父母环境因素暴露与胎儿先天性心脏病病因关系探讨

Parental environmental exposure and occurrence of congenital heart disease in their children

目的探讨先天性心脏病与患儿父母孕前半年及孕期环境因素暴露的关系。方法对先天性心脏病患儿的母亲行面对面结构式访谈,填写调查问卷,并在门诊中按1∶2配对选取对照。共回收有效问卷168份,其中病例组56例,对照组112例。利用条件Logistic回归方法,分析父母双方孕前半年及孕期环境危险因素对胎儿先天性心脏病、房间隔缺损、室间隔缺损的影响。结果母孕前半年工作生活环境嘈杂、既往自然流产史、孕早期服用激素、孕早期感冒、孕期检查到母亲或胎儿有异常与生育出先天性心脏病患儿关系显著(P<0.05),OR值(95%CI)分别为2.15(0.98～4.71)、13.16(1.31～132.72)、69.11(1.61～2970.17)、2.65(1.03～6.78)、4.07(1.42～11.68)。母孕前半年工作生活环境嘈杂与生育出房间隔缺损患儿关系显著(P<0.05),OR值(95%CI)为5.13(1.64～16.08)。父孕前半年重金属暴露、母孕期检查到母亲或胎儿有异常与生育出室间隔缺损患儿关系显著(P<0.05),OR值(95%CI)分别为4.14(1.081～15.867)、12.48(1.346～115.71)。结论改善父母双方健康状况,控制或减少父母双方工作生活环境中危险因素暴露,加强孕期检查,对于降低胎儿先天性心脏病发生风险尤为重要。

Objective To explore the relationship between the development of congenital heart disease （CHD） in children and their parents＇ environmental exposure during pre-gestational and gestational periods in high prevalent district. Methods Face-to-face structured interviews were carried out to mothers with CHD children （subjects） and 1 ： 2 casecontrol study was designed. One hundred and sixty-eight useable questionnaires had been collected including 56 subjects and 112 controls. Conditional logistic stepwise regression was performed to analyze the environmental risk factors during past six months before pregnancy and during gestational periods of parents with CHD children. Results Living in noisy environments during past six months before pregnancy, previous spontaneous abortion, taking hormone and catching a cold during the first trimester and other types of fetal abnormality detected during pregnancy related to the occurrence of CHD （P〈 0.05, OR = 2.15, 13.16, 69.11, 2.65, 4.07, respectively）. Maternal exposure to noisy environments during past six months before pregnancy highly related to the occurrence of atrial septal defect （P 〈 0.05, OR = 5.13）. Paternal exposure to heavy metal during past six months before pregnancy and fetal abnormality detected during pregnancy related to the occurrence of ventricular septal defect （P 〈 0.05, OR = 4.14, 12.48, respectively）. Conclusions Improving parentsj health, status or reducing the exposure of environmental risk factors and strengthening pregnant care were thought to be good for reducing development of congenital heart disease.