胎儿宫内发育与成年期脑血管病患病风险的相关性

The association between the risk of adult cerebral vascular disease and the intrauterine growth： a retrospective birth cohort study in a Chinese population

目的在一个中国人群中分析胎儿宫内发育与成年期脑血管病患病风险的相关性。方法采用历史回顾性研究方法，以中国医学科学院北京协和医院1921—1941、1948-1954年出生的2085名出生队列人群为研究对象。从产科病历获得他们与宫内发育有关的围产资料，通过对该人群临床体检和问卷调查，综合病史、体检、血生化检查、头颅CT扫描等方法诊断脑血管病病例以及成年期脑血管病危险因子；分别应用单因素和多因素统计分析方法，分析测量宫内发育与调查时点现患脑血管病之间的关联强度，探讨胎儿宫内发育状况与成年期脑血管病患病风险的相关性。结果共检出128例（6．1％）脑血管疾病患者，其中脑梗死68例，脑出血9例，无症状性脑梗死53例。单因素分析显示脑血管病组出生体重、出生头围均低于未患病组；多因素Logistic回归分析在调整性别、孕周、出生时父亲职业等其他围产资料以及年龄、高血压病、糖尿病、高低密度脂蛋白胆固醇血症、超重、吸烟、文化程度等成年期危险因子后，出生体重按连续计量资料进入多因素分析模型，出生体重每增加1kg，成年期脑血管病患病风险下降67％（OR=0．33，95％ CI 0．17-0．62）；出生体重按等级计数资料进入多因素分析模型，2500～3000g组脑血管病患病风险较3001—3500g对照组增加86％（OR=1．86，95％ CI 1．14～3．00，该组患病率8．7％）；而3500g以上组患病危险则较对照组下降68％（OR=0．32，95％C10．13～0．77，该组患病率2．4％），出生头围和其他围产资料与成年期脑血管病之间未见到显著相关性；多因素分析提示高年龄、高血压病、超重等成年期危险因子也是本组脑血管病的危险因素。结论与国外类似流行病学研究结果一致，在首次对一个中国出生队列人群研究中同样发现，以低出生体重为标志的宫内发育迟缓与成年期脑血管病患病风险存在相关性；低出生体重（2500～3000g）是成年期脑血管病的危险因素，高出生体重（〉3500g）是成年期脑血管病的保护因素。高年龄、高血压病、超重等成年期因子也是本组脑血管病的危险因素。

Objective To investigate the possible relationship between the risk of cerebral vascular disease （CVD） in adulthood and the intrauterine growth in a Chinese cohort. Methods Two thousand five hundred and three infants born in the Peking Union Medical College Hospital in Beijing during 1921 to 1941 and 1948 to 1954 were followed-up and their medical records at birth were reviewed. Among them, 2085 grown-ups agreed to participate in this study at the Department of Neurology of Peking Union Medical College Hospital from September 2003 to March 2005. Patient questionnaire, ease history, clinical assessment and computer tomography brain scan were examined in each of patients to make a diagnosis of CVD. Statistic analysis of x^2 test, t-test and Logistic regression analysis were conducted to investigate a relationship between the risk of adult CVD and intrauterine growth. Results One hundred and twenty-eight （6. 1% ） participants were diagnosed with CVD, including 68 of infarction, 9 of hemorrhage and 53 of asymptomatic infarction. Risk for CVD was significantly related to low birth weight. The association remained significant after adjusting for other growth indexes at birth and adulthood confounding factors using multiple factors Logistic regression analysis. Compared to the control group （birth weight 3001-3500 g）, the rate of CVD increased by 86% to 8. 7% in lower birth weight （2500-3000 g） and showed to be a risk factor for CVD （ OR = 1.86, 95% CI 1.14-3.00）, while higher birth weight （ 〉 3500 g） with 2.4% rate of CVD was a risk factor （OR = 0. 32, 95% CI 0.13-0.77）. Multiple factors Logistic regression analysis suggested that age, hypertension and overweight were also significantly related to adult CVD （ P 〈 0. 05 ）. Conclusions The study for the first time indicates strong evidence of an association between birth weight and adult cerebral vascular disease in a Chinese population. Lower birth weight （2500-3000 g） relates to a high risk of CVD, and higher birth weight （ 〉3500 g） relates to a protective role in CVD. Age, hypertension and obesity are also risk factors of CVD.