早孕期父母亲吸烟与子代先天性心脏病相关性的meta分析  

Parental smoking and congenital heart disease: a meta-analysis

作　　者：袁腾 艾克拜·艾散 吐妮克·马合沙提 田认 李云霞[1] 陈铀[1] Yuan Teng;Aikebai Aisan;Tunike Maheshati;Tian Ren;Li Yunxia;Chen You(Department of Cardiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心,乌鲁木齐830054

出　　处：《中华围产医学杂志》2022年第11期844-851,共8页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金(81860064)。

摘　　要：目的系统评价早孕期母亲主动吸烟、被动吸烟及父亲吸烟与子代先天性心脏病(congenital heart disease,CHD)的相关性。方法计算机检索PubMed、Web of Science、Cochrane Library、中国知网、万方数据库、中国生物医学数据库关于早孕期父母亲吸烟与子代CHD相关性的病例对照研究,检索时限均从建库至2021年4月。纳入标准:研究类型为病例对照研究;研究对象为CHD患者,年龄、种族均不限;结局指标为经过心脏超声或者心脏外科手术明确诊断的CHD;偏倚风险评估(纽卡斯尔-渥太华量表评分)≥4分。采用RevMan5.4软件进行统计分析,通过Q检验和I^(2)检验共同进行异质性的判定。根据异质性结果选择随机或固定效应模型合并OR值。并根据CHD的亚型进行亚组分析。绘制漏斗图判断纳入研究是否存在发表偏倚。结果共纳入35篇文献,包括38125例研究对象。结果显示,母亲早孕期主动、被动吸烟者子代患CHD的风险分别是母亲未吸烟者的1.20倍(OR=1.20,95%CI:1.15~1.26,Z=8.15,P<0.001,I^(2)=35%)和1.95倍(OR=1.95,95%CI:1.70~2.24,Z=9.52,P<0.001,I^(2)=69%);父亲在母亲早孕期吸烟子代患CHD的风险是父母亲均未吸烟者的1.88倍(OR=1.88,95%CI:1.49~2.36,Z=5.39,P<0.001,I^(2)=69%)。亚组分析显示,母亲主动吸烟增加子代发生房间隔缺损的风险(OR=1.41,95%CI:1.03~1.92,P=0.030,I^(2)=71%),母亲被动吸烟增加子代发生房室间隔缺损的风险(OR=1.76,95%CI:1.37~2.26,P<0.001,I^(2)=11%)。结论早孕期父母亲吸烟均增加子代CHD的患病风险。Objective To assess the association between maternal smoking,passive exposure to smoking,or paternal smoking in the first trimester and the risk of congenital heart disease(CHD)in offspring.Methods A meta-analysis was performed on selected case-control studies on parents in the first trimester and CHD involving CHD patients regardless of age or ethnicity,after searching PubMed,Web of Science,Cochrane Library,CNKI,WanFang Data,and China Biology Medicine up to April 2021.The main outcome was CHD confirmed by cardiac ultrasound or cardiac surgery and the quality of included studies was assessed using the Newcastle-Ottawa Scale(≥4 scores).Statistical analysis was carried out using RevMan5.4 software and heterogeneity was determined by Q test combined with I^(2) test.In accordance with the heterogeneity test results,the appropriate model(random or fixed)was selected.Subgroup analysis was performed according to the subtype of CHD.Potential publication bias was assessed by funnel plots.Results A total of 35 studies involving 38125 subjects were included.The pooled results showed that the risk of CHD in offspring born to mothers who were active or passive smokers in the first trimester was 1.20(OR=1.20,95%CI:1.15-1.26,Z=8.15,P<0.001,I^(2)=35%)and 1.95 times(OR=1.95,95%CI:1.70-2.24,Z=9.52,P<0.001,I^(2)=69%)that of non-smoking mothers.The risk of CHD in offspring of fathers who smoked in the first trimester was 1.88 times higher than that of non-smoking parents(OR=1.88,95%CI:1.49-2.36,Z=5.39,P<0.001,I^(2)=69%).Subgroup analysis indicated an association between active maternal smoking in the first trimester and an increased risk of atrial septal defect(OR=1.41,95%CI:1.03-1.92,P=0.030,I^(2)=71%)as well as between maternal passive smoking and increased risk of atrioventricular septal defect(OR=1.76,95%CI:1.37-2.26,P<0.001,I^(2)=11%).Conclusion Maternal and paternal smoking in the first trimester may both increase the risk of CHD in offspring.

关 键 词：吸烟 烟草烟污染 心脏缺损 先天性 META分析 环境暴露 

分 类 号：R715.3[医药卫生—妇产科学]