孕产妇血清与新生儿脐带血中维生素A、E、D、K水平差异性研究

Study on the difference of vitamin A,E,D and K levels in maternal serum and neonatal umbilical cord blood

摘要

目的 本研究旨在分析孕产妇血清与新生儿脐带血中脂溶性维生素(A、E、D、K)水平的差异及其相关影响因素。方法 选取2023年6月至2024年11月于大理州人民医院分娩的5 240例健康孕产妇,4 677例单胎新生儿及304例双胎新生儿作为研究对象,采集孕产妇产检或临产前静脉血及新生儿脐带血,采用高效液相色谱串联质谱法(HPLC-MS/MS)检测维生素A(VA)、维生素E(VE)、25-羟维生素D(VD、VD₂、VD₃)及维生素K₁(VK₁)、维生素K₂-MK-4(MK-4)及维生素K₂-MK-7(MK-7)水平,并分析母婴间维生素水平的相关性及影响因素。结果 脐带血中VA、VD、VD₂、VD₃、VE、VK₁、MK-4、MK-7水平显著低于孕产妇血清,差异具有统计学意义(t值分别为88.7、78.0、32.0、70.0、196.8、4.8、23.9、51.7,均P<0.05)。除VD₂、K₁、MK-4外(t值分别为-0.6、0.1、-0.9,均P>0.05),其余维生素水平在单胎和双胎间均有显著差异(t值分别为4.7、-5.0、-5.0、-11.3、-6.9,均P<0.05)。脐带血中VA、VD、(总VD、VD₂、VD₃)、VE、VK₁、MK-4、MK-7水平与其对应的孕产妇血清水平均无显著相关性(均P>0.05)。多因素Logistic回归分析显示,调整各维生素间相互影响后,孕产妇血清VA(OR=105.2,95%CI:32.34~339.13,P<0.001)、VD₂(OR=0.60,95%CI:0.55~0.66,P<0.001)、VE(OR=0.47,95%CI:0.44~0.49,P<0.001)、MK-4(OR=0.56,95%CI:0.37~0.85,P=0.001)和MK-7(OR=0.93,95%CI:0.87~0.99,P<0.05)与新生儿脐带血维生素D缺乏风险独立相关,但因VA的OR值受单位效应影响被极大放大(换算为每0.1 mg/L后OR约为1.59),且该关联与相关性分析结果不一致,不宜解释为因果或独立预测因素,需进一步验证。结论 新生儿脐带血脂溶性维生素水平显著低于孕产妇,或与胎盘选择性转运及孕产妇营养状态相关,母婴维生素水平无显著线性相关,提示无法通过孕产妇血清维生素水平直接预测新生儿脐带血维生素水平。本研究为高原母婴营养管理提供了依据。

Abstract

Objective This study aims to analyze the differences in the levels of fat-soluble vitamins (A,E,D,K) in the serum of pregnant women and the umbilical cord blood of newborns,as well as the related influencing factors. Methods A total of 5 240 healthy pregnant women who delivered at Dali prefecture people's hospital between June 2023 and November 2024 were enrolled as study subjects,including 4 677 singleton newborns and 304 twin newborns.Venous blood samples from the mothers during prenatal examinations or before labor,as well as umbilical cord blood samples from the newborns,were collected.Levels of vitamin A (VA),vitamin E (VE),25-hydroxyvitamin D (VD,VD₂,VD₃),vitamin K₁ (VK₁),vitamin K₂-MK-4 (MK-4),and vitamin K₂-MK-7 (MK-7) were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS).The correlation between maternal and neonatal vitamin levels and their influencing factors were analyzed. Results The levels of VA,VD,VD₂,VD₃,VE,VK₁,MK-4,and MK-7 in umbilical cord blood were significantly lower than those in the pregnant women's serum,and the differences were statistically significant (t=88.7,78.0,32.0,70.0,196.8,4.8,23.9,and 51.7,respectively,all P<0.05).Except for VD₂,K₁,and MK-4 (t=-0.6,0.1,and -0.9,respectively,all P>0.05),the levels of other vitamins showed significant differences between single-birth and twin-born infants (t=4.7,-5.0,-5.0,-11.3,and -6.9,respectively,all P<0.05).The levels of VA,VD,(total VD,VD₂,VD₃),VE,VK₁,MK-4,and MK-7 in umbilical cord blood were not significantly correlated with the corresponding levels in the pregnant women's serum (all P>0.05).Multivariate Logistic regression analysis showed that after adjusting for the mutual influence of vitamins,the levels of VA (OR=105.2,95%CI:32.34-339.13,P<0.001),VD₂ (OR=0.60,95%CI:0.55-0.66,P<0.001),VE (OR=0.47,95%CI:0.44-0.49,P<0.001),MK-4 (OR=0.56,95%CI:0.37-0.85,P=0.001),and MK-7 (OR=0.93,95%CI:0.87-0.99,P<0.05) in the pregnant women's serum were independently associated with the risk of vitamin D deficiency in the newborn's umbilical cord blood,but the OR value of VA was greatly amplified due to the unit effect (after conversion to 0.1 mg/L,the OR was approximately 1.59),and this association was inconsistent with the correlation analysis results,and should not be interpreted as a causal or independent predictive factor.Further verification is required. Conclusion The levels of fat-soluble vitamins in the umbilical cord blood of newborns were significantly lower than those in the pregnant women,or were related to placental selective transport and the nutritional status of pregnant women.There was no significant linear correlation between the vitamin levels of mothers and infants.This suggests that the vitamin levels in the umbilical cord blood of newborns cannot be directly predicted by the vitamin levels in the pregnant women's serum.This study provides a basis for maternal and infant nutrition management in the plateau region.

关键词

孕产妇 / 血清 / 新生儿 / 脐带血 / 脂溶性维生素 / 胎盘转运

Key words

pregnant women / serum / neonate / umbilical cord blood / fat-soluble vitamin / placental transport

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基金资助

中华国际科学交流基金会检验检测科技专项基金(Z2022LYN001)