Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia.
Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia.
复制标题
妊娠中期血清同型半胱氨酸水平升高以及随后发生先兆子痫的风险。
DOI：
10.1159/000010148
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发表时间：
1999
影响因子：
2.1
通讯作者：
Luthy,DA
中科院分区：
文献类型：
--
作者：
Sorensen,TK;Malinow,MR;Williams,MA;King,IB;Luthy,DA
目的：血浆同型半胱氨酸升高是血管内皮功能障碍和血管疾病的危险因素。在妊娠晚期，先兆子痫患者的同型半胱氨酸水平高于正常血压的孕妇。研究设计：采用前瞻性嵌套病例对照研究设计，比较52例妊娠高血压综合征(妊娠高血压综合征伴蛋白尿)患者和56例整个妊娠期间血压正常的孕妇的血清同型胞苷浓度。研究对象是从3042名女性基础人群中挑选出来的，她们在平均孕周16周时提供了血液样本，并在我们中心分娩。结果：29%的先兆子痫患者血清同型半胱氨酸水平为≥5.5、μ摩尔/L(控制值分布的上十分之一)，而对照组为13%。调整了孕妇的年龄、胎次和体重指数后，妊娠中期同型半胱氨酸升高与先兆子痫风险增加3.2倍相关(调整后OR=3.295%CI1.1-9.2p=0.030)。有证据表明，孕妇肥胖(如孕前体重指数所示)与妊娠中期血清同型胞浆(E)升高之间存在交互作用。同型半胱氨酸水平升高的未产妇患先兆子痫的风险是无同型半胱氨酸升高的经产妇的9.7倍(95%CI2.1-14.1p=0.003)。孕前体重指数较高(≥21.4g/m2，或50百分位数以上)且同型半胱氨酸水平升高的女性，与无同型半胱氨酸升高的较瘦女性相比，发生子痫前期的可能性增加6.9倍(95%可信区间1.4-32.1；p=0.016)。结论：我们的研究结果与临床先兆子痫前血管内皮功能障碍的其他指标一致。旨在研究饮食和/或药物介质对先兆子痫患者同型半胱氨酸代谢的影响的研究是有必要的。
Objective:Elevated plasma homocyst(e)ine is a risk factor for endothelial dysfunction and vascular disease. In late gestation, levels of homocyst(e)ine are higher in preeclamptics, as compared with normotensive pregnant women. Our objective was to determine whether homocyst(e)ine elevations precede the development of preeclampsia.Study Design:We used a prospective nested case-control study design to compare second trimester maternal serum homocyst(e)ine concentrations in 52 patients who developed preeclampsia (pregnancy-induced hypertension with proteinuria) compared with 56 women who remained normotensive throughout pregnancy. Study subjects were selected from a base population of 3,042 women who provided blood samples at an average gestational age of 16 weeks and later delivered at our center. Serum homocyst(e)ine was measured by high-performance liquid chromatography and electrochemical detection.Results:Approximately 29% of preeclamptics, as compared to 13% of controls had homocyst(e)ine levels ≥5.5 μmol/l (upper decile of distribution of control values). Adjusted for maternal age, parity, and body mass-index, a second trimester elevation of homocyst(e)ine was associated with a 3.2-fold increased risk of preeclampsia (adjusted OR = 3.2; 95% CI 1.1–9.2; p = 0.030). There was evidence of a interaction between maternal adiposity (as indicated by her prepregnancy body mass index) and parity with second trimester elevations in serum homocyst(e)ine. Nulliparous women with elevated homocyst(e)ine levels experienced a 9.7-fold increased risk of preeclampsia as compared with multiparous women without homocyst(e)ine elevations (95% CI 2.1–14.1; p = 0.003). Women with a higher prepregnancy body mass index (≥21.4 kg/m2, or upper 50th percentile) and who also had elevated homocyst(e)ine levels, as compared with leaner women without homocyst(e)ine elevations were 6.9 times more likely to later develop preeclampsia (95% CI 1.4–32.1; p = 0.016).Conclusion:Our findings are consistent with other indications of vascular endothelial dysfunction predating clinical preeclampsia. Studies designed to examine the effect of dietary and/or pharmacological mediators of homocyst(e)ine metabolism in preeclampsia are warranted.