Department of Obstetrics and Gynaecology, Changhai Hospital, Naval Military Medical University, Shanghai, China.
Department of Laboratory Diagnostics, Changhai Hospital, Naval Military Medical University, Shanghai, China.
Gynecol Endocrinol. 2022 Sep;38(9):705-712. doi: 10.1080/09513590.2022.2110233. Epub 2022 Aug 15.
We aimed to investigate the correlation between blood homocysteine (Hcy) levels and pre-eclampsia (PE) risk in pregnant women.
Related articles were searched using PubMed, Embase, and Web of Science databases. Methodological quality of included studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Cochran's Q and I tests were used to evaluate heterogeneity. Egger's test was used to evaluate publication bias. A sensitivity analysis was performed to test stability of the results using a one-by-one elimination method. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence.
Nine studies (4384 PE and 26021 non-PE patients) were included in the meta-analysis. The methodology of them was of good quality, with NOS scores of 5-8. However, there was a significant heterogeneity among included studies. Therefore, the random effect model was generated and combined results suggested a significant association between increased level of Hcy in pregnant women and PE risk. Although a significant publication bias was found in the current study with a P value of 0.006 in the Egger test, sensitivity analysis showed that the combined results were stable and did not vary significantly from any single study. However, the GRADE evidence quality was very low, which may lower the recommendation of pooled results.
Increased levels of Hcy in maternal blood were significantly associated with the risk of PE, but low certainty of evidence need to be improved by more high-quality studies.
本研究旨在探讨孕妇血液同型半胱氨酸（Hcy）水平与子痫前期（PE）风险之间的相关性。
使用 PubMed、Embase 和 Web of Science 数据库检索相关文献。采用 Newcastle-Ottawa 质量评估量表（NOS）评估纳入研究的方法学质量。采用 Cochran's Q 和 I 检验评估异质性。采用 Egger 检验评估发表偏倚。采用逐一剔除法进行敏感性分析，以检验结果的稳定性。采用推荐、评估、发展与评价分级（GRADE）评估证据确定性。
纳入 9 项研究（PE 患者 4384 例，非 PE 患者 26021 例）进行荟萃分析。这些研究的方法学质量较好，NOS 评分为 5-8 分。然而，纳入研究之间存在显著异质性。因此，采用随机效应模型进行合并，并得出结论：孕妇血液 Hcy 水平升高与 PE 风险之间存在显著相关性。尽管本研究中存在显著的发表偏倚（Egger 检验 P 值为 0.006），但敏感性分析表明，合并结果稳定，与任何单个研究均无显著差异。然而，GRADE 证据质量非常低，可能降低汇总结果的推荐力度。
母体血液 Hcy 水平升高与 PE 风险显著相关，但需要更多高质量研究来提高证据确定性。
