本文選題：早產(chǎn)　切入點(diǎn)：維生素D　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究背景及目的早產(chǎn)(preterm birth,PTB)的定義是妊娠滿(mǎn)28周到不滿(mǎn)37周分娩者。早產(chǎn)是導(dǎo)致新生兒死亡的最主要原因,也是出生后兒童生長(zhǎng)發(fā)育障礙特別是神經(jīng)發(fā)育障礙的危險(xiǎn)因素。早產(chǎn)的危險(xiǎn)因素及其具體的發(fā)生機(jī)制尚不完全清楚。目前認(rèn)為早產(chǎn)是一種多因素綜合征,常見(jiàn)的危險(xiǎn)因素包括感染和炎癥等。維生素D(VD)影響早產(chǎn)的發(fā)生可能是通過(guò)調(diào)節(jié)免疫和體內(nèi)炎癥因子水平途徑。目前為止,關(guān)于孕期維生素D與早產(chǎn)關(guān)聯(lián)的研究結(jié)論上不一致,且前瞻性隊(duì)列研究較少。而關(guān)于同一孕婦孕期維生素D水平在不同妊娠時(shí)期的水平變化及與早產(chǎn)關(guān)聯(lián)的研究更是少見(jiàn)報(bào)道。因此,本研究懫用前瞻性出生隊(duì)列研究設(shè)計(jì)檢測(cè)育齡婦女孕早、中、晚期維生素D水平,分析相關(guān)影響因素,探討不同孕期維生素D缺乏對(duì)早產(chǎn)發(fā)生風(fēng)險(xiǎn)的影響以及可能的關(guān)鍵期問(wèn)題,為降低早產(chǎn)發(fā)生率提供科學(xué)依據(jù)。方法本研究是以馬鞍山優(yōu)生優(yōu)育隊(duì)列為基礎(chǔ),開(kāi)始于2013年5月,截止到2014年9月,收集有關(guān)孕母的社會(huì)人口學(xué)特征問(wèn)卷(年齡、孕齡、教育程度、居住地、家庭收入等)、既往妊娠史(妊娠次數(shù)、不良妊娠史等),孕期補(bǔ)充含VD補(bǔ)充劑情況,妊娠合并癥及胎兒出生結(jié)局資料等信息。本研究從該隊(duì)列中隨機(jī)選擇801人收集并采用放射免疫分析法檢測(cè)孕早、中、晚三期血清維生素D水平。以20ng/ml為分界點(diǎn)將25(OH)D水平分為缺乏和不缺乏組,采用χ2檢驗(yàn)、方差分析(ANOVA)和多因素logistic回歸分析不同孕期維生素D缺乏的影響因素;分別以20ng/ml和30ng/ml為分界點(diǎn)將維生素D水平分為缺乏組、不足組和充足組;以維生素D分組為不足組作為參照,單因素和多因素二分類(lèi)logistic回歸分析探討不同孕期母體維生素D缺乏與總早產(chǎn)、自發(fā)性早產(chǎn)及醫(yī)源性早產(chǎn)發(fā)病風(fēng)險(xiǎn)的關(guān)聯(lián)�？刂颇挲g、孕前BMI、血清收集季節(jié)和孕周等影響孕期維生素D水平的變量后,采用stata10.0分析維生素D與早產(chǎn)發(fā)生風(fēng)險(xiǎn)的非線(xiàn)性關(guān)聯(lián)。所有檢驗(yàn)均采用雙側(cè)檢驗(yàn),P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果本研究隊(duì)列中,25(OH)D水平在不同時(shí)點(diǎn)存在變化:孕中期水平最高(平均為29.1±12.1ng/ml,缺乏率最低為25.5%),孕晚期水平其次(平均為20.1±9.7ng/ml,缺乏率為59.6%),孕早期水平最低(平均為19.2±8.4ng/ml,缺乏率最高為60.9%);孕早、中、晚期維生素D水平均存在季節(jié)差異:血清收集季節(jié)為夏秋季組的25(OH)D水平顯著高于冬春季組(P0.001);本研究發(fā)現(xiàn)除了季節(jié)對(duì)孕期維生素D水平影響外,年齡≥30歲是孕中期維生素D缺乏的保護(hù)因素,孕前BMI≥24kg/m2會(huì)增加孕中期維生素D缺乏的風(fēng)險(xiǎn);年齡≥30歲、初次妊娠是孕晚期維生素D缺乏的保護(hù)因素;血清收集季節(jié)在夏秋季、孕期補(bǔ)充含VD的孕婦孕早、中、晚期維生素D缺乏的風(fēng)險(xiǎn)均顯著降低;與維生素D不足組相比,多因素分析結(jié)果顯示孕早期和孕晚期維生素D缺乏和充足組早產(chǎn)的發(fā)生風(fēng)險(xiǎn)未見(jiàn)明顯增加(孕早期OR值及95%CI分別為:0.89(0.40~1.98)、0.26(0.03~2.04);孕晚期分別為:0.82(0.23~2.98)、3.48(0.90~13.48));孕中期維生素D缺乏組總早產(chǎn)以及自發(fā)性早產(chǎn)和醫(yī)源性早產(chǎn)的發(fā)生風(fēng)險(xiǎn)均顯著增加(總早產(chǎn):4.00(1.46~10.94);自發(fā)性早產(chǎn):2.63(1.12~6.16);醫(yī)源性早產(chǎn):10.48(1.34~81.71)),且兩者存在非線(xiàn)性關(guān)聯(lián)(P=0.026):當(dāng)維生素D水平小于20.2ng/ml時(shí),早產(chǎn)風(fēng)險(xiǎn)顯著增加;當(dāng)孕中期維生素D水平在20~24ng/ml時(shí),早產(chǎn)的發(fā)生風(fēng)險(xiǎn)最低;當(dāng)超過(guò)24ng/ml時(shí),早產(chǎn)風(fēng)險(xiǎn)趨于平緩。