父母围孕期环境暴露与0～10岁儿童小耳畸形发病相关性的病例对照研究

Case-control study on associations between parental environmental exposure during peri-conceptional period and microtia in children 0-10 years of age

[目的]探究孕前6个月至孕早期3个月内(围孕期)父母的生活环境及职业有害因素暴露与单纯型先天性小耳畸形发病的相关性。[方法]采用病例对照研究设计,对2015年6月—2016年6月期间于上海交通大学医学院附属第九人民医院就诊的0~10岁单纯型先天性小耳畸形患者(病例组)及同年龄段因外伤、发热或急诊就诊患儿(对照组)的父母进行面对面访谈和问卷调查,收集其社会人口学以及围孕期生活环境、生活习惯、职业接触等资料,将获得的数据进行单因素卡方检验和非条件多因素logistic回归分析。[结果]最终获得124例病例和126例对照的问卷资料。单因素分析发现:围孕期居住地附近(≤3 km2)有排放污水、固体废物和空气污染物的工业生产企业,围孕期居住地室内装修或添置新家具,母亲围孕期职业环境中的重金属暴露、染发烫发、被动吸烟以及父亲围孕期重金属和有机溶剂的职业有害因素暴露皆可能是先天性小耳畸形的危险因素(均P<0.05)。非条件多因素logistic回归分析的结果显示:母亲文化程度低(OR=0.737,95%CI:0.545~0.996),围孕期室内装修(OR=4.546,95%CI:1.668~12.390),围孕期母亲被动吸烟频率高(OR=1.420,95%CI:1.059~1.903)以及父亲职业环境中重金属暴露(OR=2.880,95%CI:1.036~8.007)均可能是小耳畸形发病的相关危险因素。[结论]围孕期多种环境和职业有害因素暴露对小耳畸形发病的影响值得关注和进一步研究。

[ Objective ] To assess the associations of parental exposure to potential environmental or occupational risk factors from 6 months prior to conception to the first trimester of pregnancy （pert-conceptional period） with the occurrence of isolated microtia. [ Methods ] A case-control study was performed in Shanghai Ninth People＇s Hospital from June 2015 to June 2016. Personal interviews and questionnaire surveys were conducted among the parents of children aged 0-10 years with diagnosed congenital microtia （ease group） and traumatic injuries/other emergent conditions （control group）. Their demographic information, residential environment, living habits, andjoccupational exposure during pert-conceptional period were collected for chi-square test and non- conditional multiple logistic regression analysis. [ Results ] A total of 124 cases and 126 controls were included for analysis. The results of chi-square test showed that parental exposure to industrial pollution （such as sewage, solid waste, and air pollutants） near residence （ ≤ 3 km2）, indoor decoration, and new furniture in residence during pert-conceptional period, maternal exposure to heavy metals at workplace, hair dyeing or perming, and passive smoking during peri-conceptional period, as well as paternal occupational exposure to heavy metals and organic solvent might be the risk factors of congenital microtia （P〈0.05）. The results of non-conditional multiple logistic regression analysis showed that maternal factors including lower educat!onal level （OR=0.737, 95%CI： 0.545-0.996）, indoor decoration during peri-conceptional period （OR=4.546, 95%CI： 1.668-12.390）, and more passive smoking exposure during peri-eoneeptional period （OR=1.420, 95%CI： 1.059-1.903）, as well as paternal exposure to heavy metals at workplace （OR=2.880, 95%CI： 1.036-8.007） might be the risk factors for microtia. [ Conclusion ] The impacts of exposure to various environmental and occupational risk factors during peri-conceptional period on the occurrence of microtia deserve more attention and further study.