环境、行为、生活方式因素导致唇腭裂发生的循证医学研究

Evidence-based medicine research of CLP induced by factors of environmental,behavioral and lifestyle

目的:研究我国与唇腭裂发生有关的环境、行为和生活方式,为设计适合我国国情的唇腭裂预防干预策略提供循证依据。方法:通过系统性综述方法,检索数据库文献,收集国内外唇腭裂的环境、行为、生活方式病因学研究文献,选择其中Meta分析或系统综述文献纳入研究。结果:共纳入Meta分析和系统综述文献13篇,均为英文文献;中文数据库中未检索到符合要求的文献。对检索到文献行系统回顾后发现了唇腭裂的一些明确致病因素。其中环境因素包括孕期及孕前期用药(皮质激素类、卡马西平、抗癫痫药物等)及孕母所处环境(杀虫剂)、行为和生活方式因素(孕妇超重或肥胖、吸烟、新生儿出生次序)。结论:孕母所处的环境因素、行为和生活方式因素与唇腭裂发病有显著关联。现有的病因学研究存在很多相互矛盾的结论,唇腭裂的病因学仍有待继续探索。唇腭裂病因研究的中文文献质量等级普遍较低,不能为循证医学提供高等级证据。

Objective：To study the factors of environmental,behavioral and lifestyle related to cleft lip and palate（CLP） in China,to provide evidence for designing prevention and intervention measures of CLP suitable for the population in China. Methods：The databases were searched by systematic review method,the etiological literatures of CLP related factors of environmental,behavioral and lifestyle at home and abroad were collected,Meta analysis and systematic review literatures were included in the study. Results：All 13 eligible Meta analysis and systematic review literatures were included,all of them were English papers;no eligible Chinese studies were found in the main databases.Some definite pathogenic factors of CLP were found after systematic review of the literatures.The environmental factors included drug usage before pregnancy and during the first trimester of pregnancy（corticoids,carbamazepine and antiepileptic drugs） and the living and working environment of the pregnant women（insecticides）,behavior and lifestyle factors（overweight or obesity,smoking and the birth order）. Conclusion：The environmental factors,behavioral factors and lifestyle factors of pregnant women are related to the onset of CLP significantly;the current etiological study has many contradictory conclusions,the etiology of CLP needs further research,the quality of literatures in Chinese is low in general,which can hardly provide solid evidences for evidence-based research.