新生儿脐血硒和铁及铜水平与先天性心脏病关联的巢式病例对照研究  

A nested case-control study on the association of neonatal cord blood selenium,iron and copper with congenital heart disease

作　　者：刘倩 毛宝宏[1] 李建华 王文第[1] 杜世华[1] 刘青[1] 易彬[1] Liu Qian;Mao Baohong;Li Jianhua;Wang Wendi;Du Shihua;Liu Qing;Yi Bin(Gansu Provincial Maternity and Child-Care Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院,兰州730050

出　　处：《中华预防医学杂志》2023年第2期200-207,共8页Chinese Journal of Preventive Medicine

基　　金：甘肃省重点研发计划项目(20YF8WA095);甘肃省自然科学基金(21JR1RA043)。

摘　　要：目的探讨新生儿脐血硒和铁及铜水平与先天性心脏病(CHD)发生风险的关系,并分析其交互效应。方法研究对象来源于2010—2012年建立的兰州地区出生队列,在孕早期对孕妇相关信息进行基线调查,并在孕中期、孕晚期及产后42 d分别进行随访。采集分娩时新生儿脐静脉血,并从医疗记录中提取其出生结局信息。采用巢式病例对照研究方法,选择队列中新发的经超声心动检查确诊的97例CHD患儿作为病例组,在出生后健康的适龄足月儿中按照母亲年龄、街区以及CHD发病时间进行1∶2配对选取194例新生儿作为对照组。采用电感耦合离子质谱的方法检测新生儿脐血硒、铁和铜的质量浓度(后称浓度)。根据对照组新生儿脐血中硒、铁和铜浓度的四分位数中的Q1和Q3将元素暴露分为低、中、高浓度3组,以中浓度为参考标准,采用条件logistic回归模型分析脐血硒、铁和铜浓度与CHD的关联,以相乘模型分析其交互作用与CHD的关联。结果病例组中新生儿脐血铜浓度M(Q1,Q3)为746.12(467.48,759.74)μg/L,对照组为535.69(425.21,587.79)μg/L,组间比较差异有统计学意义(P<0.05)。调整混杂因素后logistic回归模型显示,脐血高铜(OR=4.062,95%CI:2.013~8.199)或高铜合并高铁(OR=3.226,95%CI:1.343~7.750)的新生儿CHD发病风险均增加,硒和铁浓度与新生儿CHD发病尚未见关联。脐血中铜和铁对CHD的发病风险存在相乘的交互作用(OR=1.303,95%CI:1.056~1.608)。结论铜和铁元素存在相乘的交互作用,脐血高铜、高铜合并高铁是新生儿CHD发病的危险因素。Objective To investigate the relationship between the levels of selenium,iron and copper in cord blood of neonates and the risk of congenital heart disease(CHD),and analyze their interaction effects.Methods The subjects were obtained from the birth cohort in Lanzhou area established from 2010 to 2012.A baseline survey was conducted in the first trimester,and the follow-up was conducted in the second trimester,third trimester and 42 days after delivery.The umbilical vein blood was collected from newborns at delivery,and information on their birth outcomes was extracted from medical records.A nested case-control study was used to select 97 neonates with CHD newly diagnosed by echocardiography as the case group,and 194 neonates were selected as the control group by 1∶2 matching according to their mother′s age,block and CHD onset time.Inductively coupled ion mass spectrometry was used to detect the concentrations of selenium,iron and copper in neonatal cord blood.The element exposure was categorized into three groups,the low,medium and high concentrations,according to the quartiles Q1 and Q3 of selenium,iron and copper concentrations in the control group.The association between cord blood selenium,iron and copper concentrations and CHD was analyzed by conditional logistic regression model using medium concentration as the reference standard.The association of their interactions with CHD was analyzed by a phase multiplication model.Results The M(Q1,Q3)concentration of neonatal cord blood copper was 746.12(467.48,759.74)μg/L in the case group and 535.69(425.21,587.79)μg/L in the control group,with a statistically significant difference between the two groups(P<0.05).After adjustment for confounders,logistic regression models showed that the risk of CHD development was increased in neonates with either high copper in cord blood(OR=4.062,95%CI:2.013-8.199)or high copper combined with high iron(OR=3.226,95%CI:1.343-7.750).No correlation was observed between selenium and iron concentrations and the development of CHD

关 键 词：先天性心脏病 脐血 硒 铁 铜 交互作用 巢式病例对照研究 

分 类 号：R722.1[医药卫生—儿科]