孕母全血中铅浓度与子代发生先天性心脏病风险的病例对照研究

Case-control study for association between maternal blood lead exposure and risk of congenital heart defect in the offspring

目的 探讨孕母全血中铅浓度与子代发生先天性心脏病（先心病）风险的关系。方法 以医院为基础的病例对照研究,纳入120例患儿与108对照胎儿。采用非条件Logistic回归分析校正了协变量,研究全部先心病与不同血铅浓度的剂量效应。结果 非条件Logistic多因素回归模型分析显示,校正了孕母年龄、孕前体质量指数、孕前是否吸烟、样本收集的孕周以及是否服用叶酸等混杂因素后,发现孕母全血中的铅浓度较高浓度组和最高浓度组相对于低浓度组子代：（1）发生总的先心病风险的aOR（95%CI）值分别为5.53（2.50-12.27）和6.51（4.08-22.15）;（2）发生间隔缺损风险的aOR（95%CI）值分别为5.60（2.18-14.36）和10.39（3.90-27.68）;（3）圆锥干缺损风险的a OR（95%CI）值分别为7.33（2.22-24.18）和9.09（2.71-30.48）;（4）左心室流出道畸形风险的a OR（95%CI）值分别为6.52（1.16-36.75）和0.58（0.05-7.00）;（5）右心室流出道畸形风险的a OR（95%CI）值分别为33.95（3.15-366.12）和72.10（6.15-845.19）,差异均有统计学意义（P〈0.05;P〈0.01）。结论 孕母全血中铅浓度与子代发生先心病的风险增加有关,提示我们需要关注由此带来的公共卫生问题。

Objectives To evaluate the association between maternal blood lead exposure and congenital heart defect （CHD） in the offspring. Methods This hospital-based case-control study included 120 case and 108 control fetus. Unconditional Logistic regression was used to assess the relationship between maternal whole blood lead （BPb） concentration and fetus＇ total CHDs and subtype of CHDs with extensive adjustment for potential confounders. Results After adjusting for maternal age, pre-pregnant body mass index （BMI）, maternal smoking, gestational week at blood sample collection and folate acid intake, there was a dose-response association between maternal BPb concentration （Napierian logarithm transformed） and CHDs. The mothers exposed to high concentration and median concentration of BPb had increased risk for all types of CHDs in the offspring, with an adjusted odds ratio （aOR） （95%CI） of 5.53 （2.50-12.27） and 6.51（4.08-22.15） in total CHDs, 5.60（2.18-14.36） and 10.39（3.90-27.68） in isolated septal defect, 7.33（2.22-24.18）and 9.09（2.71-30.48） in conotruneal defects, 6.52（1.16-36.75） and 0.58（0.05-7.00） in left ventricle outflow tract obstruction, 33.95 （3.15-366.12） and 72.10 （6.15-845.19） in right ventricle outflow tract obstruction, respectively （P〈0.05 ;P〈0.01）. Conclusions There is a statistically significant association between maternal blood lead concentration and risk of CHD in the offspring, which may be an emerging risk factor for CHDs.