基于病例对照和剂量反应关系的0~6岁儿童先天性心脏病影响因素  

Study on influencing factors of congenital heart disease in children aged 0-6 years based on case-control and dose-esponse relationship

作　　者：闫欢 曹永文 叶佳欣 沈燕飞[3] 戈小洁 杨娜 刘倩倩 吴杨昊天 韩雪梅[1] YAN Huan;CAO Yong-wen;YE Jia-xin;SHEN Yan-fei;GE Xiao-jie;YANG Na;LIU Qian-qian;WU-YANG Hao-tian;HAN Xue-mei(Institute of Social Medicine and Health Management,School of Public Health,Lanzhou University,Lanzhou 730000,China;Department of Planning Finance,Gansu Provincial Maternal and Child Health Care Hospital,Lanzhou 730000,China;Legal Affairs Office of Gansu Provincial People's Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学公共卫生学院社会医学与卫生事业管理研究所,兰州730000 [2]甘肃省妇幼保健院计划财务部,兰州730000 [3]甘肃省人民医院法律事务办公室,兰州730000

出　　处：《中华疾病控制杂志》2021年第5期559-565,共7页Chinese Journal of Disease Control & Prevention

基　　金：甘肃省自然科学基金(18JR3RA054);甘肃省卫生行业科研计划项目(GSWSKY2017-43)。

摘　　要：目的分析甘肃省0~6岁儿童先天性心脏病(congenital heart disease,CHD)的非遗传影响因素,为预防儿童CHD提出建议。方法采用分层等距抽样方法,在甘肃全省抽取并筛查5个区县0~6岁儿童29566例。将从中筛查出的106名CHD患儿作为病例组并随机抽取同年龄、同性别、相同生活环境下的健康儿童318名,作为对照组进行1∶3病例对照匹配;应用Cox比例风险模型拟合Logistic回归分析模型分析儿童CHD的影响因素;应用限制性立方样条模型分析儿童出生体重与CHD患病的剂量反应关系。结果多因素分析结果表明:儿童出生体重、母亲文化程度、食用腌晒食品、药物流产史、孕前服用排卵药物、孕期食用鱼肉、经常体育锻炼与儿童CHD的患病风险均存在相关性(均有P<0.05)。限制性立方样条反应分析结果显示:儿童出生体重与CHD患病的关联强度呈线性剂量—反应关系(总趋势P<0.001,非线性P=0.246)。结论建议育龄妇女做好孕前检查,合理使用促排卵药物;孕期妇女要做好孕期保健和筛查,多食用鱼虾等海产品,不食用腌晒食品,适当进行体育锻炼,加强妇幼保健知识的学习降低儿童CHD的患病风险。Objective By analyzing the non-genetic factors of congenital heart disease(CHD)in children aged 0 to 6 years in Gansu Province,suggestions were put forward to prevent CHD in children.Methods We chose 29566 children aged 0 to 6 from 5 districts and counties in Gansu Province from September to December 2016 by stratified isometric sampling method.We selected 106 children with CHD as the case group,and randomly selected 318 children of the same age,gender and living environment from healthy children as the control group for 1∶3 case-control matching.Then,we used logistic regression analysis method fitted by Cox proportional hazard model to analyze the influencing factors of CHD in children.At the same time,the dose-response relationship between birth weight and CHD disease in children was analyzed using a restrictive cubic spline model.Results Low birth weight(P=0.028),low educational level of the mother(P=0.035),consumption of salted food(P=0.007),medical abortion history(P=0.001),ovulation medication before pregnancy(P<0.001),consumption of fish during pregnancy(P=0.020)and appropriate physical exercise(P<0.001)were related to the risk of CHD in children.The results of restrictive cubic spline response analysis showed a linear dose-response relationship between birth weight and congenital heart disease(overall trend P<0.001,non-linear P=0.246).Conclusions It is suggested that women of childbearing age should take pre-pregnancy examination and rationally use ovulatory drugs.Pregnant women should pay attention to health care and screening during pregnancy,eat more fish,shrimp and other seafood,not eat salted and dried food,take physical exercise appropriately and strengthen the study of maternal and child health care knowledge to reduce the risk of congenital heart disease in children.

关 键 词：儿童 先天性心脏病 影响因素 病例对照研究 剂量反应关系 

分 类 号：R174.6[医药卫生—妇幼卫生保健]