本文選題：低出生體重 + 影響因素��； 參考：《華中科技大學(xué)》2016年碩士論文

【摘要】：目的:低出生體重(LBW)是一種全球性公共衛(wèi)生問題,其涉及范圍廣泛,對個體早期的生長發(fā)育以及青少年和成年期的慢病發(fā)生均會造成長遠(yuǎn)影響,嚴(yán)重制約人口健康和經(jīng)濟(jì)文化的發(fā)展,給醫(yī)藥衛(wèi)生系統(tǒng)增添了沉重的負(fù)擔(dān)。胚胎期是個體生命的起源階段,母體孕期的生活習(xí)慣以及接觸的各種暴露因素都會對胚胎發(fā)育造成影響,而鋁元素是生活中常見的一種重金屬,研究報道鋁元素具有生殖毒性,會導(dǎo)致胚胎宮內(nèi)發(fā)育受損,然而目前關(guān)于孕期鋁暴露與新生兒出生體重的流行病學(xué)證據(jù)尚不足。因此,此次調(diào)查深入研究孕期各暴露因素以及鋁暴露與新生兒低出生體重的關(guān)系,為防止產(chǎn)前不良因素和不良妊娠結(jié)局的發(fā)生提供科學(xué)的指導(dǎo)意見。方法:以健康寶貝隊列(healthy baby cohort)為基礎(chǔ),采用病例對照研究,從隊列中選取低出生體重新生兒158例,按照孕婦年齡以及新生兒性別進(jìn)行1:3配比,再從隊列中選取正常體重新生兒474例,病例和對照均為2012年11月1日至2014年4月1日在武漢市婦幼保健院出生且無明顯出生缺陷的單胎活產(chǎn)兒;低出生體重兒的出生體重2500g,正常新生兒為體重在2500g-4000g(包括2500g)。在孕婦分娩住院時填寫問卷,收集父母的基本信息、生活工作狀況、家庭經(jīng)濟(jì)條件、母親孕期營養(yǎng)等情況;新生兒信息來自于醫(yī)院資料的搜集整理。選擇Epidata3.1對問卷實行雙錄入并創(chuàng)建數(shù)據(jù)庫,孕婦尿液樣本則由受過專業(yè)培訓(xùn)的實驗員收集,使用電感耦合等離子體質(zhì)譜儀(ICP-MS)檢測尿樣中鋁元素的含量,將尿鋁濃度按三分位數(shù)分為高中低三個等級,運用SPSS17.0分析軟件,描述基本信息,并選用二分類logistic單因素和多因素回歸進(jìn)行因素分析,以及符號秩和檢驗和條件logistic回歸,統(tǒng)計低出生體重組與對照組的尿鋁濃度差異以及鋁暴露與低出生體重的關(guān)聯(lián)。結(jié)果:1、632個孕婦的平均年齡為28.7歲;新生兒性別比為0.95(男孩:女孩);病例組平均分娩孕周為36.1周,對照組為38.9周;病例組和對照組的平均出生體重分別為2252g和3310g。2、多因素logistic回歸分析結(jié)果顯示,孕期增重多(OR=1.073,P0.01),懷孕周期長(OR=2.707,P0.01)是低出生體重的保護(hù)因素;孕期陰道流血(OR=1.981,P0.05),妊娠期高血壓(OR=5.271,P0.01),羊水過少(OR=9.175,P0.01)是低出生體重的危險因素。3、在低出生體重與孕期鋁暴露的病例對照研究中,Wilcoxon秩和檢驗結(jié)果為:Z=3.2715,P=0.0011,說明病例組和對照組的尿鋁濃度有顯著性差別,且提示病例組濃度要高于對照組。4、將尿鋁高濃度組、中濃度組分別與低濃度組進(jìn)行比較,logistic回歸分析結(jié)果顯示,中濃度尿鋁對新生兒低出生體重的影響分析結(jié)果為OR=1.55,P0.05,高濃度尿鋁對低出生體重的影響分析結(jié)果為OR=2.24(95%CI:1.40-3.60),P0.01。5、將低出生體重危險因素分析得出的影響因素作為校正因素,logistic回歸分析結(jié)果顯示,中濃度尿鋁對新生兒低出生體重的影響分析結(jié)果為OR=1.27,P0.05,高濃度尿鋁對低出生體重的影響分析結(jié)果為OR=1.31(95%CI:1.02-2.03),P0.05。6、按母親年齡的中位數(shù)分為兩組:≤28歲組和28歲組,兩組中鋁暴露對低出生體重的影響表現(xiàn)一致:校正其他因素前,尿鋁中濃度組與低出生體重?zé)o顯著性關(guān)聯(lián),高濃度組對低出生體重有顯著性影響(P0.05),校正其他影響因素后,無論暴露濃度高低,胚胎期鋁暴露對低出生體重均無顯著性影響。7、按新生兒性別分組,男孩組與女孩組的結(jié)果一致,均顯示為:校正其他因素前,尿鋁中濃度組與低出生體重?zé)o顯著性關(guān)聯(lián),高濃度組對低出生體重有顯著性影響(P0.05),校正其他影響因素后,無論暴露濃度高低,胚胎期鋁暴露對低出生體重均無顯著性影響。結(jié)論:1、孕期增重多、懷孕周期長是低出生體重的保護(hù)因素,因此,應(yīng)加強孕婦對孕期保健的認(rèn)知,并保證孕婦孕期的營養(yǎng)充足,防止母體營養(yǎng)不良所致的胎兒發(fā)育受損的現(xiàn)象;此外,孕期還要預(yù)防流產(chǎn)和早產(chǎn)的發(fā)生,使得分娩孕周處于正常范圍內(nèi)。羊水過少、陰道流血、妊娠高血壓是低出生體重的危險因素,故應(yīng)在孕期加強警惕,采取有效措施加以預(yù)防。2、低出生體重與孕期鋁暴露的關(guān)聯(lián)表現(xiàn)為,暴露程度較低時,可認(rèn)為關(guān)聯(lián)無統(tǒng)計學(xué)意義;暴露程度較高時,具有顯著性關(guān)聯(lián),說明高濃度鋁暴露是低出生體重的危險因素。因此,妊娠期婦女應(yīng)識別環(huán)境中的鋁制產(chǎn)品或者含鋁產(chǎn)品,減少該類產(chǎn)品的使用,將不良影響降至最低。
[Abstract]:Objective: low birth weight (LBW) is a global public health problem. It is a global public health problem. It has a wide range of problems. It has a long-term impact on the growth and development of individuals and the occurrence of slow diseases in adolescents and adults. It seriously restricts the health of the population and the development of economy and culture, and adds a heavy burden to the medical and health systems. The embryo period is an individual student. In the origin stage of life, the life habits of the maternal pregnancy and various exposure factors in contact will affect the development of embryos, and aluminum is a common heavy metal in life. It is reported that the reproductive toxicity