CAJ | 학술논문

目的探讨与胎儿发生先天性心脏病(简称先心病)相关的母体危险因素. 方法本研究为病例对照研究.2006年11月至2009年10月,16645例孕妇于北京大学人民医院以及北京市海淀、昌平、门头沟及大兴区4家妇幼保健院接受胎儿心血管畸形筛查,产前或新生儿生后超声心动图检查诊断为先心病的112例孕妇(胎儿复杂型先心病40例,简单型先心病72例)作为病例组.随机选取同期在5家医院行妊娠中晚期超声胎儿系统筛查且新生儿超声心动图检查无异常的304例孕妇作为对照组.采用单因素及二项分类Logistic回归模型分析与胎儿发生先心病相关的母体危险因素, 结果 (1)一般情况:胎儿复杂型先心病组孕妇平均年龄28.3岁(21 ～40岁),胎儿简单型先心病组孕妇平均年龄29.9岁(22～39岁),与对照组孕妇平均年龄[29.5岁(20～44岁)]比较差异均无统计学意义(t值分别为1.511和-0.826,P值分别为0.138及0.410).(2)单因素分析:复杂型先心病组孕妇妊娠早期上呼吸道感染的发生率为46.2％(18/39),不良环境接触(房屋装修)的比例为32.5％(13/40),均高于对照组[分别为14.9％(45/303)和2.0％(6/304)],差异均有统计学意义(x2=22.399和62.678,OR=4.895和23.753,95％CI:2.419～9.905和8.358～67.506,P均=0.000).简单型先心病组孕妇有先心病家族史的比例为4.2％(3/72),高于对照组[0.0％(0/304)],差异有统计学意义(Fisher精确概率法,P=0.007).(3) Logistic回归分析:妊娠早期上呼吸道感染(OR=5.120,95％CI:2.340～11.206,P=0.000)及不良环境接触史(OR=23.030,95％CI:7.506～70.665,P=0.000)是胎儿发生复杂型先心病的危险因素. 结论妊娠早期上呼吸道感染及不良环境接触史可能是导致子代发生复杂型先心病的危险因素；母亲先心病家族史可能是胎儿发生简单型先心病的危险因素.
목적 탐토여태인발생선천성심장병(간칭선심병)상관적모체위험인소. 방법 본연구위병례대조연구.2006년11월지2009년10월,16645례잉부우북경대학인민의원이급북경시해정、창평、문두구급대흥구4가부유보건원접수태인심혈관기형사사,산전혹신생인생후초성심동도검사진단위선심병적112례잉부(태인복잡형선심병40례,간단형선심병72례)작위병례조.수궤선취동기재5가의원행임신중만기초성태인계통사사차신생인초성심동도검사무이상적304례잉부작위대조조.채용단인소급이항분류Logistic회귀모형분석여태인발생선심병상관적모체위험인소, 결과 (1)일반정황:태인복잡형선심병조잉부평균년령28.3세(21 ～40세),태인간단형선심병조잉부평균년령29.9세(22～39세),여대조조잉부평균년령[29.5세(20～44세)]비교차이균무통계학의의(t치분별위1.511화-0.826,P치분별위0.138급0.410).(2)단인소분석:복잡형선심병조잉부임신조기상호흡도감염적발생솔위46.2％(18/39),불량배경접촉(방옥장수)적비례위32.5％(13/40),균고우대조조[분별위14.9％(45/303)화2.0％(6/304)],차이균유통계학의의(x2=22.399화62.678,OR=4.895화23.753,95％CI:2.419～9.905화8.358～67.506,P균=0.000).간단형선심병조잉부유선심병가족사적비례위4.2％(3/72),고우대조조[0.0％(0/304)],차이유통계학의의(Fisher정학개솔법,P=0.007).(3) Logistic회귀분석:임신조기상호흡도감염(OR=5.120,95％CI:2.340～11.206,P=0.000)급불량배경접촉사(OR=23.030,95％CI:7.506～70.665,P=0.000)시태인발생복잡형선심병적위험인소. 결론 임신조기상호흡도감염급불량배경접촉사가능시도치자대발생복잡형선심병적위험인소；모친선심병가족사가능시태인발생간단형선심병적위험인소.
Objective To investigate maternal risk factors for fetal congenital heart diseases (CHD). Methods A case-control study was conducted on 16 645 pregnant women who underwent cardiovascular malformation screening for fetal cardiovascular system,whose pregnancy outcomes were recorded,and whose newborns were scanned by an echocardiography in Peking University People's Hospital,Haidian,Changping,Mentougou and Daxing Maternal and Child Health Hospital from Nov.2006 to Oct.2009.One hundred and twelve pregnant women whose babies were found to be CHD (40 severe CHD and 72 simple CHD) before or after delivery were taken as study group.Women in control group (n =304) were randomly selected from those pregnant women who had infants without CHD.Logistic regression analysis and x2 test were used to analyze the maternal risk factors for fetal CHD. Results (1) The average age of women whose infants had severe CHD was 28.3 years (21-40 years),and it was 29.9 years (22-39 years) for women whose infants had simple CHD.There were no significant differences between the control group (29.5 years,20-44 years) and the above two groups (t=1.511 and -0.826,P=0.138 and 0.410 respectively).(2) Single factor analysis:during first trimester,the rate of upper respiratory infection (18/39,46.2 ％) and exposure to certain chemicals (13/40,32.5％) of severe CHD group were higher than those of control group [(14.9％ (45/303) and 2.0％ (6/304)] (x2 =22.399 and 62.678,OR=4.895 and 23.753,95％CI:2.419-9.905 and 8.358-67.506,P =0.000 respectively).Compared with control group (0.0％,0/304),the rate of pregnant women with CHD family history in simple CHD group was significantly higher (4.2％,3/72)(Fisher exact test,P=0.007).(3) Logistic regression analysis:maternal upper respiratory infections (OR =5.120,95％CI:2.340-11.206,P =0.000) and exposure to certain chemicals (f)R=23.030,95％CI:7.506-70.665,P=0.000) during first trimester were risk factors for fetal severe CHD. Conclusions Upper respiratory infection and exposure to certain chemicals during first trimester might play important roles in the occurrence of fetal severe CHD.Maternal family history of CHD might associate with fetal simple CHD.