基于倾向得分匹配法的父亲相关因素与儿童急性白血病的关联

Association between paternal-related factors and childhood acute leukemia based on propensity score matching

目的研究父亲相关因素与儿童急性白血病(acute leukemia,AL)易感性的关联。方法基于成组病例-对照研究,于2014-2016年在河南省4家医院募集AL患儿及对照。用倾向得分匹配法(propensity score matching,PSM)均衡组间协变量,标准化差异法验证匹配效果。匹配后数据用条件Logistic回归模型作关联分析,计算调整人群归因危险度百分比(population attributable risk percent,PARP),并作亚组分析。结果共纳入病例、对照各407例。经PSM共匹配出270对病例及对照,匹配后16个协变量的标准化差异值均小于0.1。条件Logistic回归分析显示:父亲孕前6个月农药暴露(OR调整=1.93,95%CI:1.23~3.05)、染发(OR调整=2.31,95%CI:1.04~5.12)与儿童AL相关联,其调整PARP分别为11.42%、4.62%。其中前一个关联在男性、确诊年龄<5岁、居住地农村、有父亲孕前烟草暴露史的儿童亚人群中有统计学意义(均有P<0.05)。结论父亲孕前6个月暴露于农药、染发能增加儿童AL的易感性,应在孕前保健中予以控制。

Objective To investigate the association between paternal-related factors and the susceptibility of childhood acute leukemia （AL）. Methods Based on case-control study, AL children and their 1 ： 1 controls matched with residential region, age and gender were recruited from four hospitals in Henan Province from 2014 to 2016. Propensity score matching （PSM） was used to equalize covariates, the matching effect was verified by standardized difference method. Conditional Logistic regression was used to analyze the association between variables and childhood AL with the matched data. The adjusted population attributable risk percent （PARP） and subgroup analyses were performed. Results A total of 407 cases and 407 controls were included in the analysis. A total of 270 pairs of cases and controls were matched by PSM. The standardized difference values of 16 covariates were less than 0. 1 after PSM. Conditional Logistic regression showed that paternal exposure to pesticides （ ORaaj = 1. 93, 95% CI： 1.23-3.05） , hair coloring （ ORadi = 2.31, 95% CI： 1.04- 5. 12） 6 months before pregnancy increased the risk of childhood AL, of which PARP were 11.42%, 4.62% respectively. The relationship between paternal exposure to pesticides and childhood AL were still obvious in sub-population with male, age at diagnosis less than 5 years old, rural residents, and those with paternal exposure to tobacco （ all P〈0.05）. Conclu- sion Paternal exposure to pesticides, hair coloring 6 months before pregnancy can increase the susceptibility of childhood AL, which should be controlled in prenatal care.