【摘要】：目的:本課題以大樣本人群作為研究對象,采用出生隊列研究方法分析孕婦血清鎘水平與早產(chǎn)和小于胎齡兒的關(guān)聯(lián)及其部分機(jī)制。方法:本課題的研究對象來自于中國安徽出生隊列(C-ABCS)合肥亞隊列,該隊列共招募了4358例孕婦作為研究對象,按照本課題的設(shè)計要求和標(biāo)準(zhǔn)留取了3254例單胎母嬰,采集所有的孕婦血清,并跟蹤回訪收取了孕婦的人口學(xué)特征和新生兒的部分資料。采用石墨爐原子吸收分光光度法(GFAAS)檢測孕婦血清鎘濃度,用Logistic回歸分析計算孕婦血清鎘水平與早產(chǎn)和小于胎齡兒關(guān)聯(lián)的比值比(OR)以及95%可信區(qū)間(CI);在控制了孕婦年齡、孕前體質(zhì)指數(shù)(BMI)、血清采集時間和家庭人均月收入等混雜因素后計算出調(diào)整OR。同時,本研究采用三分位數(shù)的方法將孕婦血清鎘的濃度進(jìn)行了分級,分別比較了孕婦在不同鎘暴露程度下,其子代出現(xiàn)早產(chǎn)和小于胎齡兒的風(fēng)險,也進(jìn)一步分析了孕婦不同孕齡血清鎘水平與早產(chǎn)和小于胎齡兒之間的關(guān)聯(lián)。結(jié)果:本研究中,共測量了3254名孕婦的血清Cd的濃度,其平均血清Cd濃度為0.89μg/L,最小值為0.04μg/L,最大值為8.08μg/L,中位數(shù)為0.79μg/L。首先分析了孕婦血清鎘水平與小于胎齡兒風(fēng)險的關(guān)聯(lián),將孕婦低水平血清鎘組濃度(L-Cd)定義為小于1.06μg/L,孕婦高水平血清鎘組濃度(H-Cd)定義為大于等于1.06μg/L。結(jié)果顯示,孕婦H-Cd組小于胎齡兒的發(fā)生率10.6%明顯高于孕婦L-Cd組小于胎齡兒的發(fā)生率7.5%(OR:1.45;95%CI:1.11,1.90;P=0.007),調(diào)整OR為1.43(95%CI;1.09,1.88;P=0.009);在孕中期,孕婦H-Cd組小于胎齡兒的發(fā)生率11.2%明顯高于孕婦L-Cd組小于胎齡兒的發(fā)生率7.3%(OR:1.59;95%CI:1.15,2.21;P=0.006),調(diào)整OR為1.57(95%CI:1.13,2.19;P=0.007)。緊接著,本研究分析了孕婦血清鎘水平與早產(chǎn)的關(guān)聯(lián),將孕婦血清鎘濃度分為高中低三個等級,其中孕婦高水平血清鎘組濃度(H-Cd)界定為0.95μg/L,中水平血清鎘組濃度(M-Cd)界定為0.65-0.94μg/L,孕婦低水平血清鎘組濃度(L-Cd)界定為0.65μg/L。結(jié)果顯示,孕婦L-Cd組、孕婦M-Cd組和孕婦H-Cd組的早產(chǎn)率分別為3.5%,3.8%和9.4%。孕婦H-Cd組胎兒早產(chǎn)的發(fā)生率明顯高于孕婦L-Cd組胎兒早產(chǎn)的發(fā)生率(OR:2.86;95%CI:1.95,4.19;P0.001),調(diào)整的OR為3.02(95%CI:2.02,4.50;P0.001)。同時,本研究還分析了孕早、中期孕婦血清鎘水平與早產(chǎn)的關(guān)聯(lián)。在孕早期,孕婦L-Cd組,孕婦M-Cd組和孕婦H-Cd組的早產(chǎn)率分別為2.3%,4.0%和8.6%。其中孕婦H-Cd組胎兒早產(chǎn)的發(fā)生率明顯高于孕婦L-Cd組胎兒早產(chǎn)的發(fā)生率(OR:4.46;95%CI:2.01,9.93;P0.001),調(diào)整的OR為4.51(95%CI:2.02,10.06;P0.001)。在孕中期,孕婦L-Cd組,孕婦M-Cd組和孕婦H-Cd組的早產(chǎn)率分別為4.2%,3.7%和9.8%,其中孕婦H-Cd組胎兒早產(chǎn)的發(fā)生率明顯高于孕婦L-Cd組胎兒早產(chǎn)的發(fā)生率(OR:2.72;95%CI:1.71,4.31;P0.001),調(diào)整的OR為2.68(95%CI:1.68,4.27;P0.001)。最后,本研究還分析了孕婦血清鎘水平與不同程度早產(chǎn)的關(guān)聯(lián)。孕婦H-Cd組的胎兒中期早產(chǎn)率為2.2%顯著高于孕婦L-Cd組胎兒中期早產(chǎn)率的0.8%(OR:2.94;95%CI:1.55,5.59;P0.001),調(diào)整的OR為2.95(95%CI:1.55,5.62;P0.001)。孕婦H-Cd組的胎兒晚期早產(chǎn)率為8.4%顯著高于孕婦L-Cd組胎兒晚期早產(chǎn)率2.1%(OR:4.27;95%CI:2.95,6.19;P0.001),調(diào)整OR為4.25(95%CI:2.93,6.17;P0.001)。結(jié)論:孕期母體血清鎘的水平與小于胎齡兒和早產(chǎn)發(fā)生風(fēng)險呈正相關(guān)
[Abstract]:Objective: to analyze the relationship between maternal serum cadmium level and premature birth and less than gestational age by the method of birth cohort study in this subject. Methods: the object of this study was from the Anhui Hefei cohort (C-ABCS) in Hefei, China, which recruited 4358 pregnant women as a study. In accordance with the design requirements and standards of the subject, 3254 cases of single pregnant mother and baby were collected, all the pregnant women's serum were collected, and the demographic characteristics of pregnant women and some data of the newborn were collected after the follow-up visit. The serum cadmium concentration of pregnant women was detected by Graphite Furnace atomic absorption spectrophotometry (GFAAS), and the maternal serum was calculated by Logistic regression analysis. The ratio Ratio (OR) and 95% confidence interval (CI) were associated with preterm birth and less than gestational age. The concentration of serum cadmium in pregnant women was graded by three digits after controlling the age of pregnant women, the preconception body mass index (BMI), the time of serum collection and the monthly income of the family. The risk of preterm birth and less than gestational age of pregnant women at different levels of cadmium exposure was compared, and the correlation between serum cadmium level and preterm birth and less gestational age in pregnant women at different gestational ages was