围生儿先天性心脏病发病及其危险因素的病例对照研究

A case-control study on the risk factors of congenital heart disease among perinatal infants

目的 调查围生儿先天性心脏病（先心病）的发病情况,探讨先心病发生的危险因素。方法 收集杭州市第一人民医院2009—2013年围生儿资料,进行病例对照研究,对先心病组和对照组各176名围生儿的家长进行问卷调查,采用单因素和多因素条件Logistic回归分析,筛选与先心病发生相关的危险因素。结果 围产儿26 295人中发现先心病176例,发生率为62.73/万;其中单一畸形109例,心脏复合畸形67例。多因素Logistic回归分析显示,服用叶酸（OR=0.275,95%CI：0.079~0.982）是先心病的保护性因素,妊娠早期使用药物（OR=3.350,95%CI：1.024~13.992）、妊娠早期感染（OR=4.235,95%CI：1.275~18.735）、不良生育史（OR=3.679,95%CI：1.102~14.113）、高龄产妇（OR=2.974,95%CI：1.213~16.372）和吸烟（OR=4.229,95%CI：1.167~15.782）是先心病的危险因素。结论 适时补充叶酸,避免妊娠早期感染、药物使用和主/被动吸烟,加强孕期检查,对预防围产儿先心病具有重要意义。

Objective To investigate the incidence of congenital heart disease（ CHD） among perinatal infants in Hangzhou City and to explore risk factors of congenital heart disease in order to provide suggestions for CHD＇ s prevention. Methods A hospital- based case- control study was carried out. Cases and controls were interviewed. By means of univariate and multiple logistic regression analysis,risk factors were analyzed. Results The incidence of CHD from 2009 to 2013 was62. 73 per 10,000. Of 176 perinatal infants with CHD,109 were single deformity and 67 were composite deformities of heart. The logistic regression analysis showed that maternal contact with harmful drugs during early pregnancy（ OR =3. 350,95% CI = 1. 024- 13. 992）,maternal respiratory infection during early pregnancy（ OR = 4. 235,95% CI = 1. 275- 18. 735）,abnormal childbearing history（ OR = 3. 679,95% CI = 1. 102- 14. 113）,maternal smoking（ OR = 4. 229,95% CI = 1. 167- 15. 782） and elderly parturient women（ OR = 2. 974,95% CI = 1. 213- 16. 372） were the risk factors of CHD. And maternal folic acid supplementation（ OR = 0. 275,95% CI = 0. 079- 0. 982） was the protective factor.Conclusion It＇ s of great importance to avoid risk factors and supply folic acid properly during pregnancy to prevent CHD.