of aluminum elements can lead to the damage to the intrauterine development of the embryo, but the flow of aluminum exposure and the birth weight of the newborn during pregnancy The evidence is still inadequate. Therefore, the survey studies the relationship between exposure factors in pregnancy and the relationship between aluminum exposure and neonatal low birth weight, and provides scientific guidance for preventing prenatal adverse factors and adverse pregnancy outcomes. Method: Based on the healthy baby cohort, a case control study was used. 158 cases of low birth weight newborns were selected from the cohort, according to the age of pregnant women and the sex of the newborn 1:3, and then 474 cases of normal weight newborn were selected from the cohort. The cases and the control were all single born babies born in Wuhan maternal and child health care hospital from November 1, 2012 to April 1, 2014 without obvious birth defects; low birth weight was low. The birth weight of the infant was 2500g, and the normal newborn was 2500g-4000g (including 2500g). The questionnaire was filled in when the pregnant women were in hospital. The basic information of the parents, the living conditions, the family economic conditions, the maternal nutrition and so on. The information of the newborns came from the collection and arrangement of the hospital data. The questionnaire was selected by Epidata3.1 to carry out a double entry into the questionnaire. And the database was created. The urine samples of pregnant women were collected by the trained experimenters. The content of aluminum in urine samples was detected by inductively coupled plasma mass spectrometry (ICP-MS). The urine aluminum concentration was divided into three grades in high school by three digits. The basic information was described by SPSS17.0 analysis, and the two classification of logistic single causes was selected. Factor analysis, factor analysis, symbolic rank sum test and conditional logistic regression, and the correlation between aluminum concentration and low birth weight in the low birth weight group and the control group, and the correlation between aluminum exposure and low birth weight. Results: the average age of 1632 pregnant women was 28.7 years; the neonatal sex ratio was 0.95 (boys: girls); the average childbirth in the case group. The pregnancy week was 36.1 weeks and the control group was 38.9 weeks. The average birth weight of the case group and the control group was 2252g and 3310g.2 respectively. The multiple factor Logistic regression analysis showed that the weight gain during pregnancy was more (OR=1.073, P0.01), the long pregnancy cycle (OR=2.707, P0.01) was the protection factor of low birth weight; vaginal bleeding (OR=1.981, P0.05), pregnancy hypertension (OR). =5.271, P0.01), OR=9.175 (P0.01) is a risk factor for low birth weight.3. In a case-control study of low birth weight and prenatal exposure to aluminum, Wilcoxon rank and test results are: Z=3.2715, P=0.0011, indicating a significant difference in the urinary aluminum concentration between the case group and the control group, suggesting that the concentration of the case group