結(jié)論研究隊(duì)列中妊娠期女性維生素D缺乏率較高,特別是孕早期和孕晚期;研究隊(duì)列中,孕期和季節(jié)對(duì)25(OH)D水平有影響;年齡、孕前BMI、妊娠次數(shù)、血清收集季節(jié)、補(bǔ)充含VD補(bǔ)充劑等均對(duì)孕期維生素D有影響;研究隊(duì)列中孕中期維生素D缺乏會(huì)增加總早產(chǎn)以及自發(fā)性早產(chǎn)和醫(yī)源性早產(chǎn)的發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Background and objective: premature delivery (preterm birth, PTB) is defined as 28 weeks less than 37 weeks of pregnancy with preterm delivery. Is the main cause of neonatal death, and after the birth of children's growth and development disorder especially risk factors for neurodevelopmental disorders. The risk factors of premature delivery and its specific pathogenesis is not entirely clear now think the preterm birth is a multifactorial syndrome, common risk factors include infection and inflammation. The vitamin D (VD) effect of preterm birth may be through the regulation of immune and inflammatory factor level way. So far, no consistent conclusions about vitamin D and preterm birth associated, and prospective cohort less research. Study on changes in different period of pregnancy pregnant women with the same level of vitamin D levels and associated with preterm birth is rarely reported. Therefore, forward-looking in this study Zhi The birth of women of childbearing age cohort study design, advanced detection of early pregnancy, vitamin D levels, analyze the related factors, to explore the different effects of vitamin D deficiency during pregnancy on risk of preterm birth and critical period may, in order to reduce the incidence of premature delivery and provide a scientific basis. This study is based on the Ma'anshan birth cohort based, began in the in May 2013, by the end of September 2014, the social demographic characteristics questionnaire about pregnant women (age, gestational age, educational level, residence, family income, previous pregnancy history) (pregnancy, adverse pregnancy history), supplemented with VD supplements during pregnancy, pregnancy complications and fetal birth outcome data and other information. The research collected randomly selected from the cohort of 801 people and analysis were measured by radioimmunoassay in the early, late in the three period, the level of serum vitamin D. With 20ng/ml as the boundary point 25 (OH) D levels were divided into 緙轟箯鍜屼笉緙轟箯緇，

本文編號(hào)：1636503