云南省先天性心脏病相关危险因素的病例对照研究

Case-control study on risk factors for congenital heart diseases in Yunnan province

目的:分析云南省先天性心脏病(congenital heart diseases, CHD)发生的危险因素。方法:选择2017年1月至2018年1月在昆明医科大学第一附属医院经心脏彩超、心血管影像学检查确诊并住院治疗的1～10岁CHD患儿作为病例组。另选择同期在儿科住院部、门诊排除CHD和(或)其他先天性疾病的1～10岁儿童作为对照组。对照组母亲孕时年龄、孕期长短与病例组相近。与两组母亲进行面对面问卷访谈,调查家庭情况、居住环境、生活习惯、工作环境、妊娠史、疾病及服药史、负性生活事件及精神状态、饮食营养状况等内容,并进行单因素及多因素logistic回归分析。结果:单因素分析结果显示,母亲孕早期被动吸烟、孕早期接触农药、不良妊娠史、孕前患慢性病、孕早期感冒、孕早期发热、孕早期经历负性生活事件、孕早期服用解热镇痛药物、孕早期服用抗生素是CHD发生的危险因素(P<0.05)。多因素logistic回归分析表明,母亲孕早期被动吸烟(OR=2.26, 95%CI 1.12～4.58)、不良妊娠史(OR=2.73, 95%CI 1.31～5.69)、孕早期感冒(OR=4.33, 95%CI 2.15～8.70)、孕早期经历负性生活事件(OR=2.14, 95%CI 1.06～4.32)是CHD发生的主要危险因素;孕期常食用蛋肉鱼虾(OR=0.35, 95%CI 0.15～0.79)、孕前及孕期补充叶酸、维生素及微量元素(OR=0.32, 95%CI 0.16～0.64)是减少CHD发生的保护性因素(P<0.05)。结论:母亲孕前及孕期加强蛋白质、维生素、微量元素等合理搭配,同时减少烟雾暴露,减少感冒、负性生活事件及不良妊娠的发生,对预防和降低子代CHD的发生有重要意义。

Objective:To analyze the related risk factors for congenital heart disease(CHD)in Yunnan province.Methods:The 1-10-year-old children who were diagnosed with CHD by ultrasound and cardiovascular CT were selected as the case group.These children were hospitalized at the First Affiliated Hospital of Kunming Medical University from January 2017 to January 2018.Meanwhile,the children aged 1-10 years old excluded CHD and/or other congenital malformations,with similar age at conception and gestation with the case group,were selected as the control group at the same period from the Department of Pediatrics and the Outpatient Department of Pediatrics.The mothers in the two groups underwent face-to-face interview questionnaire investigation.The family situation,living environment,living habits,working environment,pregnancy history,disease and medication history,negative life events and mental state,dietary nutrition,and so on were investigated.Univariate and multivariate factor logistic regression analysis were performed.Results:Univariate analysis results showed that passive smoking during early pregnancy,exposure to pesticides during early pregnancy,abnormal pregnancy history,chronic diseases before pregnancy,a cold or a fever during early pregnancy,negative life events during early pregnancy,taking antipyretic and analgesic drugs or antibiotic medicine during early pregnancy were risk factors for CHD.Multivariate factor logistic regression analysis results showed that passive smoking during early pregnancy(OR=2.26,95%CI 1.12-4.58),abnormal pregnancy history(OR=2.73,95%CI 1.31-5.69),have a cold during early pregnancy(OR=4.33,95%CI 2.15-8.70),negative life events during early pregnancy(OR=2.14,95%CI 1.06-4.32)were the major risk factors for CHD,and regular consumption of milk,egg,meat,and shrimp during pregnancy(OR=0.35,95%CI 0.15-0.79),supplementation of folic acid,vitamins,and microelements before pregnancy and during pregnancy(OR=0.32,95%CI 0.16-0.64)were the protective factors for reducing the incidence of CHD(P<0.05).Conclusions:It is of great significance to prevent and reduce the occurrence of offspring CHD by strengthening the reasonable combination of protein,vitamins,microelements and the like before and during pregnancy,reducing smoke exposure,and reducing the occurrence of colds,negative life events,and adverse pregnancy.