孕期叶酸摄入与MTHFR基因多态性对产后抑郁的影响

摘要

目的 探讨叶酸摄入量与亚甲基四氢叶酸还原酶(MTHFR)基因多态性与产后抑郁的关系.方法 将2014年1月至2016年6月之间来延安大学附属医院产科进行产检的800例孕妇纳入本项研究,采用开放式问卷调查的方式收集妊娠12周和28周妇女服用叶酸的信息,通过PCR-RFLP检测MTHFR基因C677T和A1298C多态性.于产后8周通过爱丁堡产后抑郁量表(EPDS)进行产后抑郁诊断.统计分析叶酸摄入与MTHFR C677T和A1298C基因多态性与产后抑郁的关系.结果 800例受试者中产后抑郁症患者218例,正常582例.产后抑郁妇女与正常妇女妊娠期间每天的叶酸摄入量和不同时间补充叶酸无明显差异,但是产后抑郁妇女血清叶酸水平显著低于正常妊娠妇女(x2=15.76,P＜0.001).两组受试者MTHFR C677T和A1298C多态性位点的基因型频率间差异存在统计学意义,其中杂合子CT(x2=13.67,P＜0.01)、AC(x2=3.39,P=0.02)和纯合子Tr(x2=8.65,P＜0.01)、CC(x2=15.18,P＜0.01)是产后抑郁发生的高风险因子.此外,不同MTHFR C677T和A1298C基因型(CC、CT、rr和AA、AC、CC)产后抑郁的妇女在孕期摄入的叶酸量、不同时间补充叶酸和血清叶酸水平无明显差异(x2值为0.07 ～ 2.79,均P ＞0.05).结论 低叶酸摄入量和不同时间补充叶酸不是产后抑郁发病的风险因素,但叶酸水平与MTHFR C677T和A1298C基因型是产后抑郁发病的独立风险因素.%Objective To investigate the relationship between folic acid intake during pregnancy and methylenetetrahydrofolate reductase (MTHFR) polymorphism and postpartum depression.Methods Altogether 800 pregnant women receiving check-up in obstetrics department in Affiliated Hospital of Yan' an University from January 2014 to June 2016 were included in this study.Information on use of folic acid supplements was collected from women at 12 and 28 weeks of gestation based on an open-ended questionnaire.MTHFR C677T and A1298C polymorphism was detected by PCR-RFLP.Postpartum depression was diagnosed in 8 weeks postpartum through Edinburgh postnatal depression scale (EPDS).Relationship between folic acid intake during pregnancy and MTHFR polymorphism and postpartum depression was analyzed by statistical analysis.Results There were 218 cases of postpartum depression and 582 normal cases in 800 subjects.No significant difference was found in daily folic acid intake and different folic acid supplementary time between women with postpartum depression and normal women.But serum folic acid level of women with postpartum depression was significantly lower than that of normal women (x2 =15.76,P ＜ 0.001).There were significant differences in genotype frequency at polymorphic site of MTHFR C677T and A1298C between two groups.Among them,heterozygous CT (x2 =13.67,P ＜ 0.01),AC (x2 =3.39,P =0.02) and homozygous TT (x2 =8.65,P ＜0.01),CC (x2 =15.18,P ＜0.01) were high risk factors of postpartum depression.In addition,women with postpartum depression with different MTHFR C677T and A1298C genotype (CC,CT,TT and AA,AC,CC) were not significantly different in daily folic acid intake,different folic acid supplementary time and serum folic acid level during pregnancy (x2 value ranged 0.07-2.79,all P ＞ 0.05).Conclusion Low intake of folic acid and different supplementary time of folic acid are not risk factors for postpartum depression,but serum folic acid level,MTHFR C677T and A1298C genotype are independent risk factors for postpartum depression.