further analyzed. Results: in this study, the serum concentration of Cd in 3254 pregnant women was measured, and the average serum Cd concentration was 0.89 g/L, The minimum value of 0.04 mu g/L, the maximum value of 8.08 mu g/L, and the median of 0.79 mu g/L., first analyzed the correlation between the serum cadmium level of pregnant women and the risk of less than fetal age. The low level serum cadmium concentration (L-Cd) of pregnant women was defined as less than 1.06 Mu g/L, and the high level serum cadmium group concentration (H-Cd) of pregnant women was defined as the result of 1.06 mu g/L. and H-Cd group of pregnant women. The incidence of less than gestational age was 10.6% significantly higher than that of pregnant women in group L-Cd less than 7.5% (OR:1.45; 95%CI:1.11,1.90; P=0.007), and OR was 1.43 (95%CI; 1.09,1.88; P=0.009); in the middle of pregnancy, the incidence of group H-Cd less than fetal age 11.2% was significantly higher than that of pregnant women's L-Cd group less than 7.3% (OR:1.59; 95%CI:1.15,2.). 21; P=0.006), OR was adjusted to 1.57 (95%CI:1.13,2.19; P=0.007). In this study, the relationship between serum cadmium level and preterm birth of pregnant women was analyzed. The serum cadmium concentration in pregnant women was divided into three grades in high school, and the high level of maternal serum cadmium concentration (H-Cd) in pregnant women was defined as 0.95 mu g/L, and the level of serum cadmium group concentration (M-Cd) was defined as 0.65-0.94 u g/L, and pregnancy was defined as 0.65-0.94 u g/L. The low level of serum cadmium concentration (L-Cd) defined as 0.65 mu g/L. showed that the preterm birth rate of pregnant women L-Cd group, pregnant woman M-Cd group and pregnant H-Cd group was 3.5%, and the incidence rate of fetal premature delivery in H-Cd group of pregnant women was significantly higher than that of pregnant women L-Cd group (OR:2.86; 95%CI:1.95,4.19; P0.001), and the adjusted OR was 3.02. .50; P0.001). At the same time, this study also analyzed the relationship between early pregnancy and maternal serum cadmium levels and preterm birth. In the early pregnancy, the pregnant women L-Cd, the pregnant M-Cd group and the H-Cd group were 2.3%, 4% and 8.6%. respectively. The incidence of premature birth in H-Cd group was significantly higher than that of the pregnant L-Cd group (OR:4.46; 95%CI:2.01,). 9.93; P0.001), the adjusted OR was 4.51 (95%CI:2.02,10.06; P0.001). The premature birth rate of pregnant women in group L-Cd, pregnant woman M-Cd group and pregnant woman H-Cd group was 4.2%, 3.7% and 9.8% respectively. The incidence of premature birth in pregnant H-Cd group was significantly higher than that of pregnant women in group L-Cd (OR:2.72; 95%CI:1.71,4.31; P0.001) and 2.68 I:1.68,4.27; P0.001). Finally, the study also analyzed the association of serum cadmium levels in pregnant women with different degrees of preterm birth. The mid-term premature birth rate of fetal H-Cd was 2.2% significantly higher than that of pregnant women in group L-Cd, 0.8% (OR:2.94; 95%CI:1.55,5.59; P0.001), and the adjusted OR was 2.95 (95%CI:1.55,5.62; P0.001). The preterm birth rate was 8.4% significantly higher than that of pregnant women in group L-Cd (OR:4.27; 95%CI:2.95,6.19; P0.001), and OR was 4.25 (95%CI:2.93,6.17; P0.001). Conclusion: the level of maternal serum cadmium in pregnant women is positively correlated with the risk of less than gestational age and the risk of premature birth.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.21

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