围孕期先天性心脏病危险因素的1∶2配比病例对照研究  

1 ∶ 2 matched case-control study on the risk factors related to congenital heart disease during the peri-conceptional period

作　　者：李侠[1] 谢胜男[1] 王寅[2] 王建敏[1] 凌子羽 纪昌文 张清凯 杨森焙[1] 张静[1] 

机构地区：[1]华中科技大学同济医学院公共卫生学院儿少卫生与妇幼保健学系,武汉430030 [2]华中科技大学协和医院心外科 [3]武汉市江汉区妇幼保健院

出　　处：《中华流行病学杂志》2014年第9期1024-1027,共4页Chinese Journal of Epidemiology

基　　金：湖北省人口和计划生育委员会资助（JS-20130020）

摘　　要：目的 探讨围孕期环境暴露因素与先天性心脏病（CHD）发生风险之间的关系.方法 采用1∶2配比的病例对照研究方法,于2012年1月至2014年1月对武汉市某区妇幼机构儿童进行“CHD免费筛查”,通过常规听诊、超声心动图初筛,并经市级以上医院确诊.以CHD患儿为病例组,按照年龄、性别、社区配对选择健康的儿童为对照组.用EpiData 3.1软件录入数据,用SPSS 11.5软件进行单因素和多因素的条件logistic回归分析.结果 采集138名患儿和276名对照儿童的父母信息.对27个主要研究因素进行单因素条件logistic回归分析.结果显示,孕早期补钙、孕早期精神刺激、母亲孕期营养、不良孕产史、经产妇、围孕期患病及居住地附近有污染企业与子代CHD发生有一定关联;多因素条件logistic回归分析显示,孕早期精神刺激（HR=3.35,95％CI：1.28 ～ 8.79）、母亲孕期营养不良（HR=1.50,95％CI：1.10 ～ 2.03）及不良孕产史（HR=1.62,95％CI：1.03 ～ 2.57）是子代发生CHD的危险因素,而孕早期适当补钙（HR=0.40,95％CI：0.25～0.65）则可降低CHD发生的风险.结论 CHD的发生可能与孕早期精神刺激、围孕期营养、孕早期补钙及既往不良生育史有一定关系,应加强围孕期保健,降低CHD的发病率.Objective To explore the possible risk factors during the periconceptional period relevant on the occurrence of congenital heart diseases （CHD） in the offspring.Methods A 1 ∶ 2matched case-control study was designed.From January 2012 to January 2014 in a district from Wuhan city,HuBei province,children were proved by MCH institutions through the ＂free screening for congenital heart disease＂ program.Cases with CHD were screened out by conventional auscultation,echocardiography figure and confirmed by physicians from the high-level hospitals.According to age,gender,community paired healthy children were chosen as controls.EpiData 3.1 software was used to input data,using SPSS 11.5 software to analyze the possible risk factors under simple and multiple factors logistic regression.Results Information from parents of 138 cases and 276 controls was collected.27 major factors from the conditional logistic regression analysis showed that factors as：mental stress during early pregnancy,calcium supplement in the early stage of pregnancy,pregnancy malnutrition,having histories of abnormal childbearing,women with multiparous experiences and residence nearby sources of pollution （enterprises） etc.were associated with the incidence of congenital heart disease in the offspring.Data from the multivariate logistic regression analysis showed that factors as：mental stress during early pregnancy （HR=3.35,95%CI：1.28-8.79）,pregnancy malnutrition during pregnancy （HR=1.50,95% CI：1.10-2.03） and with abnormal childbearing history （HR=l.62,95%CI：1.03-2.57） were risk factors.However,calcium supplement during early pregnancy （HR=0.40,95% CI：0.25-0.65） could reduce the risk of CHD.Conclusion The occurrence of CHD might be related to factors as：mental stress during early pregnancy,calcium supplement during early pregnancy,pregnancy malnutrition and having histories of abnormal childbearing.Peri-conceptional care should be strengthened to reduce the incidence of congenital heart disease.

关 键 词：先天性心脏病 围孕期 危险因素 病例对照研究 

分 类 号：R714.55[医药卫生—妇产科学]