本文選題：死胎 + 危險(xiǎn)因素　； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究目的:通過(guò)對(duì)“免費(fèi)孕前優(yōu)生健康檢查”項(xiàng)目收集的數(shù)據(jù)進(jìn)行整理分析,探討我國(guó)農(nóng)村地區(qū)死胎的相關(guān)危險(xiǎn)因素。研究設(shè)計(jì):數(shù)據(jù)來(lái)源為“國(guó)家免費(fèi)孕前優(yōu)生健康檢查”項(xiàng)目自2010年1月至2012年12月收集的數(shù)據(jù)。該項(xiàng)目在全國(guó)31個(gè)省、市、自治區(qū),220個(gè)區(qū)縣進(jìn)行多階段分層抽樣。來(lái)自全國(guó)的248501對(duì)計(jì)劃在半年內(nèi)懷孕的夫妻被納入研究。通過(guò)問(wèn)卷調(diào)查收集了夫妻懷孕前的社會(huì)人口學(xué)特征、孕產(chǎn)史、行為習(xí)慣、危險(xiǎn)因素接觸情況等暴露信息以及妻子懷孕后的相關(guān)暴露信息。妊娠結(jié)局通過(guò)醫(yī)生填寫(xiě)記錄。采用巢式病例對(duì)照研究,通過(guò)傾向值評(píng)分匹配的方法對(duì)于病例和對(duì)照進(jìn)行1:8配對(duì),校正混雜因素在病例組與對(duì)照組間的分布情況。主要采用t檢驗(yàn)、卡方檢驗(yàn)、多水平logistic回歸分析對(duì)數(shù)據(jù)進(jìn)行比較分析。結(jié)果:母親年齡、教育程度、父親職業(yè)、地域因素在病例組與對(duì)照組分布不均衡,且在各其他危險(xiǎn)因素的暴露組與對(duì)照組間分布也有顯著性差異,分析結(jié)果顯示可能是暴露與結(jié)局間的潛在混雜因素,應(yīng)在為病例匹配對(duì)照時(shí)予以校正。經(jīng)過(guò)傾向值評(píng)分匹配后,病例組與對(duì)照組在匹配的因素上分布均衡。單因素分析結(jié)果顯示,孕前母親厭食蔬菜(OR=2.25,95%CI(1.16～4.39)),被動(dòng)吸煙(OR=1.56,95%CI(1.01～2.41)),接觸農(nóng)藥(OR=2.24,95%CI(1.26～3.97)),母親感覺(jué)有生活/工作壓力(OR= 1.37,95%CI(1.06～1.78))、與親友同事關(guān)系緊張(OR=1.58,95%CI(0.99～2.53))、高血壓(OR=1.73,95%CI(1.17～2.56));父親吸煙(OR=1.28,95%CI(1.09～1.5)),飲酒(OR=1.22,95%CI(1.03～1.43)),接觸有機(jī)溶劑(OR=1.71,95%CI(1.05～2.77)),父親有生活/工作壓力較大(OR=2.41,95%CI(1.37～4.23))均為死胎發(fā)生的危險(xiǎn)因素。母親補(bǔ)充葉酸為死胎的保護(hù)因素,與不補(bǔ)充葉酸相比,停經(jīng)前至少3個(gè)月便開(kāi)始補(bǔ)充葉酸OR=0.70(95%CI:0.58～0.85),停經(jīng)前1-2月開(kāi)始補(bǔ)充葉酸OR=0.71(95%CI:0.56～0.9),停經(jīng)后補(bǔ)充葉酸的OR=0.78(95%CI:0.63～0.96),差異均有統(tǒng)計(jì)學(xué)意義。多水平logistic回歸結(jié)果與單因素分析結(jié)果基本一致,在控制了水平二,省份的影響之后,個(gè)體水平的暴露因素中,母親農(nóng)藥接觸(OR=1.9,95%CI(1.06～3.39)),高血壓(OR=1.58,95%CI(1.07～2.34)),厭食蔬菜(OR=1.99,95%CI(1.00～3.93)),服用葉酸及開(kāi)始時(shí)間(與不服用葉酸相比,停經(jīng)前至少3個(gè)月便開(kāi)始補(bǔ)充葉酸OR=0.72(95%CI:(0.59～0.89),停經(jīng)前 1-2月開(kāi)始補(bǔ)充葉酸OR=0.71(95%CI(0.55～0.92),停經(jīng)后補(bǔ)充葉酸OR=0.81,95%CI:(0.65～1.02)),壓力(與無(wú)壓力相比,感覺(jué)有一點(diǎn)壓力組OR=1.34,95%CI(1.02～1.76)),均有統(tǒng)計(jì)學(xué)意義;父親吸煙(OR=1.22,95%CI(1.02～1.46))、接觸有機(jī)溶劑(OR=1.64,95%CI(1.01～2.69))有統(tǒng)計(jì)學(xué)意義。結(jié)論:母親農(nóng)藥接觸、厭食蔬菜、高血壓、父親吸煙、接觸有機(jī)溶劑均為死胎的危險(xiǎn)因素,母親服用葉酸是死胎的保護(hù)因素。
[Abstract]:Objective: to study the risk factors of stillbirth in rural areas of China by analyzing the data collected from the item entitled "Free Pre-pregnancy Health examination". Research Design: data from the National Free Pre-Maternal Health screening Program from January 2010 to December 2012. The project carried out multi-stage stratified sampling in 31 provinces, municipalities, autonomous regions and 220 districts and counties. 248501 couples from across the country who plan to become pregnant within six months were included in the study. The social demographic characteristics, pregnancy history, behavior habits, risk factor exposure and other exposure information were collected by questionnaire. Pregnancy outcomes are recorded by a doctor. A nested case-control study was used to match the distribution of confounding factors between the case group and the control group at 1:8 by means of the tendency score matching method to correct the distribution of the confounding factors between the case group and the control group. T test, chi-square test and multi-level logistic regression analysis were used to compare and analyze the data. Results: the age of mother, education level, father's occupation, geographical factors were not evenly distributed between the case group and the control group, and there were significant differences between the exposure group and the control group of other risk factors. The results suggested that it might be a potential confounding factor between exposure and outcome and should be corrected for case matching. After the tendency score was matched, the distribution of matching factors between the case group and the control group was balanced. The results of single factor analysis show that 瀛曞墠姣嶄翰鍘岄钄彍(OR=2.25,95%CI(1.16锝，

本文編號(hào)：2111931