is higher than that of the control group, and the urine is higher than that of the control group. The results of logistic regression analysis showed that the effect of middle concentration of urine aluminum on low birth weight of newborn was OR=1.55, P0.05, and the effect of high concentration of urine aluminum on low birth weight was OR=2.24 (95% CI:1.40-3.60), P0.01.5, and the risk factors of low birth weight were divided. Logistic regression analysis showed that the effect of medium concentration of urine aluminum on the low birth weight of newborn was OR=1.27, P0.05, and the result of high concentration of urine aluminum was OR=1.31 (95%CI:1.02-2.03) and P0.05.6, which was divided into two groups according to the median age of mother: group less than 28 years old. The effect of aluminum exposure on low birth weight in the two groups was consistent with the 28 year old group. Before the correction of other factors, there was no significant association between the concentration group in the urinary aluminum and the low birth weight. The high concentration group had a significant effect on the low birth weight (P0.05). After the correction of other factors, no matter the exposure concentration was high and low, the aluminum exposure of the embryo to low birth weight was no more. The significant effect of.7, according to the neonatal sex group, the boys group and the results of the girls group, all showed that before the correction of other factors, there was no significant association between the concentration group in the urine and the low birth weight, and the high concentration group had a significant effect on the low birth weight (P0.05). After correcting the factors of his influence, no matter the exposure concentration was high or low, the aluminum exposure stage in the embryo period was exposed. There is no significant effect on low birth weight. Conclusion: 1, more weight increases during pregnancy and long pregnancy cycle is a protective factor for low birth weight. Therefore, it is necessary to strengthen the cognition of pregnant women's health care during pregnancy, ensure adequate nutrition of pregnant women during pregnancy and prevent fetal malnutrition caused by maternal malnutrition, and also prevent abortion and premature birth during pregnancy. The incidence of childbirth is in the normal range. Oligohydramnios, vaginal bleeding, pregnancy induced hypertension are the risk factors of low birth weight. Therefore, we should strengthen vigilance during pregnancy and take effective measures to prevent.2. The association between low birth weight and pregnant aluminum exposure is that when the exposure degree is low, there is no statistical significance; violence is not significant. When exposure is high, there is a significant correlation, indicating that high concentration of aluminum exposure is a risk factor for low birth weight. Therefore, pregnant women should identify the aluminum products or aluminum products in the environment, reduce the use of such products and minimize the adverse effects.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R17

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