不良妊娠史和多环芳烃-DNA加合物对胎停育的交互作用  

Interaction between adverse pregnancy history and polycyclic aromatic hydrocarbon-DNA adducts on missed abortion

作　　者：张嘉宇 籍静茹[2] 刘莎 武嫣斐[2] 常可为 韩梅 魏俊妮 ZHANG Jiayu;JI Jingru;LIU Sha;WU Yanfei;CHANG Kewei;HAN Mei;WEI Junni(Department of Epidemiology,School of Public Health,Shanxi Medical University,Taiyuan,Shanxi 030001,China;First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学公共卫生学院流行病学教研室,山西太原030001 [2]山西医科大学第一医院,山西太原030001

出　　处：《环境与职业医学》2022年第6期659-664,共6页Journal of Environmental and Occupational Medicine

基　　金：山西省应用基础研究项目(201901D111206);山西省卫健委科研计划项目(2020086)。

摘　　要：[背景]胎停育发生率逐年上升,但病因尚未完全阐明,不良妊娠史及多环芳烃(PAHs)的暴露均有可能增加胎停育的发病风险。[目的]探讨不良妊娠史和PAHs暴露对孕早期胚胎停育的影响及交互作用,为胎停育病因研究提供依据。[方法]选取2019年3—12月在山西医科大学第一医院产科诊断为胚胎停育的114名孕妇作为病例组,选择同医院同期自愿要求人工流产的139名正常妊娠妇女作为对照组,收集研究对象的基本情况及流产、死胎和宫内生长发育迟缓等不良妊娠史,采集流产绒毛组织检测组织中PAH-DNA加合物水平,按孕次及不良妊娠史分层并以四分位数法进行分组,依次为Q1(<404.61 ng·L^(-1))、Q2(404.61~453.75 ng·L^(-1))、Q3(453.76~506.72 ng·L^(-1))、Q4(≥506.73 ng·L^(-1))。采用SPSS 25.0统计软件进行χ^(2)检验和多因素logistic回归,采用相加和相乘模型探讨不良妊娠史和PAH-DNA加合物对胎停育影响的交互作用。将PAH-DNA加合物按三分位数法和四分位数法分组,分别以P、P、P及P作数据切点进行敏感性分析。[结果]怀孕次数≥2次的160名研究对象中,病例组孕妇不良妊娠史占比(57.81%)高于对照组(17.71%)(P <0.001)。按孕次分层对两组间不同PAH-DNA加合物水平进行χ^(2)检验,结果显示孕≥2次者PAH-DNA加合物水平与胎停育有关(χ^(2)=10.14,P=0.017)。在孕次≥2次的研究对象中进一步按有无不良妊娠史分层分析,无不良妊娠史者PAH-DNA加合物与胎停育有关(χ^(2)=9.70,P=0.021)。调整变量后多因素logistic回归分析结果表明不良妊娠史(OR=5.88,95%CI:2.79~12.39)和PAH-DNA加合物(OR=3.01,95%CI:1.22~7.40)可能会增加胎停育发生的风险,但未发现两者的交互作用,交互作用超额相对危险度(RERI)、交互作用归因百分比(AP)、交互作用指数(SI)及其95%CI分别为0.60(–0.58~1.77)、0.74(–0.83~2.30)、0.20(0.01~5.43)。[结论]不良妊娠史和PAH-DNA加合物可能会增加[Background] The incidence rate of missed abortion is increasing year by year,but the etiology has not been fully elucidated.Adverse pregnancy history and exposure to polycyclic aromatic hydrocarbons(PAHs) may increase the risk of missed abortion.[Objective] To investigate the interaction between adverse pregnancy history and PAHs exposure on missed abortion in early pregnancy,and to provide evidence for the etiologic research of missed abortion.[Methods] A total of 114 pregnant women diagnosed with missed abortion in the Department of Obstetrics of the First Hospital of Shanxi Medical University from March to December 2019 were selected as the case group,and 139 pregnant women who visited the same hospital for voluntary induced abortion in the same period as the control group,to collect basic information and medical information of abortion,stillbirth,intrauterine growth retardation,and other adverse pregnancy history.Abortion villus tissues were collected to detect PAH-DNA adducts levels,stratified by pregnancy and adverse pregnancy history and grouped by quartile method:Q( < 404.61 ng·L^(-1)),Q(404.61-453.75 ng·L^(-1)),Q(453.76-506.72 ng·L^(-1)^),and Q(≥506.73 ng·L^(-1)).SPSS 25.0 statistical software was used for χ^(2) test and multiple logistic regression,and additive and multiplicative models were used to investigate the interaction between adverse pregnancy history and PAH-DNA adducts level on missed abortion.The PAH-DNA adducts were grouped by tertiles and quartiles,and P,P,Pand Pwere used as data cut points for sensitivity analysis.[Results] The proportion of adverse pregnancy history in the case group(32.46%) was higher than that in the control group(12.23%)(P < 0.001).Among 160 subjects with≥2 pregnancies,the proportion of adverse pregnancy history in the case group(57.81%) was higher than that in the control group(17.71%)(P < 0.001).The results of χ^(2) test stratified by pregnancy for different PAH-DNA adducts levels between the two groups showed that the PAH-DNA adducts level was associated

关 键 词：不良妊娠史 多环芳烃 多环芳烃-DNA加合物 胎停育 交互作用 

分 类 号：R173[医药卫生—妇幼卫生保健]