北京：人民卫生出版社，2018:83-91.
• [4] Herrmann W,H Bner U,Koch I,et al.Alteration of homocysteine catabolism in pre-eclampsia,HELLP syndrome and placental insufficiency[J].Clinical Chemistry Laboratory Medicine,2004,354(10):810-1116.
• [5] Polat M,Bibero lu E H,Güler,et al.Coexistence of preeclampsia and inherited thrombophilia in Turkish pregnant women[J].Turkish Journal of Medical Sciences,2015,46(4):1094-1100.
• [6] Kharb S,Nanda S.Patterns of Biomarkers in Cord Blood During Pregnancy and Preeclampsia[J].Curr Hypertens Rev, 2017,13(999):57-64.
• [7] Powers R W,Evans R W,Majors A K,et al.Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation[J].American Journal of Obstetrics Gynecology,1998,179(6):1605-1611.
• [8] Laivuori H,Kaaja R,Turpeinen U,et al.Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia[J].ObstetricsandGynecology,1999,93(4):489-493.
• [9]张玉毅,李鹏,张玉波.高同型半胱氨酸与早发型重度子痫前期相关性研究及治疗[J].山西医药杂志,2015,44(22):2663-2665.
• [10]张彦玲,李合欣,冯勤梅.妊娠晚期正常孕妇及妊娠期高血压疾病孕妇血浆内同型半胱氨酸含量血清叶酸维生素B_(12)差异及分析[J].中国药物与临床,2012,12(02):216-218.
• [11]马倩倩,李小英,黄莺,等.同型半胱氨酸、叶酸和维生素B12水平在维汉两族子痫前期患者中的表达及意义[J].医学临床研究,2013(1):35-37.
• [12]隋霜,杜彦玫,张艳梅,等.同型半胱氨酸、叶酸和维生素B12与子痫前期的相关性分析[J].现代妇产科进展,2013,22(9):744-745.
• [13]张海萌,隋霜,李小英,等.同型半胱氨酸及其代谢因子与维吾尔族妇女子痫前期的相关性研究[J].中国医药,2014,9(4):545-547.
• [14]周洁.叶酸代谢相关基因多态性及血同型半胱氨酸与子痫前期的相关性研究[D].汕头大学,2017.
• [15]王军,李巨,谭岩,等.早发型重度子痫前期与血浆同型半胱氨酸浓度相关性及相应治疗[J].中国实用妇科与产科杂志,2009,25(4):280-282.
• [16]卢北燕,刘谡,杨光.重度子痫前期患者分娩前后血清中同型半胱氨酸、叶酸及维生素B12的浓度变化[J].黑龙江医药科学,2017,(1):103-104.
• [17]陈春娥,肖丽娟,张建鸿.子痫前期伴高同型半胱氨酸血症70例临床护理[J].齐鲁护理杂志,2008,(14):42-43.
• [18]何瑞荣,丁少波,黄余龙,等.子痫前期患者血浆总同型半胱氨酸水平及其与叶酸、维生素B12的关系[J].中国药师,2009,(5):549-551.
• [19]孙丹.子痫前期与MTHFR基因多态性及同型半胱氨酸水平关系的研究[D].大连医科大学,2007.
• [20] Saito S.Th17 cells and regulatory T cells:new light on pathophysiology of preeclampsia[J].Immunol Cell Biol,2010,88(6):615-617.
• [21] Herrmann W,Isber S,Obeid R,et al.Concentrations of homocysteine, related metabolites and asymmetric dimethylarginine in preeclamptic women with poor nutritional status[J].Clinical chemistry and laboratory medicine,2005,43(10):1139-1146.
• [22] Cherukad J,Wainwright V,Watson ED. Spatial and temporal expression of folate-related transporters and metabolic enzymes during mouse placental development[J].Placenta,2012,33(5):440-448.
• [23] Wright AJ,Dainty JR,Finglas PM.Folic acid metabolism in human subjects revisited:potential implications for proposed mandatory folic acid fortification in theUK[J].BrJ Nutr.2007;98:667-675.
• [24] Powers RW,Minich LA,Lykins DL,et al.Methylenetetrahydrofolate reductase polymorphism, folate, and susceptibility to preeclampsia[J].Journal of the Society for Gynecologic Investigation,1999,6(2):74-79.
• [25] Acilmis YG,Dikensoy E,Kutlar AI,et al.Homocysteine, folic acid and vitamin B12 levels in maternal and umbilical cord plasma and homocysteine levels in placenta in pregnant women with pre-eclampsia[J].The journal of obstetrics and gynaecology research,2011,37(1):45-50.
• [26] Mahmoud A,Elkattan EA,Eldaly AA,et al.A comparative study of folate and vitamin B12 serum levels in preeclamptic versus normotensive pregnant women in correlation with uterine and umbilical artery Doppler findings and pregnancy outcome[J].Journal of the Turkish German Gynecological Association,2009,10(3):152-157.
• [27] Rajkovic A,Mahomed K,Rozen R,et al.Methylenetetrahydrofolate reductase 677 C--> T polymorphism,plasma folate,vitamin B(12)concentrations,and risk of preeclampsia among black African women from Zimbabwe[J].Molecular genetics and metabolism,2000,69(1):33-39.