先天性室间隔缺损危险因素分析

Analysis of the risk factors for congenital ventricular septal defect

目的探讨先天性室间隔缺损(VSD)发生的相关因素,为先天性VSD的病因学研究及预防措施制定提供依据。方法选择2014年1月至2017年1月郑州市儿童医院收治的167例先天性VSD患儿为VSD组,另选择符合匹配条件的334例非先天性心脏病患儿为对照组,以问卷调查方式收集2组患儿父母的相关资料,并进行多因素logistic回归分析,筛选VSD发生的危险因素。结果 VSD组患儿父亲有毒有害物质接触、吸烟者比例高于对照组(P <0. 05),2组患儿父亲的年龄、职业、文化程度、精神压力、厌食蔬菜等因素比较差异无统计学意义(P> 0. 05)。VSD组患儿母亲孕前精神压力、孕前未规律服用叶酸、不良妊娠结局、孕早期有毒有害物质接触、孕早期发热、孕早期服用药物者比例高于对照组(P <0. 05),2组患儿母亲的年龄、职业、文化程度、孕前有毒有害物质接触、厌食蔬菜、阴道出血等因素比较差异无统计学意义(P> 0. 05)。多因素logistic回归分析显示,父亲接触有毒有害物质及母亲孕前精神压力、孕早期接触有毒有害物质和孕早期服用药物是VSD发生的危险因素(P <0. 05),规律服用叶酸是VSD发生的保护因素(P <0. 05)。结论先天性VSD发病的影响因素较多,父亲接触有毒有害物质及母亲孕前精神压力、孕早期接触有毒有害物质和孕早期服用药物是VSD发生的危险因素,规律服用叶酸是VSD发生的保护因素,应加强健康教育和孕期保健,降低VSD的发生风险。

Objective To investigate the related factors of congenital ventricular septal defect(VSD),and to provide evidence for the etiology and prevention of congenital VSD.Methods A total of 167 children with congenital VSD in Zhengzhou Children′s Hospital from January 2014 to January 2017 were selected as VSD group,and 334 children with non-congenital heart disease were selected as control group.The data of the parents of the children were collected by questionnaires,and the risk factors for VSD were screened by multivariate logistic regression analysis.Results The proportions of father exposed to toxic and harmful substances and smoking in VSD group were higher than those in the control group(P<0.05).There was no significant difference in the father′s factors of age,occupation,education level,mental stress and anorexia of vegetables between the two groups(P>0.05).The proportions of mothers who had pregestational mental stress took folic acid regularly before pregnancy,adverse pregnancy outcomes,exposure to toxic and harmful substances in early pregnancy,fever in early pregnancy and drug application in early pregnancy in VSD group were higher than those in the control group(P<0.05).There were no significant differences in the maternal factors of age,occupation,education level,exposure to toxic and harmful substances before pregnancy,anorexia of vegetables and vaginal bleeding between the two groups(P>0.05).Multivariate logistic regression analysis showed that father exposure to toxic and harmful substances and the mother with mental stress before pregnancy,exposure to toxic and harmful substances and medication in early pregnancy were the risk factors for VSD(P<0.05).The regular folic acid intake was a protective factor for VSD(P<0.05).Conclusions There are many factors influencing the incidence of congenital VSD.The father′s exposure to toxic and harmful substances and the mother′s mental stress before pregnancy,exposure to toxic and harmful substances and taking drugs in early pregnancy are the risk factors for VSD.The regular use of folic acid is a protective factor for VSD.The health education and prenatal care should be strengthened to reduce the risk of VSD.