569例稽留流产的流行病学特征及影响因素分析

Epidemiological characteristics and influencing factors of 569 cases of missed abortion

目的探讨稽留流产的流行病学特征及影响因素。方法选取2000年1月至2016年1月收入温州市中医院诊治的569例稽留流产患者作为研究组,另选择同期收入院诊治的550例正常妊娠且自愿要求人工终止妊娠的孕妇作为对照组,通过病例-对照回顾性研究,回顾分析两组孕妇的临床资料,探讨影响稽留流产发生的相关影响因素。结果单因素分析显示,在18个临床因素中,有显著统计学差异(均P<0.05)的因素为:多次流产史(χ~2=65.88)、环境因素(接触装修工业材料等有毒物质,χ~2=118.63)、染色体异常(χ~2=138.10)、饮酒(χ~2=52.69)、吸烟(χ~2=125.89)、孕期服药(χ~2=77.38)、合并贫血(χ~2=92.34)、乙型肝炎病毒携带(χ~2=33.10)、心理应激因素(焦虑、抑郁情绪,χ~2值分别为83.81、17.31)、感染因素[合并沙眼衣原体感染(CT),合并解脲支原体(UU)感染,合并弓形虫、其他病原体、风疹病毒、巨细胞病毒、疱疹病毒(TORCH)感染,χ~2值分别为234.33、73.32、5.00]、妊娠期性交(χ~2=117.42,P<0.05)。经Logistic回归模型分析显示:多次流产史(OR=1.43)、接触装修材料等有毒物质(OR=1.73)、染色体异常(OR=5.66)、吸烟(OR=1.88)、饮酒(OR=2.15)、合并CT感染(OR=1.93)、合并UU感染(OR=2.01)、合并TORCH感染(OR=1.34)是影响稽留流产发生的独立危险因素。结论孕妇的多次流产史、染色体异常、接触装修材料等工业毒物、吸烟和饮酒等不良习惯,以及妊娠期病原体感染是影响稽留流产发生的独立危险因素,对其干预方法仍应以预防为主,需采取综合性对策性防治。

Objective To explore epidemiological characteristics and influencing factors of missed abortion.Methods Altogether 569 cases of missed abortion admitted and treated in Wenzhou Traditional Chinese Medicine Hospital from January 2000 to January2016 were chosen as study group,and 550 cases of normal pregnancy voluntarily requesting artificial termination of pregnancy treated in the hospital at the same period were chosen as control group.Clinical data of two groups were analyzed through retrospective case-control study and related influencing factors of missed abortion were explored.Results Univariate analysis showed that factors with statistical significant difference（all P0.05）in 18 clinical factors were multiple abortion history（χ~2=65.88）,environmental factor（contact with decoration industrial materials and other toxic substances,χ~2=118.63）,chromosome abnormality（χ~2=138.10）,drinking（χ~2=52.69）,smoking（χ~2=125.89）,medication during pregnancy（χ~2=77.38）,anemia（χ~2=92.34）,hepatitis B virus carrier（χ~2=33.10）,psychological stress factors（anxiety,depression,χ~2 value was 83.81 and17.31,respectively）,infection factors [chlamydia trachomatis（CT）,ureaplasma urealyticum（UU）,toxoplasma,other pathogen,rubella virus,cytomegalovirus,herpes virus（TORCH）infection,χ~2 value was 234.33,73.32 and 5.00,respectively）]and sexual intercourse during pregnancy（χ~2=117.42,P0.05）.Logistic regression model analysis showed that multiple abortion history（OR =1.43）,contact with decoration materials and other toxic substances（OR =1.73）,chromosomal abnormalities（OR=5.66）,smoking（OR=1.88）,drinking（OR=2.15）,CT infection（OR=1.93）,UU infection（OR=2.01）,TORCH infection（OR=1.34）were independent risk factors of missed abortion.Conclusion Multiple abortion history of pregnant women,chromosomal abnormalities,contact with decoration materials and other industrial toxins,bad habits such as smoking and drinking,and infection of pathogen during pregnancy are independent risk factors of missed abortion.Priority in intervention should be given to prevention,and comprehensive countermeasures should be taken.