红细胞叶酸与同型半胱氨酸和女性生殖障碍的关联性分析：基于不同生育状态的横断面研究

Analysis of the Association between Red Blood Cell Folate, Homocysteine, and Female Reproductive Disorders: A Cross-Sectional Study Based on Different Fertility Statuses

摘要: 目的：探讨红细胞叶酸与同型半胱氨酸在不同生育状态女性中的分布特征、关联特异性及其对生殖障碍的影响作用。方法：本研究采用横断面研究设计，纳入2024年1月至2025年6月期间就诊于宝鸡市妇幼保健院生殖医学中心，并同期完成血同型半胱氨酸及红细胞叶酸定量测定的368名女性作为研究对象。根据生育状态，将其分为生殖障碍组(239例)、健康备孕组(62例)和早孕组(67例)。首先采用单因素方差分析、Kruskal-Wallis H检验或χ²检验比较三组基线资料；进而使用Spearman秩相关分析探讨变量间的相关性；最后应用二元Logistic回归模型识别生殖障碍的独立影响因素。结果：组间比较显示，三组女性的年龄、红细胞叶酸及血同型半胱氨酸水平总体差异均有统计学意义(P < 0.05)。相关性分析显示，在全人群中红细胞叶酸与血同型半胱氨酸呈负相关(r_s = −0.158, P = 0.002)，但分层分析揭示该关联仅在于早孕组中显著(r_s = −0.316, P = 0.009)。多因素Logistic回归分析显示，在调整年龄后，血同型半胱氨酸升高(OR = 1.073, 95% CI: 1.014~1.136, P = 0.015)是生殖障碍的独立危险因素，而红细胞叶酸升高(OR = 0.995, 95% CI: 0.991~0.998, P = 0.005)是独立保护因素。结论：横断面数据显示，女性生殖障碍与同型半胱氨酸水平升高、红细胞叶酸水平存在统计学关联；红细胞叶酸与同型半胱氨酸的相关关系仅在早孕人群中显著，提示二者相关性存在生育状态异质性。因此，在临床实践中，红细胞叶酸–同型半胱氨酸代谢相关指标可作为育龄女性生殖健康筛查参考指标，临床需结合个体代谢特征综合干预以改善妊娠相关结局。

Abstract: Objective: To explore the distribution characteristics and association specificity of red blood cell folate and homocysteine among women in different reproductive states, as well as their impacts on reproductive disorders. Method: This study employed a cross-sectional research design. A total of 368 women who visited the Reproductive Medicine Center of Baoji Maternal and Child Health Hospital from January 2024 to June 2025 and completed quantitative determinations of blood homocysteine and red blood cell folate during the same period were recruited as the research subjects. Based on their reproductive status, these subjects were divided into three groups: the reproductive disorder group (n = 239), the healthy preconception group (n = 62), and the early pregnancy group (n = 67). Initially, one-way ANOVA, Kruskal-Wallis H test, or χ² test was utilized to compare the baseline data among the three groups. Subsequently, Spearman’s rank correlation analysis was conducted to explore the correlations among variables. Finally, a binary Logistic regression model was applied to identify the independent influencing factors of reproductive disorders. Result: Inter-group comparisons revealed statistically significant differences in age, red blood cell folate, and homocysteine levels among the three groups (P < 0.05). Correlation analysis indicated that within the entire population, red blood cell folate was negatively correlated with blood homocysteine (r_s = −0.158, P = 0.002). However, stratified analysis revealed that this association was only significant in the early pregnancy group (r_s = −0.316, P = 0.009). Multivariate Logistic regression analysis showed that, after adjusting for age, elevated blood homocysteine (OR = 1.073, 95% CI: 1.014~1.136, P = 0.015) was an independent risk factor for reproductive disorders, whereas elevated red blood cell folate (OR = 0.995, 95% CI: 0.991~0.998, P = 0.005) was an independent protective factor. Conclusion: Cross-sectional data show that female reproductive disorders are statistically associated with elevated homocysteine levels and reduced red blood cell folate levels; the correlation between red blood cell folate and homocysteine is significant only in the early pregnancy population, suggesting that the relationship between the two varies depending on reproductive status. Therefore, in clinical practice, red blood cell folate - and homocysteine-related metabolic markers can serve as reference indicators for screening the reproductive health of women of childbearing age. Clinicians should implement comprehensive interventions tailored to individual metabolic characteristics to improve pregnancy-related outcomes.