發(fā)布時間：2018-09-05 15:26

【摘要】：[目的]本研究旨在探討我省先天性心臟病(Congenital heart disease,CHD)發(fā)病的影響因素,并對不同亞型CHD發(fā)病的影響因素進行初步分析,為提出針對性的預防措施提供參考,并為今后進一步開展不同CHD表型的病因學研究提供方向。[方法]采用病例對照研究的方法。選擇昆明醫(yī)科大學第一附屬醫(yī)院2016年1月至2016年12月期間于心內科、心外科、兒科住院部及心內科、心外科、兒科、兒�？崎T診就診的來自于我省各州、市、縣的經心臟彩超、心血管CT確診的367名0～10歲CHD患兒為病例組,同期隨機選取我院兒科住院部、兒科、兒�？崎T診就診的來自于我省各州、市、縣的無任何先天畸形的367名0～10歲兒童作為對照組。對兩組患兒的父母采用統(tǒng)一的問卷調查表,由研究者本人當面詢問填寫,內容包括:母親信息、父親信息、兒童信息。采用Epidata3.1軟件錄入數(shù)據,采用SPSS20.0軟件進行單因素及多因素logistic回歸分析。[結果]本研究多因素logistic回歸分析結果顯示:母親文化程度(OR=0.462,95%CI:0.326-0.654)、母親不良生育史(OR=1.828,95%CI:1.520-2.197)、母親孕早期發(fā)熱(OR=2.675,95%CI:1.762-4.061)、母親孕早期精神事件(OR=6.560,95%CI:4.407-9.766)、母親孕早期被動吸煙(OR=4.092,95%CI:3.002-5.577)、母親孕早期接觸農藥(OR=4.183,95%CI:1.829-9.565)、母親孕期補充營養(yǎng)(OR=0.112,95%CI:0.033-0.377)、父親文化程度(OR=0.261,95%CI:0.122-0.558)與CHD的發(fā)生有關聯(lián)。不同亞型CHD發(fā)病的影響因素不完全相同,影響房間隔缺損(Atrial septal defect,ASD)發(fā)生的因素為母親文化程度(OR=0.476,95%CI:0.275-0.826)、母親不良生育史(OR=2.625,95%CI:1.781-3.869)、母親孕早期接觸農藥(OR=6.007,95%CI:3.812-9.466)、母親孕早期精神事件(OR=3.967,95%CI:2.397-6.565);影響室間隔缺損(Ventricular septal defect,VSD)發(fā)生的因素為母親文化程度(OR=0.215,95%CI:0.102-0.455)、母親不良生育史(OR=2.257,95%CI:1.396-3.648)、母親孕早期精神事件(OR=5.028,95%CI:2.979-8.485)、母親孕早期被動吸煙(OR=2.807,95%CI:1.624-4.849)、父親接觸農藥(OR=2.625,95%CI:1.763-3.907);影響動脈導管未閉(Patent ductus arteriosus,PDA)發(fā)生的因素為母親文化程度(OR=0.763,95%CI:0.654-0.891)、母親不良生育史(OR=1.923,95%CI:1.003-3.687)、母親孕早期精神事件(OR=3.180,95%CI:1.777-5.692)、胎數(shù)2(OR=1.556,95%CI:1.383-1.750);影響復雜CHD發(fā)生的因素為母親孕早期發(fā)熱(OR=3.080,95%CI:1.228-7.723)及出生體重異常(OR=3.831,95%CI:2.026-7.243)。[結論]1、母親不良生育史、母親孕早期發(fā)熱、母親孕早期精神事件、母親孕早期被動吸煙、母親孕早期接觸農藥是CHD的危險因素;2、父母文化程度高、母親孕期補充優(yōu)質蛋白、以葉酸為主的多種維生素及微量元素為CHD的保護因素;3、導致不同亞型CHD發(fā)生的影響因素不完全相同;4、提高父母文化程度,加強孕前遺傳咨詢和篩查,重視孕期心理健康保健,合理營養(yǎng),預防感染,避免接觸二手煙及農藥,以預防和減少各型CHD的發(fā)生。
[Abstract]:[objective] to explore the influencing factors of congenital heart disease (Congenital heart disease,CHD) in our province, and to analyze the influencing factors of different subtypes of CHD. It also provides the direction for further research on the etiology of different CHD phenotypes. [methods] A case-control study was conducted. From January 2016 to December 2016, the first affiliated Hospital of Kunming Medical University was selected from the outpatient clinics of Department of Cardiology, Cardiology, Department of Pediatrics and Cardiology, Cardiology surgery, Department of Pediatrics, Department of Pediatrics and Paediatrics from the states, cities and counties of our province. At the same time, 367 patients with 10 years old CHD diagnosed by cardiovascular CT were randomly selected from the inpatient department of pediatrics, and pediatric care department from the provinces and cities of our province. 367 0-year-old 10-year-old children without any congenital malformations in county were used as control group. The parents of the two groups were investigated with a unified questionnaire, which was filled out by the researcher in person. The contents included: mother information, father information, and children information. Epidata3.1 software was used to input data and SPSS20.0 software was used to carry out univariate and multivariate logistic regression analysis. [results] the results of multivariate logistic regression analysis showed that: mother's education level (OR=0.462,95%CI:0.326-0.654), mother's bad birth history (OR=1.828,95%CI:1.520-2.197), mother's first trimester fever (OR=2.675,95%CI:1.762-4.061), mother's early mental event (OR=6.560,95%CI:4.407-9.766), mother's passive smoking (OR=4.092,95%CI:3.002-5.577), mother's early pregnancy contact. Pesticides (OR=4.183,95%CI:1.829-9.565), maternal supplemental nutrition (OR=0.112,95%CI:0.033-0.377) and father's education (OR=0.261,95%CI:0.122-0.558) were associated with the occurrence of CHD. The influencing factors of different subtypes of CHD were not identical. The factors that affect the occurrence of atrial septal defect (Atrial septal defect,ASD) are OR=0.476,95%CI:0.275-0.826, OR=2.625,95%CI:1.781-3.869, OR=6.007,95%CI:3.812-9.466, OR=3.967,95%CI:2.397-6.565 and (Ventricular septal defect,VSD. 鍖栫▼搴，

本文編號：2224683