再生障碍性贫血的多危险因素病例对照研究

A case-control study of multiple risk factors related to aplastic anemia

目的：了解和掌握本地区再生障碍性贫血（AA）发生的相关因素,尤其是多因素联合作用对其发生的影响,旨在为开展AA的Ⅰ级预防工作提供科学依据。方法：以我院近10年住院患者为研究对象,采用病例-对照研究方法。病例组（AA患者）220例,对照组986例,问卷调查内容包括个人一般情况、既往病史、家族史、发病前3个月内感染史等。对调查结果进行Logistic单因素和多因素回归分析;并对有意义的危险因素计算总分并采用ROC分析进行分类,观察各因素联合作用对AA发生的影响。结果：单因素和多因素分析均发现,住宅周围3km内有化工厂,居住新装修的住房,早产儿或低体重儿等是AA发病的独立危险因素（P〈0.05）;而主要饮用自来水是AA发病的保护因素（OR=0.127,P〈0.05）。单因素分析发现除上述因素外,危险因素还包括自付医疗费用、吸烟、饮酒等,保护性因素包括新房装修后长时间通风,未发现AA发病与化肥接触、吸烟时间、饮酒时间存在明显相关性。多因素联合作用分析结果显示,每增加1个危险因素,AA的发生风险增加4.791（3.927-5.846）倍,ROC分析结果显示危险因素个数≥2个发生AA的风险是〈2个的74.837（42.453-131.925）倍。结论：对高危人群进行危险因素的控制有助于有效预防和控制AA的发生发展。

Objective：To ascertain the risk factors for aplastic anemia（AA）in this region at the moment,especially multiple factors comprehensive effect.Method：A case-control study was conducted and based on our patients＇ information in ten years.A total of 220AA cases without medical histories of cancer,radiotherapy and chemotherapy were collected as observation group,and 986gender and age-matched cases without hematology disease but were hospitalized at the same time for other reasons were collected as control group.Single and multiple Logistic regression analyses were used to analyze the collected information.Result：Single and multiple Logistic regression analyses found that living with chemical plants around in 3km,living in newly decorated houses,low birth weight or premature infants and so on were the independent risk factors of AA（OR〉1,P〈0.05）,mainly drinking tap water（OR=0.127）was the protective factor of AA（OR〈1,P〈0.05）.In addition to the above factors,single factor analysis found that there were other risk factors such as the private patients,smoker,alcoholic etc,while ventilating for a long time after decoration was a protective factor.At present,there was no certain correlation found among the incidence of AA with fertilizer contact,smoking time and drinking time.Conclusion：Control of risk factors for high risk population helps to prevent and control the occurrence and development of AA.