胎儿出生缺陷发生相关影响因素的多因素Logistic回归分析

The multivariate logistic regression analysis of related factors of fetal birth defects

目的:探讨胎儿出生缺陷(BD)发生的危险因素。方法:回顾性分析收治的494例有产前诊断指征孕妇的临床资料,所有孕妇均行羊水细胞染色体核型分析,根据胎儿妊娠结局将其分为BD组62例与无BD组432例。记录两组孕妇羊水细胞染色体核型结果及产前诊断指征,并采用多因素Logistic回归分析探讨有产前诊断指征孕妇BD发生的影响因素。结果:单因素分析结果表明BD组与无BD组年龄、不良孕产史、唐氏筛查高/临界风险、无创检查异常、地贫基因携带、染色体数目异常以及染色体结构异常之间比较差异均有统计学意义(均P<0.05)。以胎儿BD发生为因变量进行多因素Logistic回归分析,结果显示高龄产妇(>35岁)(OR=2.024,95%CI:1.387~3.125)、不良孕产史(OR=1.457,95%CI:1.142~2.829)、唐氏筛查高/临界风险(OR=1.631,95%CI:1.034~2.606)、无创检查异常(OR=2.258,95%CI:1.495~3.781)、地贫基因携带(OR=1.543,95%CI:1.141~2.321)、染色体数目异常(OR=1.729,95%CI:1.261~2.689)以及染色体结构异常(OR=2.894,95%CI:1.773~4.254)均为胎儿BD发生的独立危险因素(均P<0.05)。结论:高龄产妇(>35岁)、不良孕产史、唐氏筛查高/临界风险、无创检查异常、地贫基因携带、染色体数目异常以及染色体结构异常均为胎儿BD发生的独立危险因素,针对其制定有效的干预措施可减少胎儿BD的发生。

Objective To discuss the risk factors of fetal birth defect(BD).Method The clinical data of 494 pregnant women with prenatal diagnosis indications were retrospectively analyzed,all pregnant women underwent amniotic fluid cell karyotype analysis,then divided into the BD group 62 cases and the no BD group 432 cases according to the fetal pregnancy outcome.The karyotype results of amniotic fluid cells and the indications of prenatal diagnosis were recorded,the multivariate logistic regression analysis was used to explore the influencing factors of BD in pregnant women with indications of prenatal diagnosis.Results The univariate analysis showed that age,adverse pregnancy and childbirth history,high/critical risk of Down′s screening,abnormal noninvasive examination,thalassemia gene carrying,abnormal chromosome number and abnormal chromosome structure between the BD group and the non BD group were significant differences(all P<0.05).Using the occurrence of fetal BD as the dependent variable,the multivariate logistic regression analysis showed that elderly pregnant women(>35 years old)(OR=2.024,95%CI:1.387~3.125),adverse pregnancy and childbirth history(OR=1.457,95%CI:1.142~2.829),high/critical risk of Down′s screening(OR=1.631,95%CI:1.034~2.606),abnormal noninvasive examination(OR=2.258,95%CI:1.495~3.781),thalassemia gene carrying(OR=1.543,95%CI:1.141~2.321),Abnormal chromosome number(OR=1.729,95%CI:1.261~2.689)and abnormal chromosome struct ure(OR=2.894,95%CI:1.773~4.254)were independent risk factors for the occurrence of fetal BD(all P<0.05).Conclusion Elderly pregnant women(>35 years),adverse pregnancy and childbirth history,high/critical risk of Down′s screening,abnormal noninvasive examination,thalassemia gene carrying,abnormal chromosome number and abnormal chromosome structure are all independent risk factors for fetal BD,effective intervention measures can reduce the occurrence of fetal BD.