新疆石河子地区儿童先天性心脏病与母亲妊娠期相关危险因素分析

Analysis of Risk Factors related to Congenital Heart Disease in Children and Mother's Pregnancy in Shihezi Region of Xinjiang Province

目的:探讨新疆石河子地区儿童先天性心脏病(CHD)的发生与母亲妊娠期相关危险因素。方法:选取2019年1月至2021年12月于石河子大学第一附属医院确诊的347例CHD患儿为病例组,另选取同时期健康体检无CHD儿童347例为对照组,对两组受试患儿的母亲进行问卷调查,通过单因素及多因素条件Logistic回归模型对危险因素进行分析,探讨儿童先天性心脏病相关致病因素。结果:(1)347例CHD患儿中,CHD分型差异性具有统计学意义,发病率前五位依次为室间隔缺损、房间隔缺损、动脉导管未闭、合并两种类型心脏缺陷、肺动脉瓣狭窄;(2)单因素Logistic结果提示:妊娠年龄>35岁、母孕期吸烟接触史、孕早期农药等化学物质接触史、孕早期发热疾病史、孕期基础疾病用药史、妊娠期糖尿病史是CHD发生的危险因素;孕期规律补充叶酸及规律补充维生素是CHD发生的保护因素;(3)多因素Logistic分析提示:按照危险因素影响由强到弱的顺序依次为孕早期发热性疾病、妊娠期糖尿病、母孕年龄>35岁、孕期吸烟接触史,保护因素为孕期规律口服叶酸及维生素。结论:CHD由多种因素共同导致,孕产期妇女应尽量避免接触相关危险因素,加强叶酸及维生素补充宣教,减少CHD的发生。

Objective:To investigate the incidence of congenital heart disease(CHD)in children in Shihezi region of Xinjiang and the risk factors related to maternal pregnancy.Methods:347 children with CHD diagnosed in the First Affiliated Hospital of Shihezi University Medical College from January 2019 to December 2021 were selected as the case group,and 347 children without CHD in the same period of physical examination were selected as the control group.The mothers of the two groups of children were investigated by questionnaire.The risk factors were analyzed by single factor and multiple factor conditional logistic regression model to explore the pathogenic factors related to children's congenital heart disease.Results:(1)In 347 children with CHD,the difference of CHD classification was statistically significant.The top five incidence rate were ventricular septal defect,atrial septal defect,patent ductus arteriosus,combined with two types of heart defects,and pulmonary valve stenosis.(2)The results of single factor Logistic analysis showed that the risk factors of CHD were:pregnancy age>35 years old,maternal exposure to smoking during pregnancy,exposure to pesticides and other chemicals in early pregnancy,history of febrile diseases in early pregnancy,history of medication for basic diseases in pregnancy,and history of diabetes in pregnancy;Regular supplementation of folic acid and vitamin during pregnancy are protective factors for CHD.(3)Multivariate logistic analysis showed that according to the order of risk factors from strong to weak,the order of risk factors was febrile disease in the first trimester of pregnancy,diabetes in pregnancy,maternal pregnancy age>35 years,smoking exposure history in pregnancy,and the protective factors were regular oral folic acid and vitamins in preg-nancy.Conclusion:CHD is caused by many factors.Pregnant women should try to avoid exposure to relevant risk factors,strengthen the education of folic acid and vitamin supplements,and reduce the incidence of CHD.