婴幼儿血管瘤相关危险因素的多中心病例对照研究

Logistic regression analysis of maternal and perinatal risk factors for infantile hemangioma

目的了解婴幼儿血管瘤(IH)的人口统计学和临床特征,研究IH的相关危险因素。方法本研究为多中心病例对照研究,纳入2018年10月至2020年12月于四川大学华西医院、四川大学华西第二医院、成都市玉林社区中心医院就诊的IH患儿(病例组)及正常儿童(对照组),对两组的人口学特征,母亲孕前、孕期及围产期相关危险因素进行记录和统计分析。采用二分类Logistic回归进行单因素及多因素分析。结果病例组1479例,男456例、女1023例,月龄3.74±2.82;对照组1086例,男359例、女727例,月龄3.95±2.77,两组性别、年龄、民族、出生体重及出生身高等差异均无统计学意义(P>0.05)。IH病灶常见受累部位依次为头面部(564例,38.1%)、躯干(449例,30.6%)、四肢(356例,24.1%)等。1109例(75.0%)就诊时病灶处于增殖期,1059例(71.6%)为浅表型,1306例(88.3%)呈局灶性。瘤体面积为0.01~168.00(6.24±12.91)cm^(2),其中节段性IH瘤体面积7.50~168.00(32.17±26.94)cm^(2)。单因素分析显示,孕前因素中分娩史、既往流产史,孕期因素中胎儿宫内窘迫、胎儿脐带缠绕、先兆流产史、前置胎盘、羊水过少、妊娠期甲状腺功能减退、妊娠期贫血、孕酮/黄体酮药物使用史、甲状腺素药物使用史、子宫肌瘤病史,围产期因素中胎儿胎位、妊娠周数、胎膜早破及未足月胎膜早破史对于IH的发生均可能产生影响,差异均有统计学意义(P<0.05)。二元Logistic回归多因素校正分析显示,胎儿胎位臀位、早产、胎儿脐带缠绕及孕期服用甲状腺激素史对IH患病的影响差异无统计学意义(P>0.05);分娩史为IH患病最强的独立性危险因素(校正后OR=5.624,95%CI:4.275~7.398,P<0.001),妊娠期甲状腺功能减退及子宫肌瘤史均为IH患病的保护性因素。结论本研究IH患儿平均就诊月龄4个月,病灶最常见部位为头面部,多处于增殖期,表现为浅表型及局灶性,患儿IH的发生发展可能与胎盘疾病、缺氧、母亲孕期激素水平等因素有密切关系。

Objective To analyze demographic and clinical characteristics of infantile hemangioma(IH),and to explore related risk factors for IH.Methods A multicenter case-control study was conducted.IH patients(case group)and healthy children(control group)were collected from West China Hospital of Sichuan University,West China Second University Hospital of Sichuan University and Yulin Community Central Hospital of Chengdu from October 2018 to December 2020.The data on patients'demographic characteristics,and risk factors during their mothers'pre-pregnancy,pregnancy and perinatal period were collected and retrospectively analyzed.Univariate and multivariate analyses were performed using binary logistic regression.Results A total of 1479 patients with IH and 1086 healthy children were included in this study.There were 456 males and 1023 females in the case group,with the age being 3.74±2.82 months,and there were 359 males and 727 females in the control group,with the age being 3.95±2.77 months.There was no significant difference in the gender ratio,age,ethnic composition,birth weight or birth height between the case group and control group(all P>0.05).IH lesions mostly affected the head and face(564 cases,38.1%),followed by the trunk(449 cases,30.6%)and limbs(356 cases,24.1%).At the visit,1109(75.0%)patients presented with proliferating IH,1059(71.6%)with superficial IH,and 1306(88.3%)with focal IH.The IH lesion area ranged from 0.01 to 168.00(6.24±12.91)cm^(2),and the segmental IH area ranged from 7.50 to 168.00(32.17±26.94)cm^(2).Univariate logistic regression analysis showed some factors influencing the occurrence of IH(all P<0.05),including pre-pregnancy factors(delivery history and miscarriage history),pregnancy factors(fetal distress,cord entanglement,history of threatened abortion,placenta previa,oligohydramnios,gestational hypothyroidism,gestational anemia,history of progesterone supplementation,history of thyroxine drug use,history of uterus myomas),and perinatal factors(including fetal position,gestational weeks,premature rupture of membranes and preterm premature rupture of membranes).Multivariate binary logistic regression adjusted analysis showed that fetal breech presentation,preterm birth,cord entanglement and history of thyroxine drug use during pregnancy did not influence the occurrence of IH(all P>0.05);the delivery history was the strongest independent risk factor for IH(adjusted OR=5.624,95%CI:4.275 to 7.398,P<0.001),and gestational hypothyroidism and history of uterus myomas were protective factors for IH.Conclusions In this study,the average age of IH patients at visit was 4 months,skin lesions mostly occurred on the head and face,and most were superficial and focal in the proliferative stage.The occurrence and development of IH may be associated with placental diseases,hypoxia,maternal hormone levels during pregnancy,etc.